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Inspection carried out on 10 November 2016

During a routine inspection

This comprehensive inspection took place on 10 November 2016 and was unannounced. The inspection team consisted of two adult social care inspectors. Home of Comfort Nursing Home is registered to provide accommodation, support and nursing care for up to 30 people. At the time of the inspection, there were 27 people living at the home.

At the last inspection on 23 December 2013 we found the service to be compliant with all regulations we assessed at that time.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People living at the home said they felt safe. The visiting relatives we spoke with also said they felt their family members were safe as a result of the care provided.

We looked at four staff personnel files and there was evidence of robust recruitment procedures in place.

Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service. Staff told us they felt staffing numbers at the home were sufficient. People living at the home also said they felt there were enough staff working at the home and did not have to wait long periods for assistance.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. The staff we spoke with had a good understanding of safeguarding, abuse and how they would report concerns.

We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition.

Accidents and incidents were recorded correctly and included a record of the accident or incident, a summary chart and action plan.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use. Comprehensive records were in place and up to date regarding the safe upkeep of the premises.

Monthly infection control audits were in place and included areas such as furniture, bedrooms and the general environment and equipment. Personal protective equipment (such as gloves and aprons) were available throughout the home. Cleaning schedules were in place and up to date. The premises were clean throughout and free from any malodours.

There was an up to date a fire policy and procedure. Fire safety and fire risk assessments were in place and fire evacuation drills were carried out regularly and staff attendance recorded to ensure all staff undertook regular drills.

We observed staff administering medicines and saw that people were given their medicines as required. Staff who administered medicines had all completed appropriate training in the safe handling of medicines. Records of medicines administration (MAR’s) had been completed consistently and accurately.

People had medication care plans in place which included their photograph to assist staff with accuracy of administration, GP details, details of currently prescribed medicines, if a specific eating regime was in place such as a soft diet, daily nutritional intake charts, and a MAR chart. There were safe systems for ordering, receiving, storage, administration and disposal of medicines.

People told us they felt staff had the sufficient skills, knowledge and training to care for them effectively.

Staff told us they received an induction when they first started working at the home which gave them a good introduction to working in a care environment.

Comprehensive staff training records were in place and staff had completed training in a variety of other areas relative to their job role The staff we spoke with said they received sufficient training to help them undertake their role effectively.

There was a staff supervision schedule and annual appraisal schedule in place, which identified meetings during the year.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was complying with the conditions applied to the authorisations. Staff demonstrated a good understanding of MCA/DoLS and told us about when they felt a DoLS authorisation might be required.

Staff were aware of how to seek consent from people before providing care or support and told us they would always ask before providing care. People living at the home told us staff always sought their consent before delivering care to them.

People we spoke with told us the food provided at the home was of a good quality. People had nutritional care plans in place and care plans also contained records of visits by other health professionals. Special diets were catered for, food allergies were recorded and people had nutrition and hydration care plans in place.

There were some adaptions to the environment, which included pictorial signs on some doors which would assist people living with a dementia.

Staff showed patience and encouragement when supporting people. We observed people were treated with kindness and dignity during the inspection. Care staff spoke with people in a respectful manner.

The people we spoke with told us they received good care whilst living at Home of Comfort and described the staff as kind and caring. People said they felt treated with dignity, respect and were given privacy at times they needed it. Staff were also able to describe how they aimed to treat people in this manner when delivering care, telling us it was extremely important. We saw that the care staff knocked on people’s bedroom doors and waited for a response before entering.

Throughout the course of the inspection we heard lots of chatter and laughter between staff and people and there was a positive atmosphere within the home. People said staff tried to promote their independence when delivering care and allow them to try and still do things for themselves.

People’s care files contained end of life care plans, which documented people’s wishes at this stage of life where they had been open to discussing this. Staff told us they involved families when developing care plans or carrying out assessments.

People living at the home told us they received a service that was responsive to their needs. We saw the home had been responsive in referring people to other services when there were concerns about their health.

When people first started living at the Home of Comfort, an initial assessment was undertaken. This enabled staff to establish what people’s care needs were and the type of individual care people required.

The care plans provided an overview of people’s care needs following their initial assessment and any actions staff needed to complete and follow in order to meet their needs. The care plans we looked at were reviewed each month, or if there was a change to people’s care needs. Care plans were also audited each month by the manager to ensure consistency and quality of recording.

The home had systems in place to seek feedback from people living at the home. This included sending a satisfaction survey which had recently been sent in September 2016.

We looked at the minutes from the most recent residents and relatives meeting. This presented people with the opportunity to discuss the care they received and inform staff about any concerns or things they might like to change within the home.

There was a system in place to handle and respond to complaints. We saw the home had an appropriate policy and procedure in place, which informed people of the steps they could take if they were unhappy with the service they received.

The home had received a high number of compliments from people who had previously used the service and their relatives.

We looked at the activities available at the home and also how people were stimulated throughout the day. The home employed an activities co-ordinator. Each person had an individual activities record and a therapeutic activity plan assessment. Each person’s expressed likes and dislikes regarding activities were also recorded in their files.

People living at the home said they knew the manager and thought highly of them and the care staff. There was a clear management structure at the home which was a registered charity. There was a board of trustees who oversaw the running of the home and all income generated was re-invested into the home and used for care delivery purposes and day to day running.

The staff we spoke with told us they enjoyed working at the home and that there was an open transparent culture. Staff also told us leadership and management at the home was strong. Staff described feeling able to approach the manager, report concerns and also felt supported to undertake their roles to the best of their ability.

The registered manager undertook regular audits covering areas such as information and involvement, personalised care/treatment, the dining experience, safeguarding, staffing/training and the environment.

We found that residents’ meetings had been held regularly. Records of these meetings were detailed and showed that various issues had been discussed.

The registered manager held a CQC notifications file, understood their role in sending notifications to CQC and had sent us notifications as required by the regulations.

Staff had access to a wide range of policies and procedures.

The service had a business continuity plan that was recently reviewed in May 2016.

Inspection carried out on 23 December 2013

During an inspection in response to concerns

We received information regarding concerns about the home’s ability to meet the needs of one person, the home’s medication procedures, the availability of nursing staff and the servicing of the home’s hoists.

We spoke to the home’s manager and two members of the home’s management committee. We observed one member of the nursing staff administering medicines to people.

We received information that the home was unable to meet the needs of one person. We saw this person’s needs were assessed and there were care plans in place with guidance for staff to follow to meet those needs. This person’s needs had been reviewed and the manager had liaised with other community health and social care professionals so that this person’s needs were monitored.

We spoke to one person who lived at the home. They said they were treated well and that they were able to exercise choice in how they spent their time.

We looked at the home’s medicines procedures. Nursing staff administered medicines to people and completed a record in the medicines administration records. There were recorded guidelines for staff to follow regarding the management of diabetes.

We saw the home had nursing staff on duty at all times, which was evidenced from the staff rota, our observations, and discussions with the manager.

Records showed the home’s hoists were serviced and that equipment was in place to provide people with safe care.

Inspection carried out on 13 November 2013

During an inspection to make sure that the improvements required had been made

This visit took place to follow compliance actions made at the last inspection on 23 July 2013. The provider sent us an action plan to say the home was compliant by 12 September 2013.

We spoke to two people who lived at the home. Both these people said they received the care they needed and said they were looked after well. We saw that both people had access to drinks which they said were always available. One person said the lunch time food was “overcooked,” but recognised this was their personal preference acknowledging that many of the people at the home needed a diet of soft food. This person also said the desserts and early evening meals were very good. Both people we spoke to said there was a choice of food at each mealtime. The other person said they were satisfied with the standard of food.

We saw the home’s chef and kitchen assistant organised food and drinks so that people had a varied and nutritious diet. Records and conversations with the chef showed people were offered a choice of food. Advice from a dietician had been sought for those at risk of malnutrition and the home used food supplements to enhance calorie intake for these people.

The home’s complaints procedure had been updated and now included the details of who a complainant could contact if they were not satisfied with the response they received from the home.

Inspection carried out on 23 July 2013

During a routine inspection

We spoke to four people who lived at the home. Each person said they received a good standard of care. People reported being treated with dignity by the staff.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We saw people had mainly positive experiences. Staff were observed to help people who needed it. Staff were observed to be kind and to offer people choices. We saw one person needed additional support.

We looked at care records for four people. Care needs were assessed and there were specific care plans for the care of people and treating specific conditions. We noted that assessments, care planning and records regarding nutritional needs were not accurate and did not show people were being adequately monitored.

We saw staff recorded a signature each time medication was administered to people and medication stocks showed people had received their medication. We noted that where people needed medication on an ‘as required’ basis that there was a lack of recorded guidance of when and how this medication should be administered.

We saw the home had between six and seven care staff on duty as well as two Registered General Nurses from 8am to 2pm. Staff told us this was sufficient to meet people’s needs but one staff member felt an additional staff member was needed during the meal times. Staff had access to a range of training courses.

Inspection carried out on 12 December 2012

During a routine inspection

The people we spoke to told us they liked living at the home and felt safe. They told us staff spoke and listened to them in a respectful way, communication was good and that they were well cared for. People told us if they had any concerns or wished to make a complaint they would tell the staff or the manager.

One person said that the standard of care was excellent and staff enabled the person to stay as independent as possible whilst in receipt of nursing care.

Visitors we spoke with made us aware they were happy with the care their relatives received. One visitor told us: “This is a very friendly place they treat my mother well the quality of care is good”.

We saw that people's privacy and independence were respected, people experienced safe and effective care based on detailed care plans and risk assessments that documented peoples preferences and met individual needs. Visitors we spoke with made us aware they had involvement in their relatives care.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

The provider employed the correct number of staff that received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor quality assurance and compliance.

Inspection carried out on 6 March 2012

During a routine inspection

Three people we spoke with told us they liked living at the home. They said it was the only place that had all single rooms and they could have their own privacy if they wanted.

They told us that most of the staff spoke to them in a "nice way". They told us they liked the staff that treated them with respect. We spoke with one person who told us that they found the home to be "a nice place to be". People we spoke to informed us they had choices on how they spent their time and could take part in activities if they wanted. One person told us that they did not always participate in the activities organised everyday but they did like the co-ordinator.

People that we spoke with were generally happy with the care and support that they received at the nursing home.

One relative we spoke with described the care that their mother had received at the end of her life. They told us that they could not have wished for a ‘more peaceful end and the care received was excellent’.

People told us that they were comfortable and staff generally responded to them quickly when they asked for help.

People living in the home told us that if they had any concerns or complaints they would raise these with a member of staff or the manager. People spoken with during the visit said they were confident any complaints they made would be taken seriously and investigated. Nobody had any concerns when we spoke to them.

Reports under our old system of regulation (including those from before CQC was created)