Archived: Catherine House General Nursing Home

Catherine House General Nursing Home is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 67 people however, the top floor is not in use.

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

People received care and support that was safe, however some relatives felt they could not comment due to not be able to visit during lockdown. One relative was concerned about people going into their loved one’s room. The provider had a robust recruitment programme and staff had received training in recognising abuse and safeguarding people. The management, administration and storage of medicines was safe.

People were protected by robust infection control policies and procedures. Staff had received training in infection control and the correct use of personal protective equipment [PPE].

There were enough staff to look after people safely and take time to sit and chat or join in an activity. A recent recruitment programme meant the service used less agency staff. This meant people experienced an improved level of consistency. Risk assessments were in place with guidance for staff about how to keep people safe.

People received responsive care and support which was personalised to their individual needs and wishes. There was clear guidance for staff on how to support people in line with their wishes. People’s end of life wishes were recorded, and the home worked with other healthcare professionals to ensure people were comfortable and pain free at the end of their life.

There was an improved activities programme in place which included meaningful activities for people living with dementia. Some relatives said the activities were good, and they had received photographs of things people had done. However, other relatives thought the meaningful activities for people living with dementia still needed some improvement.

Improvements had been made throughout the home, however relatives felt they had not been kept informed about the changes in managers and personnel, with one relative stating the arrival of a new manager was only “hearsay.”

Improvements in the service included effective systems to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views, however we need to see this can be sustained over time. Records showed the service responded to concerns and learnt from issues 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.

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 19 November 2019) and there were two breaches of regulation. 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 focused inspection to follow up breaches.

We carried out an unannounced comprehensive inspection of this service on 8 and 9 October 2019. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the Safe Care and Treatment of people and Good Governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contained those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Catherine House General Nursing Home on our website at www.cqc.org.uk.

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.

Catherine House General Nursing Home is a residential care home providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. The service can support up to 67 people.

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

The service had systems and processes in place for the safe storage, administration and use of medicines. However, these processes were not always followed.

Records were in place to show when medicines had been received, administered and disposed of. Records were not always available to ensure staff were supported to use medicines safely.

There were mixed opinions of the staffing levels in the home with some people, staff and relatives saying they felt there could be more staff whilst others thought there were enough. There was a high use of agency staff, however the staff used where familiar to the home and people living there.

There was a full activity programme in place with people taking part in craft making and enjoying visiting entertainers, however the experience for people on the two floors was very different. The first floor which was the general nursing floor was very busy with people enjoying a variety of activities. Whilst the ground floor where people living with dementia lived did not have any activities and people were observed watching TV or sleeping.

We have made a recommendation about providing meaningful activities for people living with dementia.

Audits used by the home to identify shortfalls had failed to identify some minor inconsistencies in care plan when people’s needs changed and the poor recording around the management of medicines. When audits had identified shortfalls, some actions had not been followed up. The registered manager responded promptly to shortfalls raised during the inspection and acted to improve outcomes for people.

People knew how to complain if they had concerns. However, there were mixed opinions on how effectively the home responded to concerns raised.

People received effective care from staff who were well trained and demonstrated a good knowledge of people’s needs, likes and dislikes.

People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs. However, the dining experienced for some people living with dementia was not a relaxed and social event with staff failing to engage with people when they were supporting them to eat. However, the experience for some people was a cheerful social occasion.

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.

People received care from staff who were kind and caring. Staff always respected people’s privacy and dignity.

Staff encouraged people to be involved in their care planning and reviews. People were supported to express an opinion about the care provided and could be involved in the day to day running of the home if they wished.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes. However, some care plans contained inconsistent guidance when people’s needs changed.

We have identified two breaches in relation to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Rating at last inspection

The last rating for this service was good (published 30 March 2017).

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There is 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.

We observed inconsistencies in how staff responded to people. Staff were observed treating people with respect and in a caring manner however there were occasions when staff had failed to ensure people's dignity and respect were upheld. Since the inspection a dignity champion had been appointed. The registered manager told us they hoped this would address this failure and was part of addressing this area for improvement.

People told us improvements were needed in the quality of some of the meals. There were varied comments from people about the choices available and quality: "Need more variety" and "Food should have more taste" and "Always good meal enjoy my meals". We observed attractive meals on the days of our inspections with good choices for people. There had been a meeting where people had discussed improvements and these had been actioned. The registered manager had received verbal positive feedback and was in the process of conducting a "Dining Experience" questionnaire and observation. They recognised improvements were continuing.

Staff had a good understanding of their responsibilities in protecting people from abuse. They spoke of reporting any concerns and being confident they would be listened to and action taken to address their concerns.

The registered manager had, as required, made applications under the Mental Capacity Act 2005 and obtained an authorisation under Deprivation of Liberty Safeguards (DoLS) arrangements. The service protected people's rights by seeking consent for care and use of certain equipment.

People told us they felt safe living in the home and how there were always staff available to support them. One person told us they felt safe because "I can trust the staff". A relative told us how on leaving the home after visiting "I know (Name) is safe and well looked after". Another relative told us "I would not want (Name) anywhere else".

