Archived: Inglewood Care Home

This inspection took place on 4 and 19 April. Both days of inspection were unannounced which meant the registered provider and staff did not know that we would be attending.

Inglewood care home provides support and accommodation for up to 49 people who need residential or nursing care. This includes support for people living with a Dementia. At the time of inspection there were 42 people using the service. The service was located in a residential area within its own grounds and had on-site parking. The service was close to local amenities and a short distance from the coast and town centre.

The registered manager started working at the service in November 2015 and had promptly submitted an application to become registered manager. This application was approved during our inspection of the service. 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.

At the last inspection on 11 and 14 May 2015, we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance. At the time of inspection there was no manager in place at the service. There had been no meetings for people, their relatives and staff. There were very few audits and action plans in place and there were gaps in some records looked at. Staff expressed their concerns about the staff culture at the service which they described as poor.

At this inspection we could see the registered provider had addressed each of these areas, however gaps in records remained. These gaps related to care, activities, maintenance, ‘Ten at ten’ and clinical handover meetings.

Quality assurance processes were in place. Regular audits had been carried out by the registered provider and registered manager.

Meetings for people, their relatives and staff had been carried out. Staff felt that communication could be further improved.

Staff gave mixed reviews about the leadership and staff team in place at the service. Some staff described low morale; however we could see that the registered provider had taken some action to try to address this.

The registered manager understood the requirements of their role and had submitted notifications to the Commission when needed.

In some bathrooms we found that radiators had been removed and areas left unsafe for people to use. We asked the registered manager to take urgent action to address this. They contacted us after inspection with photographs to show that the areas had been made safe.

Some bathrooms were used to store furniture which posed a health and safety risk to people. We also found that some bathrooms were in need of repair. The registered manager told us that all bathrooms at the service were scheduled to be updated in May 2016.

Safeguarding alerts had been raised when needed and records detailed investigations which had been carried out. Staff demonstrated their knowledge and understanding of the different types of abuse and the procedure they needed to follow if they suspected abuse could be taking place.

An up to date policy was in place for restraint.

Risk assessments were in place for the day to day running of the service. People had risk assessments in place specific to their individual needs. People were supported to take reasonable risks which were fully risk assessed by the service.

Health and safety certificates were up to date. Gaps in fire and maintenance records had been rectified on the day of inspection.

Robust recruitment procedures were in place. Records showed that people had been recruited safely and had not started working at the service until two checked references and a Disclosure and Barring Service (DBS) check had been carried out.

There were sufficient staff on duty to provide care and support to people in a safe manner. A dependency tool was used to determine staffing levels. Staff told us they felt stretched at times which the registered manager told us they would look into.

Medicines were managed safely. Staff worked with people’s GPs to make sure they had access to the correct medicines and the quantities needed. Medicine rounds were often interrupted which caused them to take longer.

All new staff participated in an induction programme. Mandatory training was up to date for all staff. Supervision and appraisals had not been carried out in line with the registered providers policy, however since the registered manager came into post we could see that staff had started to receive regular supervision and appraisal.

People were supported with their nutrition and hydration. Support with eating and drinking was carried out in a dignified manner. Risk assessments and care plans to support nutrition and hydration were reviewed regularly.

People had regular access to health professionals involved in their care. Any contact with the service had been documented in the care records.

The service had appropriately carried out MCA and DOLs applications to keep people safe. Staff demonstrated a good understanding of the principles of each of these.

People had access to communal and private spaces inside the service and within the grounds. Improvements had been made to the service which included dementia friendly bedroom doors and activities within corridors.

People spoke very positively about the care and support they received from staff. People told us they felt well cared for and enjoyed living at the service.

People told us they felt listened to and felt able to approach a member of staff if they needed to.

Staff understood the importance of maintaining and respecting people’s dignity. People we spoke with confirmed their dignity was always maintained. We observed this to be the case when people were assisted at mealtimes.

Information about advocacy was on display at the service. We could see that this service had been offered to people previously.

The service worked with health professionals to provide end of life care to people which reflected their needs, wishes and preferences.

There were gaps in some of the care records looked at. Care plans reflected people's individual needs and contained detailed examples of care which reflected people's wishes. These care plans had been regularly reviewed.

