Background to this inspection
Updated
16 November 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
The inspection was carried out by one inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was in the care of older people and the care of people living with dementia.
Service and service type:
This service 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection:
This inspection was unannounced.
What we did:
¿ Before the inspection we looked at the information we held about the service, this included whether any statutory notifications had been submitted. Notifications are changes, events or incidents that providers must tell us about.
¿ We also reviewed information from the local authority commissioners on the service. Prior to this inspection, commissioners had met with the provider to identify actions needed to improve the service. Commissioners reported these actions were in progress at their last visit in October 2018. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority or by a health clinical commissioning group.
¿ We checked whether Healthwatch Nottinghamshire had received feedback on the service; they had not. Healthwatch Nottinghamshire is an independent organisation that represents people using health and social care services.
¿ The provider completed a Provider Information Return. This is information we require providers to send us to give us some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
¿ During the inspection we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
¿ We spoke with five people and six relatives about the service. We also spoke with the registered manager, the staff member with responsibility for training, a senior care staff, two care staff, the activities coordinator, the care-plan coordinator, a volunteer, a domestic member of staff, a maintenance staff member, and two kitchen staff.
¿ We looked at three people’s care plans and reviewed other records relating to the care people received and how the service was managed. This included risk assessments, quality assurance checks, accident and incident reports, staff training and policies and procedures.
Updated
16 November 2019
About the service: Seely Hirst House 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, both were looked at during this inspection.
The care home accommodates up to 38 older people, including some people who were living with dementia, in one adapted building. At the time of our inspection 27 people lived there.
People’s experience of using this service:
¿The provider had made improvements to the management of risk for falls and behaviours that challenge, fluid intake, infection prevention and control and cleanliness and the application of topical medicines.
¿This meant the provider was no longer in breach of Regulation 9, 12 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
¿However, the provider had failed to ensure equipment used to help people move had been inspected as required. Not all staff who administered medicines had had their competency checked in line with good practice recommendations and we found topical creams were not always stored securely in people’s bedrooms. They had also failed to ensure their systems and processes to assess and monitor the quality and safety of services and investigate complaints were effective. In addition, the provider had not always worked effectively with other professionals to ensure continuous learning.
¿This meant they were still in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
¿Risks in the environment, such as from legionella were monitored and checked. Risks associated with people’s healthcare conditions were identified and managed. Procedures were in place and followed by staff, to ensure infection protection and control practices were effective.
¿Sufficient staff were available to meet people’s needs and staff were deployed to ensure people received support in communal areas. Staff understood what actions to take to protect people from harm and abuse. The registered manager looked to learn from incidents and make improvements when things went wrong.
¿People’s needs were assessed and monitored and people’s diverse needs were supported. Policies and procedures helped to ensure care was delivered in line with current standards.
¿Staff received support and supervision to help them work effectively in their roles, although not all staff were up to date with the areas the provider had identified they required for their job role.
¿Staff made referrals to other professionals for their advice and guidance regarding people’s care when needed. People had access to other healthcare services as required.
¿People had choices of food and drink to help them maintain a balanced diet. Staff supported people with their meals and drinks when needed.
¿People liked their home and the premises had been adapted to meet their needs.
¿People felt cared for by staff. People’s views were taken into account when their care was planned. Staff took steps to ensure people’s privacy and dignity was respected. People’s independence was promoted.
¿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 received personalised and responsive care and enjoyed how they spent their time at the service.
¿People had experienced a variable quality of experience when they had made a complaint; plans were in place to ensure people received a consistent and robust response to any complaint made. Information was available on how to complain. People’s communication needs were identified and met.
¿ The registered manager was keen to ensure care promoted positive outcomes for people. The registered manager was considered to be open and approachable. People and staff felt listened to and had opportunities to be involved in the service; more information is in the full report.
Rating at last inspection:
At our last inspection, the service was rated as 'Requires Improvement' overall and 'Safe' was rated as 'inadequate.' (Published 12 September 2018). At this inspection we found the service had made some improvements and some improvements were still required. The overall rating for this service is ‘Requires Improvement’. This is the third inspection where the service has been rated 'Requires Improvement' overall.
Why we inspected:
This is a scheduled inspection based on the previous rating. The previous inspection found four breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. These were Regulation 9 (Person-centred care), Regulation12 (Safe care and treatment), Regulation 18, (Staffing) and Regulation 17 (Good governance).
Follow up:
We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk