Archived: Mulgrave House Nursing Home

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

There were some minor issues with medicines which the registered manager resolved promptly.

People were safe as staff were able to recognise and report possible signs of abuse or neglect, and these were acted on appropriately. Any lessons learnt were integrated into practice. Risks were managed through personalised moving and handling plans which evidenced equipment and method needed for transfer. We saw evidence of sound practice as care staff were assisted by their therapy colleagues.

Staffing levels were sufficient to meet people’s needs and promote independence for those in receipt of rehabilitation support. They were supported with regular supervision and training. Communication between staff was good. The home was very clean and accessible for people.

The registered manager had a good understanding of best practice supported by colleagues from the multi-disciplinary meetings held regularly at the home. People were able to access health and social care support as needed.

The dining experience was poor on the first day of the inspection but improved significantly on the second day as the registered manager spoke with staff about the issues we raised. 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.

We observed some lovely interactions between staff and people living in the home. Staff were very caring, kind and considerate. Their focus was ensuring people reached their full rehabilitation potential and promoted interaction between people as much as possible. Care documentation was focused on achievement of specific, person-focused goals and was measurable. For people living long term in the home records showed staff knew them well.

Complaints were handled quickly and thoroughly. End of life wishes were considered and documented clearly.

The service was very focused on the rehabilitation service it offered, and this was well received by people. Due to the transient nature of people’s stay it was difficult to implement overall quality assessments but for each person satisfaction questionnaires were completed, and we saw many compliments.

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 15 December 2018) and there were two breaches 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

This was a planned inspection based on the previous rating.

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.

Mulgrave House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Mulgrave Nursing Home is a large converted property with a modern extension. The service provides care and support for up to 35 people. The service can support older people, people who are living with dementia and people who have a physical disability. Some people are supported with intermediate care, prior to them returning home or going on to another care service. The service is close to all local amenities.

There was a registered manager in post at the time of our inspection. 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.

Medicines were not always managed safely. Stocks of medicines did not always balance with records and creams were not always applied as prescribed.

Systems and processes for monitoring the quality of the care provision required strengthening. The registered manager was in the process of introducing a new quality management tool, but it was too soon to be able to assess how effective this would be. Feedback regarding the management team was positive.

People’s care plans did not always provide accurate and up to date information about their current needs to provide effective care. Some information in the care plans was contradictory.

There were sufficient numbers of staff deployed in the home and feedback from people and staff confirmed this. Recruitment was safely managed, as relevant checks undertaken ensured staff were suitable for working with vulnerable people. Staff completed induction and there was a training programme in place. Timely staff supervisions and appraisals were carried out; staff said they felt supported by the registered manager.

Some risks to individuals were appropriately assessed, monitored and reviewed. Building maintenance and fire safety was appropriately managed as the necessary checks had been completed. People felt safe and staff knew how to recognise and respond to signs of abuse. The home was clean, tidy and odour free. There were procedures in place to reduce the risk and spread of infection. Communal areas of the home were comfortably furnished and people were familiar with the layout of the home.

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 did support this practice. We found the service was working within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However, decision specific mental capacity assessments were not always in place.

People’s healthcare needs were met and they were able to access a range of healthcare professionals. People were happy with the food they received. Throughout the day, drinks and snacks were regularly provided. We observed a positive mealtime experience where people were well supported.

Staff were seen to deliver caring, kind and compassionate care. Comments from people and relatives confirmed staff provided good care. The home was warm, with a friendly atmosphere, there were good natured interactions between people and staff. People’s privacy and dignity was respected.

People received stimulation through a programme of activities with external entertainers and trips out to local facilities also took place.

The registered manager told us they had a good reputation with supporting people who were approaching the end of their life. We saw care plans mostly contained individual information regarding peoples wishes.

People and relatives knew how to complain. Complaints were appropriately dealt with and responded appropriately by the registered provider. However, not all the documentation was in the complaints file, which made it difficult to establish an evidence trail.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to medicines management and governance. You can see what action we told the provider to take at the back of the full version of the report.

Mulgrave Nursing Home is a large converted property with a modern extension attached. The service provides care and support for up to 35 people and is accommodation for people who require personal care and/or nursing. The service can support older people, people who are living with dementia and people who have a physical disability. The service is close to all local amenities.

The home had a registered manager in place. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Appropriate systems were in place for the management of medicines so people received their medicines safely.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Staff needed to be more aware of some risk assessment documents in people’s care plans to help them complete their role.

We saw people’s care plans were very person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate people were involved in all aspects of their care plans. Care plans and risk assessments were not always clearly cross referenced to support staff to know the hazards for each area of need.

We saw staff had received supervision on a regular basis; however, not all staff had received an annual appraisal. Staff had been trained and had the skills and knowledge to provide support to the people they cared for.

People told us and we saw there were enough staff on duty to meet people’s needs. We found safe recruitment and selection procedures were in place and appropriate checks had been made.

Staff understood how to work to the principles of providing choice and gaining consent from people they supported in line with the Mental Capacity Act (2005). However, more work was needed for staff to understand the requirements of the Deprivation of Liberty Safeguards (DoLS).

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were attentive and patient with people. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks. The mealtime experience was too long as people had to wait for their meal to be served. Food was of good quality and people told us they enjoyed the food. People were supported to maintain good health and had access to healthcare professionals and services.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw there was a plentiful supply of activities. However, how the service recorded activities people took part in did not evidence whether people had enough activity to prevent social isolation.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided.