Archived: Green Pastures Christian Nursing Home

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. The registered manager worked closely with the business manager and a senior nurse.

People who were supported by the service felt safe. The staff had a clear understanding on how to safeguard the people and protect their health and well-being. There were systems in place to manage safe administration and storage of medicines administered through monitored dosage systems. However, there was no system to monitor the stock of people’s prescribed medicines which were stored in boxes. Medication administration records (MAR) were not always completed to show when medication had been given or, if not taken the reason why. Thickening agents were not always stored safely.

There were enough suitably qualified and experienced staff to meet people’s needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.

The registered manager had a good understanding of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. However, staff had a mixed understanding of their responsibilities relating to the MCA.

Staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be restricted of their liberty for their safety. However, the registered manager did not have a clear understanding of their responsibilities in relation to the application of DoLS.

The registered manager informed us of all notifiable incidents. The provider had quality assurances in place. However, these quality assurance systems were not always effective. The provider’s policies needed updating. There was no whistleblowing policy in place.

There were sufficient staff to meet people’s needs. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

The provider had an infection control policy in place. Staff knew how to protect people from the potential risk of infection.

People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively.

People were supported to have their nutritional needs met. However, we saw the dining experience for people varied. In the downstairs dining room, staff looked rushed to complete lunch tasks in time for the church service.

People felt supported by competent staff. Staff benefitted from supervisions (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

There was a calm, warm and friendly atmosphere at the service. Staff we spoke with were motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People had access to activities and stimulation from staff in the home. Activities were structured to people's interests. We observed people engaged in reminiscing and one to one activities.

Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

The registered manager had a clear plan to develop and improve the home. Staff spoke positively about the management and direction they had from the manager. The service had systems to enable people to provide feedback on the support they received.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we have required the provider to take at the end of this report.

This inspection was to follow up on the findings from our previous inspection of 15 April 2014 to ensure that appropriate action had been taken by the provider to address our concerns.

We asked the provider to send us a report of the changes they would make to comply with the standards they were not meeting.

We found that the provider had taken action to ensure the provider had an effective system in place to analyse accidents and incident, to identify patterns and trends in order to apply learning and improvement from such accidents and incidents.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service safe?

We spoke with two people and one relative who told us they felt the service was safe. One said "I think I am very safe". The relative said "as safe as they could be anywhere. I've no issues with safety". The provider had taken action to identify and prevent abuse from happening in the service. There was a clear safeguarding policy published and on display around the home with instructions for care workers to take if they suspected abuse was happening. All care staff had been trained in safeguarding vulnerable adults and they knew how to raise concerns if they suspected abuse was happening. Care workers were appropriately recruited and selected. Background checks were conducted and references sought before care workers started work. All care workers received appropriate training to carry out their role.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Care was planned and delivered in a way that was appropriate to people's needs. People were assessed before admission to the home and care plans were created that reflected their individual assessments. Where risks to care were identified appropriate risk assessments were in place. For example, one person was at risk of choking. A Speech and Language Therapist (SALT) had assessed the person and recommendations regarding this person's diet were recorded. We saw that these recommendations were being adhered too.

Is the service caring?

We conducted a Short Observational Framework for Inspection (SOFI). SOFI provides a framework for directly observing and reporting on the quality of care experienced by people who cannot describe this themselves. We observed five people for 30 minutes during the lunchtime meal. We saw that people were offered choices of meals and drinks and their preferences were respected. Some people needed assistance with eating. Care workers sat level with the person and engaged them by talking and asking what they wanted to eat or drink next. They offered appropriately sized portions and worked at the person's pace, asking before continuing. People were constantly encouraged and praised. People's achievements were celebrated in a respectful and genuine fashion that clearly engaged them resulting in nods of acknowledgment and smiles. We saw that people received a high degree of care and support during the meal. All the interactions we observed during our visit were positive and caring.

Is the service responsive?

We saw that the service responded to people's needs. Some of the people using the service had complex needs. We saw that one person had mobility difficulties and walked with a frame. The service assessed the person and identified that they needed assistance and supervision with their mobility. It was recommended the person took regular walks during the day to maintain their mobility. We saw that care workers were to assist this person achieve their goal and daily notes confirmed this was happening.

A relative said "I think it is very good here. The staff are really good and many things are excellent. There are superb activities for people here and they understand what people with dementia need".

Is the service well led?

The provider dealt with complaints appropriately, in line with their policy on complaints. This policy was on display in the reception area. Risks were managed and care plans and risk assessments were reviewed monthly and audited by the manager every three months. People's opinions were sought and acted upon. Relative's forums were held where relatives could raise issues with the service. One issue raised concerned the questions in the provider's surveys. We saw that this issue was dealt with and the survey altered in line with the relatives wishes.

Accidents and incidents were recorded but not investigated. This meant that learning from accidents and incidents was difficult and did not allow the manager to look for patterns and trends. This could put people at risk because there was no system to investigate and record findings and no system to pass on learning from such accidents and incidents. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We looked at the care records for five people who lived in the home. care plans were well documented and showed that people were involved in their care. Peoples' preferences were recorded for their daily activities including getting up and going to bed, meal preferences and daily activities. Records were also kept of medical appointments and when people had seen their GP.

We used the Short Observational Framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We observed people being treated with care and dignity. Staff were patient and caring.

We spoke with four care workers and the chef during our visit. Care workers were very motivated, caring and attentive to people. One care worker told us 'I like working with people who have dementia'. Another care worker said 'Its busy but we all muck in'.

We made a random check of the medication processes and found them to be robust.

Green Pastures employed an activities co-ordinator who provided a programme of activities based on what people who lived in the home had requested. People we spoke with, who wanted to be involved in activities told us, 'there is a diary of activities I look at it and decide if there is anything I want to do'.

Staff spoken to told us they felt supported. One person told us "its always busy especially when people are off, but we are a good team and help each other out".

During our visit we observed that there were enough care workers to meet the assessed needs of the people who lived in the home. One person said 'staff come in to see me regularly'.

We looked at records kept by the home and found that not all records for all action had been recorded or were up to date.

People were encouraged to give their consent to care wherever possible and people told us that they were consulted and given choices. There was a range of activities available.The delivery of care was appropriate to people's needs although we found evidence that some care plans and risk assessments were not always reviewed frequently enough.

One person said that it was a 'lovely home with good food and care.' Another person said that 'on the whole the staff are OK.' Staff were appropriately trained and well supported. The home was planning to introduce a system of formal supervision for staff.

A visitor said that they visited the home regularly and had no concerns about the care being delivered to their relative who was 'well looked after.' The home also kept a log of all complaints, concerns and compliments received. One person had written 'my father was well looked-after while he lived there.' Another person had written 'really happy with care'.