Activity schedules were in place to show what activities were taking place. These included activities provided by the activities coordinator and activities provided by external visitors. We heard mixed reviews about the activities provided. Activities records did not always demonstrate if people had participated in activities.

People told us they knew how to make a complaint and felt able to do so. At the time of inspection nobody had wanted to raise a complaint. When complaints had been made, the service had acted appropriately to address these.

We found one breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the premises and equipment and records. You can see what action we told the provider to take at the back of the full version of this report.

Over the two days of inspection, we spoke with four people, three relatives, one visitor, the acting manager and eleven staff. We looked at four sets of care records and seven staff files. We also observed care practices within the home.

The service had a registered manager in post, however they were currently on sick leave. The home was supported by an acting manager already working at another BUPA home in the local areas.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health safety and welfare of people.

During the inspection, the team worked together to answer five key questions which are outlined below.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

All staff we spoke to were able to describe the action they would take to ensure that people were kept safe and free from harm. Staff were aware of the procedures which they needed to follow should they have concerns.

A compliance action had been set at the last inspection. At this inspection we found that the home had taken action to ensure that people had enough space to enjoy their meal time experience. We also found medication rooms were now within safe temperature limits as previously this had been a requirement.

We inspected the staff rotas which showed that there were sufficient staff on duty to meet people's needs throughout the day. However we have asked the acting manager to look at staffing during mealtimes.

The home had taken action to ensure that records were up to date and contained the information required by the Health and Social Care Act.

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

Is the service effective?

People had an individualised care plan which set out their care needs and had assessments in place specific to their individual health needs. Staff knew the people who they cared for and maintained dignity and respect when providing care. People had access to a range of health care professionals some of which visited the home.

The provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care because medication was delayed and the distribution of medication took longer than expected. This impacted upon medication given to people throughout the day. We saw that people were not always prompted to eat their meals and could be left uneaten. An activities schedule was provided but not available to the people living at the home and we could not be sure about the frequency and effectiveness of the activities provided. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

We saw that care workers showed patience and gave encouragement when supporting people. However staff were not always able to spend the time they wanted with people because of workload demands.

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People and their relatives told us they did not access the community very often. We could not be sure if activities met people's individual needs.

Is the service well-led?

Staff responded quickly to people's changing needs.

We saw that the staff team was not unified and this was impacting upon morale. We saw that action was being taken to address this.

Staff were aware of their roles and responsibilities but were struggling to meet their workload demands.

The home had a system to assure the quality of service they provided.

People and their relatives had completed a customer satisfaction survey. We saw that some action needed to be taken but we could not see if these actions had been addressed.

What people said

Not everyone was able to express their views but people who were able to told us they were satisfied with the care and support they received. One person told us they were 'well looked after' and got 'plenty to eat.'

People and their relatives told us about their concerns with the number of staff on duty and the activities which were provided. People wanted to go outside more.

One relative told us, 'My relative is looked after. Some staff are really caring but others are not.' Another relative told us, 'There are four very good members of staff who always have time for me.'

The healthcare professional told us that if their parents had to use a care home, they would have no hesitation in using this one.

The people we spoke to overall said that the food was good. We also found that the home maintained good levels of cleanliness and infection control procedures. One relative told us, 'I have never smelt urine here like in other care homes.'

We found that the provider had systems in place to manage medication and staff had received up to date training. The home also worked in partnership with other healthcare professionals.

When we inspected the home, we found some areas for concern in the safety and suitability of the premises.

Care records were not kept safely and securely, and some information was not easily accessible. We also found that policies were not all kept up to date.

During the visit, we spoke with eight people who used the service and three relatives. From our observations and discussions with people, we found that care staff worked in ways that supported the people and treated individuals with humanity as well as empathy.

People told us that they like the home and staff. Relatives were extremely complimentary about the service. People said, 'I have absolutely no complaints this is an excellent home', 'The care is good and this is always consistent irrespective of when I visit', 'There are always plenty of staff who I find are very helpful' and 'I must say they treat people with humanity.'

People also discussed how they found the manager and staff were very approachable and although none had needed to raise a complaint they found their views were regularly sought. We were told by the staff that people who used the service and relatives views were sought about all aspects of the running of the home and this was done via residents meetings and surveys.