Nashley House Retirement Home

The managers at the service had been proactive in identifying and introducing infection control measures in all areas of the service. Visitors to the service were admitted through a locked gate and taken through hand washing, sanitising and health questions on arrival at the service.

Professional visitors had a hand washing and sanitising station outside the front door which they used before entry. All visitors were required to wear personal protective equipment (PPE) in line with public Health England (PHE) guidance.

All deliveries to the service were disinfected prior to acceptance into the service and underwent a further 72 hour quarantine period. The machine used to disinfect deliveries was also used to clean communal areas and communal soft furnishings.

The service had been proactive in arranging socially distanced visits. During the summer a marquee was in the garden. The service had recently organised a visitors 'pod' to enable safe visits. The pod was heated, could be easily cleaned, and had intercom access to the dining room. People could see their visitors through the window and the microphone was designed to support people who had compromised hearing. The registered manager told us they had received positive feedback from both people who lived at the service and relatives.

Two bedrooms had been designated as 'isolation' for people admitted to the service. People were supported by one assigned member of staff per shift to reduce any potential risk to other people. Following a fourteen day isolation period people moved into the main house. If necessary people could also isolate within their bedrooms and procedures were in place should this be needed. There were arrangements in place for visits for anyone approaching the end of their life.

The managers had contingency plans in place should areas of the service need to be separated off in the event of an outbreak. There were contingency plans for staffing. One member of staff had lived temporarily in a caravan within the grounds at the beginning of the pandemic in order to minimise the risk of their contracting and passing on infection.

All areas we saw were clean and fresh smelling. There was a cleaning rota, including regular deep cleaning, in place. Furniture had been moved apart to enable some distancing but the managers told us they were mindful that primarily it was people's home. People were supported to clean their hands regularly and before entering the dining room.

Staff told us morale was good and they said they worked well together as a team. The managers told us they placed high importance on staff well-being and had put measures in place to support this.

Further information is in the detailed findings below.

What life is like for people using this service: People were relaxed, comfortable and confident in their home. The feedback we received from people and relatives was good. Staff we met and spoke with were happy working at Nashley House and enjoyed their roles and responsibilities.

Staff understood their responsibility to keep people safe from harm. People were supported to take risks and promote their independence. Risks were assessed, and plans put in place to keep people safe. There was enough staff to safely provide care and support. Checks were carried out on staff before they started work to assess their suitability to support people in a care setting. Medicines were well managed, and people received their medicines as prescribed. People were protected by the providers infection control policy and procedures.

The service was effective in meeting people’s needs. Staff received regular supervision and training. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were provided with a healthy, balanced diet whilst promoting and respecting choice.

Everyone we spoke with agreed that staff were caring and kind. Comments included “The staff are all very kind and nice people; they are so polite and respectful. They always address me by my name” and “The staff are all very friendly and caring, and very supportive towards me, I cannot thank them enough for all they do.” Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service.

The service was responsive to people’s health and social needs. People received person-centred care and support. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. Where necessary care and support had been changed to accurately reflect people's needs and improve their health and wellbeing. People were encouraged to make their views known and the service responded by making changes.

People benefitted from a service that was well led. One relative wrote to the home after a recent event; [Manager] and [Deputy Manager], what a party! Thank you for giving my mother and everyone involved in Nashley House a wonderful day.

Quality assurance systems were in place and based upon regular, scheduled audits, which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

Rating at last inspection: Good. The last inspection report was published on 22 December 2016.

Why we inspected: This was a planned comprehensive inspection. All services registered with CQC must have an inspection within the first year of their registration.

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

Nashley House Retirement Home provides accommodation and personal care for up to 52 older people.

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.

People were treated with kindness and respect by staff that had made caring relationships with them. People’s views and opinions were sought toward improving the service and making their lives better. Privacy and dignity were upheld.

There was a strong emphasis on risk management and there was a low incidence of accidents as a consequence. The premises and equipment was maintained in a safe state.

Robust recruitment practice protected people from staff who might be unsafe or unsuitable to work with older people. People were protected from abuse because the staff had a good understanding of how to respond if they had any concerns and the registered manager met their responsibilities.

There were sufficient staff to meet the needs of the people using the service and some flexibility should those needs change.

Medicines were handled for people by staff that were trained and supervised to do this safely. There were measures in place to maintain those safe standards.

Staff were very happy with the level of training they received, which they said had improved. Staff received supervision of their work, a yearly appraisal and felt able to take any questions to senior staff or the management.

