We inspected this service on 11 and 12 May 2016. The home was last inspected in April 2014, when it was compliant with the outcomes inspected. This is the home’s first comprehensive inspection under the changed methodology. The home is a nursing home providing nursing and residential care for up to 40 people. On the two days of the inspection there were 39 people living in the home.
The home is an extended period building over two floors. The home has communal areas on both floors including lounge and dining room provision. The kitchen is located on the ground floor and the laundry is a designated building in the grounds. The gardens are spacious and well maintained. We saw people enjoying the outside space during the inspection. People appeared settled and we saw some preferred to stay in their room and others liked to utilise the communal space.
The home had a registered manager at the time of the inspection who knew the home well. 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.
The home was in breach of four of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014 including identified issues with staffing, how the home acquired consent specifically within the principles of the Mental Capacity Act 2005, how the building was maintained, the records kept and quality audit.
There were a number of issues with how the home was maintained. This included obstructed fire exits, a lack of available PPE (Personal Protective Equipment), cluttered bathrooms and inappropriate storage of clinical items. The provider was required to take action to improve this.
The home had not fully embedded the principles of the Mental Capacity Act 2005 and more work was required to meet the requirements of the Act and the associated Health and Social Care Act regulation for consent. We found most consent that was acquired was given by family members rather than individuals themselves. When family members have power of attorney this is appropriate. However, we found required best interest decisions and capacity assessments had not been completed in some circumstances where family members did not have power of attorney.
When we looked in people’s care files, we found information was difficult to find and care plans and the records for meeting people’s needs were not routinely updated to ensure assessments and plans of care reflected the care being delivered. We found the home needed to address how records were kept, collated and used to inform assessments and care plans. We also found the quality audits had not been routinely completed in the last couple of months and this had an impact on the quality of the service provided, as identified within this report.
The home had a pleasant and calm atmosphere. The staff and people who lived in the home interacted well and people told us there were good relationships between staff and residents. However, we noted people were left in wheelchairs for too long and some for the majority of the day. Staff and people who lived in the home told us there was not enough staff to attend to people’s needs as they would like. Dependency assessments had been completed but the scores had not been used to determine if there was enough staff. There were particular issues when staff called in sick at short notice. The provider was required to take action to ensure there was enough staff at all times.
We have made five recommendations within the report. Staff had not received recent safeguarding training we recommended the provider ensures all staff receive up to date safeguarding training to refresh their understanding. The provider used a training matrix to keep track of the delivery of training but this was not up to date. We recommended the staff trainer ensures the training matrix is kept up to date. This would allow them to determine the appropriate and required training to be delivered to ensure mandatory training is completed as it should be. We have recommended the provider takes steps to ensure people are involved with the reviews of their care plans and we have recommended the provider updates their complaints poster to reflect the regulated activities regulations 2014.
Medicines in the home were managed well and records were accurate and up to date. The staff administering medicines had all the information they needed to do so safely. Medicines were stored correctly and the stock was all accounted for and within the use by date.
Staff were recruited to their roles in a fair and transparent way and all the required suitability checks were completed before staff commenced in the role. Staff were well supported to ensure they could complete their role effectively.
The kitchen was managed well and the people in the home enjoyed the food on offer. The chef had liaised with people and their families to gather people’s preferences and clinical and care staff shared information with the chef to ensure people’s dietary requirements were met.
Visiting professionals were happy with how staff at the home worked with them. We were told by external professionals that their care plans were followed by staff at the home and could see evidence of this in the care files we reviewed.
Staff treated people in the home with dignity and respect at all times. People in the home spoke highly of the staff and how they were treated. We saw people were given choices in their daily routine and laughter was common place. Some people told us they would like to be more formally involved with developing their plans of care and the registered manager assured us this would happen.
We reviewed the available information the home used to ensure people’s needs were met. We saw assessments and care plans were in place that followed best practice guidelines including the use of the MUST (Malnutrition Universal Screening Tool) and Waterlow (pressure area) assessments. We saw the home undertook specific monitoring of people’s needs including their weight and personal care needs. However, we found information was recorded in a number of different places. We saw information on handover sheets to ensure staff knew the priorities for people each day and saw information in the diary that showed us some aspects of the care plan were being recorded there.
The home had a comprehensive complaints policy which was implemented and followed as and when required. The home learnt from the issues identified within complaints and took steps to reduce the same issues arising. Information was shared with the staff team to ensure the steps were taken.
A set of quality audits and collection of regular feedback from people who used the service allowed the management team to address concerns as they arose. We saw the home set actions from audits and identified leads for their completion. Actions were reviewed to ensure they had been completed. Not all the audits were up to date.
Staff were happy at the home and they were supported by each other and the management team. A comprehensive set of policies and procedures were in the process of being reviewed and information was being disseminated to the team through team meetings and weekly training sessions.
You can see what action we told the provider to take at the back of the full version of the report.