Nutten Stoven Residential Home

Nutten Stoven Residential Home is a residential care home providing regulated activity of personal care to up to 30 people. The service provides support to older people some of whom may be living with dementia. At the time of our inspection there were 12 people using the service.

People’s experience of using this service and what we found

Medicines had not been safely managed in the home. The registered manager had implemented an electronic system to manage medicines, however they failed to ensure that it was working correctly leaving people at risk of not receiving their medicines as prescribed.

The registered manager completed disclosure and baring checks on staff to ensure they were safe to work with people living at the home. However, they failed to obtain a full work history or gather up to date references from their last employment in social care. This meant risks were not fully managed.

Systems were in place to monitor the quality and safety of the care provided. While they had driven improvements from the last inspection, they had failed to identify the concerns with medicines and references.

Staff were kind and caring. There were enough staff to meet people’s needs and staff received the training and support needed to provide safe care to people. They were confident to raise any concerns about people’s safety and their care needs.

Risks to people were identified and care was planned to keep people safe. People were happy with the food offered and were supported to eat safely and maintain a healthy weight. The home was clean and tidy. Staff worked to minimise the risk of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 4 May 2023).

The provider had multiple breaches of regulation at their last inspection and we imposed conditions on their registration to drive improvements in care.

At this inspection we found improvements had been made. However, more work was needed and the provider remained in breach of two regulations.

This service has been in Special Measures since 27 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nutten Stoven Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines, the safe recruitment of staff and the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nutten Stoven Residential Home is a care home providing personal care to up to 30 people. The service provides care to older people and people living with dementia. At the time of our inspection there were 21 people using the service.

People’s experience of using this service and what we found

There was no effective process in place to ensure people were protected from the risk of abuse, and staff were not always trained in safeguarding. People did not always have the means to call for assistance and risk management was poor. People were not always supported by enough staff and safe recruitment checks were not always fully completed.

People’s ‘as and when’ medicines were poorly managed, and we observed people to be in significant pain due to poor pain management. Staff administering medicines were not aware 1 person had epilepsy and they received a prescribed medication to treat this condition.

People, staff and visitors were not protected from the risk of the spread of infectious diseases, due to poor infection prevention and control.

People’s needs were not fully assessed to ensure care was appropriate for their needs and they were not always supported by well trained and competent staff.

People were not always referred to relevant healthcare professional when needed and the provider failed to ensure advice and guidance from healthcare professionals was followed. People’s relatives were concerned about their family members losing weight, and we found people were not always supported with their meals.

No menus were displayed during mealtimes and the provider had failed to ensure call buzzers were consistently in place and working correctly. The home was generally in good state of repair with reasonable decoration.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was a lack of opportunity for people to express their views they were not always involved in making decisions about their care.

People's protected characteristics under the Equalities Act 2010 were not always identified during care assessments or considered when planning their care. Feedback from people using the service was mixed, in relation to how staff spoke to them. People’s privacy and dignity was considered during personal care.

There was a lack of assessment processes to ensure care was appropriate for people’s changing needs and people’s relatives were not always included in planning their care.

There was a lack of signage throughout the service to direct people living with dementia, and multiple clocks displayed the incorrect time. There was a lack of daily activities to promote task engagement or social inclusion.

Complaints were not always adequately responded to in a timely manner and 1relative told us they found it difficult to contact staff at the home to raise concerns.

There was a lack of guidance available for care staff in relation to people’s end of life care needs and staff had not received training on end of life care and some staff lacked knowledge in this area.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 September 2022) and there were breaches in regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken action to mitigate the most urgent risks identified, and this has been effective.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, protecting people from abuse, leadership and staffing. We imposed conditions on the providers registration and requested the provider make immediate improvements at the service to improve care and reduce risk. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Nutten Stoven Residential Home is a care home providing personal care to up to 30 people. The service provides care to elderly people and people living with dementia. At the time of our inspection there were 20 people using the service.

People’s experience of using this service and what we found

Care staff were not adequately trained. This meant people were at risk of receiving care from untrained staff. A safeguarding system was in place; however, some safeguarding concerns had not been appropriately addressed or followed up by the provider. This meant people were not always kept safe or protected from the risk of abuse. Safe recruitment processes were in place, however, they were not always adhered too.

Although people using the service told us they were happy with the care they received and they felt safe, we found people were at risk due to poor quality risk management and a lack of effective monitoring systems. Staff lacked knowledge on risks related to people’s individual care needs and this information was not always available in people’s risk assessments and care plans. The environment at the care home was not always made safe by the provider.

Information regarding risks related to the use of medicines and potential side effects was not always available to staff. Medicine administration records were not consistently completed. Opportunities to improve quality of care and people’s safety were missed.

Visitor COVID-19 test results were not always requested. This meant people were not kept safe from the risk of visitors bringing COVID-19 into the home. Some care staff were observed not wearing face masks or wearing them incorrectly, such as below the nose. Some areas of the kitchen, including cooking equipment, were found to be dirty. People had access to visitors, and we found the service was working within the principles of the Mental Capacity Act.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published: 24 March 2021).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and managerial responsiveness. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can read the report from our last inspection, by selecting the ‘all reports’ link for Nutten Stoven Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection. We issued the provider with a warning notice detailing the required improvements. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

Staff had not always received safeguarding training. However, they understood their responsibility to keep people safe.

Risks associated with people’s care had been identified but was not consistently recorded.

People received prescribed medicines. However, information was not always readily available for staff on the administration of ‘as needed’ medicines.

People felt safe using the service.

Measures were in place to reduce the risk of infection.

Positive actions had been taken to reduce accident and incidents.

There were enough staff to meet the needs of people.

Safe recruitment practices were being used.

There was no registered manager in the service. However, there was a manager in post, who was going to be applying to become the registered manager.

There was an improvement relating to quality assurance processes. Audits identified areas of improvement and action was being taken to address these. This continued to require time to embed these processes with the new senior team.

Staff and relatives spoke highly of the manager and provider, who were both open and transparent during the inspection.

Staff work with other agencies to achieve better outcomes for people’s care.

People, relatives and staff were happy with the care and support available at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 23 October 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 August 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve relating to good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained at requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nutten Stoven Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nutten Stoven Residential Home provides residential care for older people. The service is registered to support up to 30 people, and 25 older people and people with dementia were using the service when we inspected.

People’s experience of using this service and what we found

People’s experience of using the service varied and the care and support provided was at times inconsistent. Staff were kind and caring, but staffing levels meant there was limited time to spend with people and provide meaningful stimulation or activities. Some people spent long periods of time socially isolated.

People living with dementia and more complex needs did not always receive effective care. The service was not designed to provide this type of support. We made a recommendation about researching and implementing good practice guidance to improve practice in this area.

People praised the care and support staff provided, and staff told us they felt supported by the registered manager. However, a robust system of supervisions and annual appraisals had not been followed to monitor performance and wellbeing. Staff had the opportunity to complete a range of training, but clear management information was not available to help make sure all staff were up-to-date with their training.

Improvements were needed to make sure medicines were managed safely. Detailed records were not always in place to help monitor the care provided, for example in relation to accidents or incident; it was not always clear what actions had been taken in response to issues or concerns.

More robust auditing was needed to monitor the service. Although the provider regularly visited the service, there was no formal system of regular supervisions and no audits to help monitor quality and safety. We made a recommendation about reviewing how staffing levels were monitored.

The registered manager was responsive to feedback. Safeguarding concerns and a complaint had been investigated and action taken to respond to concerns and make improvements. They took positive steps to make changes in response to our feedback.

The environment was generally clean and safely maintained. It was personalised and homely. The provider had taken steps to make the environment more ‘dementia friendly’. Carpets in some areas of the home were heavily patterned and we spoke with the registered manager about considering good practice guidance in future refurbishment and redecoration work.

Staff were safely recruited. The provider employed a consistent team of staff which helped them to get to know people and how to meet their needs. Staff worked well with other professionals for their advice, guidance and support.

People gave positive feedback about the food and staff supported people to eat and drink regularly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff patiently offered people choices and supported them to make decisions.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

At the last inspection service was rated Good (report published 24 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulation in relation to how the quality and safety of the service is monitored.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nutten Stoven Residential Home can provide accommodation and personal care for 30 older people. There were 19 people living in the service at the time of our inspection.

The service was operated by a partnership who was the registered provider. There was a registered manager. 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. In this report when we speak both about the partnership and the registered manager we refer to them as being, ‘the registered persons’.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse including the risk of financial mistreatment. People had been helped to avoid the risk of accidents and medicines were safely managed. There were enough staff on duty and background checks had been completed before new staff were appointed.

Staff had received training and guidance and they knew how to care for people in the right way. People had been assisted to eat and drink enough and had been supported to receive all of the healthcare assistance they needed.

The registered manager had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the care they wanted to receive and they had been given all of the assistance they needed. Staff promoted positive outcomes for people who lived with dementia. People had been helped to pursue their hobbies and interests and there was a system for quickly and fairly resolving complaints.

People had been consulted about the development of the service and quality checks had been completed. The service was run in an open and inclusive way and good team work was promoted. Staff were supported to speak out if they had any concerns and people had benefited from staff acting upon good practice guidance.

We saw there was a warm caring relationship between care workers and people living at the home. Care workers knew people's preferred name and how they liked to receive care. People we spoke with told us they were happy with the care they received. One person said, 'They look after me very well.'

People we spoke with told us the home was always kept clean. One person said, 'The staff keep my room clean.' Another person said, 'They keep it beautifully clean.' We walked around the home and saw that everything was neat and tidy.

People we spoke with told us there were enough staff available to meet their needs. One person told us, 'There is always someone here to help you, you just raise your voice a little bit and they come and see you. I've never known them to let me down.'

We saw there were enough staff available to meet people's needs. The manager had arranged for extra staff to be available at busy times of the day. Staff received training to support them in their role. Appraisals and supervisions were completed to identify issues with staff performance and future training needs.

We saw there was a folder in each person's room which included a welcome pack, the homes policies and the minutes of the latest residents' meeting. This meant people were fully informed on how the home was run.