Staff responded quickly to any change in people’s health and involved external health care professionals where advice or treatment was required. The standard of care provided was very high. One person said, “I feel confident in the care I receive from the staff and the staff are very supportive and they take care of me“.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service was upholding people’s legal rights.

People’s needs and wishes were assessed and each person had a detailed plan to inform staff how the care they required was to be delivered. People were involved in regular reviews of their care plan.

There was a broad programme of activities available for people but some people said these did not suit their interests. Activities included arts and crafts, a pantomime, quizzes and visits to local attractions. People who preferred to stay in their room were provided with one to one attention. One person said they go to the lounge where there is “company if you need it”. One male resident said they wanted more activities of interest to men. There were examples of where personal interests had been supported, including visits to a ‘do-it-yourself’ store.

People’s dietary needs were met, there were several choices of meal, but there were some negative comments about the food provided. The registered manager had regularly consulted people about the menu and the activities on offer.

People and their family members felt confident that they could take any concern or complaint to the registered manager and it would be dealt with appropriately. The registered manager said, “A complaint is an opportunity for us to learn.”

The registered manager had been in post for one year. They said the culture of the home since their arrival was “moving forwards”. In that time they had formed a strong, happy team of staff who felt the home was well-led. Many changes had been implemented, for residents, the business and premises and for supporting and valuing staff.

This inspection was carried out by an adult social care inspector. We set out to answer these five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our visit to the home when we spoke with ten people who used the service, four of their relatives, and five staff members. We also made observations and looked at a number of records. Please read the full report if you want to see the evidence supporting our summary.

Is the service safe?

The service was safe because risks to people, for example in relation to poor nutrition and a lack of mobility, were being identified. Staff then followed procedures which reduced the risks and helped to ensure people's safety. Medication was being kept securely. People appreciated the support that they received with their medication and felt it was safer for staff to be involved.

Facilities and equipment in the home were being checked to ensure they were safe and working correctly. Aids were being used to assist people with their mobility; staff had received training so that they knew how to use these safely with people.

Is the service effective?

The service was effective because people felt that the home was meeting their needs. Care plans had been produced which set out the support that each person was to receive. The plans provided guidance for staff and helped to ensure a consistent approach. Staff provided support in ways which helped people to maintain their independence.

Staff followed procedures for monitoring people's health and wellbeing. This meant that any concerns, such as a loss of weight, could be followed up in a timely way. People were supported with seeing healthcare professionals so that their healthcare needs were met.

Is the service caring?

The service was caring because of the way that staff approached their work and treated people. People described the care staff as 'very kind'; one person commented "the staff are very keen on keeping us warm and comfortable'. The relationships we observed between staff and the people who used the service appeared to be friendly and positive. Staff talked to people in a respectful way. They took time to explain what they were doing, for example when administering medicines.

Relatives we met with said they were made to feel welcome when visiting the home and they were happy with the care being provided.

Is the service responsive?

The service was responsive because risks were being assessed and action was being taken to protect people's health and welfare. People were asked about their choice of meals, which were prepared in ways which met their individual needs.

Surveys were being used to gain the views of the people who used the service, their relatives and staff. The feedback provided information about what was working well and how the service could be improved. People who used the service had the opportunity to pass on their views at other times. One person told us 'They come round every month asking if we have any complaints, it's like a meeting and we can say what we want.'

Is the service well-led?

The service was well led because there were procedures in place for monitoring the service and making improvements. People who used the service, and relatives we spoke with, had confidence in the home's manager and how the service was being run.

The manager was registered with the Commission and had support from senior staff who had been delegated specific areas of responsibility. Staff commented positively about the training they received; one care worker described this as 'fantastic'.

We found substantial changes had been made in how delivery of care was recorded. Individualised records of the delivery of care had been completed. They evidenced the care and treatment provided to people using the service. There were good arrangements for the secure storage of confidential information.

People we spoke with were satisfied with the care they received. There was a range of activities available for people. Staff told us they did not participate as much as they would have liked in activities people in the service undertook. There was no person centred guidance to staff about how to respond to risk. We found there were not robust arrangements to protect and support people with their health needs.

People told us they felt safe living in the home. Staff demonstrated a good understanding of the nature of abuse and their responsibility to report any concerns about possible abuse.

There were robust arrangements in place for the recruitment of staff which included the required checks to make sure people were suitable to be employed in the home.

There was a lack of personalised records providing information about the care provided to people living in the home. We found that information about people was not readily accessible or kept in a safe confidential way. Individualised risk assessments had not been completed.