Staff were described by people and relatives as kind and caring. People reported how there was a friendly and welcoming environment. This was confirmed by visitors we spoke with who commented how they always felt welcomed and involved in their relatives' care. One relative told us "I never feel I am in the way when I visit". People and relatives told us there were no restrictions on visiting.

The service ensured people's nutritional needs were met and took action to address any concerns about people physical wellbeing and ensure they were able to have a healthy diet suited to their needs.

People told us they felt confident about staff having the necessary skills and training. One person told us "The carers are good and really know what they are doing and I can depend on them for anything."

People had access to community health services and their GPs when this was requested. A healthcare professional we spoke with was very positive about the care provided by the service. There were good relationships with outside professionals and people had access to specialist support and advice.

People felt able to voice their views or concerns about the service. There were regular meetings where people living in the home and their relatives were kept informed about the service and people could give feedback about the quality of care provided in the home.

There were a range of quality assurance audits which had identified areas for improvement. A home improvement plan demonstrated how these had been actioned.

People and staff spoke of a registered manager who was approachable and made themselves available to people on a daily basis through walking around the home.

Due to the level of risk to the people who lived or worked in the home, we took enforcement action against the provider and served a Warning Notice on 8 August 2014. We told the provider in this notice they must reach compliance with this outcome by 8 September 2014.

This inspection was carried out to check if the provider had made the necessary improvements to infection control practice. We found the systems in place to reduce the risk and spread of infection had been significantly improved. They were now effective.

We saw all areas of the home were clean and we did not identify any infection control risks. New cleaning products and cleaning equipment were in use. New flooring had been laid which was easy to clean. The laundry area had been improved as had storage for clean and soiled items. These changes significantly reduced the risk of cross infection.

The working hours of the housekeeping team were due to be extended and their numbers increased.

The provider's audit of infection control practices was now thorough and accurately reflected the standards in the home.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service caring?

The service was not consistently caring. People were not always receiving care which met their individual needs or preferences.

People who lived in the home spoken with said they were happy with the care and support they received. Comments included: 'It's very nice here; I'm very happy', 'things are pretty good and the staff are very kindly' and 'It's nice here. The staff are very good.'

Relatives we spoke with said they were generally happy with the care provided to their family member but all felt there was 'certainly lots of room for improvement.'

We observed variable staff care practice. We saw at times people were treated with respect and warmth. At other times people were not respected and some staff interactions were unprofessional.

Is the service responsive?

The service was not responsive to people's needs. We saw care plans contained information about people's individual support needs and personal preferences, such as their likes and dislikes. People were not always supported in line with these.

People who used the service, their representatives and staff were not asked for their views about their care and treatment in line with the provider's policy.

Relatives meetings had been held but these were not well attended. We noted that when concerns about the care provided or the home more widely had been raised at these meetings they had not always been acted upon.

Is the service safe?

The service was not consistently safe for people. We saw care plans included a range of individual risk assessments and control measures, such as equipment and care guidelines for managing these risks. Some of these did not accurately reflect people's care needs or the risks involved.

The systems in place to reduce the risk and spread of infection were not effective. The cleanliness of the home varied. Four relatives we spoke with raised serious concerns about the cleanliness of the home. One relative said 'The cleaning is just not very good. The really need to improve the cleaning.'

People who lived in the home told us there were enough staff to meet their needs. One person said 'The staff are very good. When I use my bell I don't have to wait long for them to come.' There were vacancies within the staff team. Vacant hours were covered by permanent staff working additional hours or by agency staff. Recruitment was ongoing.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager said no applications had needed to be submitted. However, they knew when a Deprivation of Liberty Safeguards application should be made and who to go to if an application was required.

Is the service effective?

The service was not effective. The provider did not have effective systems in place for obtaining people's consent and acting in accordance with this. This meant people's human rights were not protected.

The d'cor and layout of the home did not promote an enabling environment for people with a dementia and we found staff had very limited knowledge about how to support people with a dementia.

There were a variety of planned activities including arts and crafts, coffee mornings, gardening club, baking, board games and church services. There was very little planned one to one time for people who did not wish to or who were unable to participate in communal activities. We observed very little stimulation for people who were less able.

Staff were provided with a range of training opportunities to enable them to provide safe and effective care. We noted that the provider's home quality visit report had described the training statistics as 'not as positive as they should be.' Formal staff supervision was irregular and records of supervisions sessions were poor. There was no evidence that any staff appraisals had been carried out.

Is the service well led?

The service had not been well led. The manager registered with the Care Quality Commission ceased working at the home on 11 July 2014. The home was now being managed by an experienced interim manager.

There was a clear staffing structure in place but some staff appeared unclear about their responsibilities and accountability. The interim manager had begun to meet with staff to reiterate their roles and responsibilities as part of the staff team.

The quality assurance manager responsible for the home had carried out monthly audits of the service. The last three months audits had picked up the same concerns identified at this inspection including poor care planning, variable care practice, issues with the environment and with staff support and training.

We were provided with a copy of the provider's recent improvement plan for the home. This showed where improvements were needed, the person responsible and the time scales for improvements to be completed. We saw early indications that the provider had begun to address some of the failings identified in this report.

Two incidents had occurred in the home which had been reported to the local authority under safeguarding protocols. We had not received a statutory notification for either of these two incidents at the time they occurred.

We had general discussions with people who lived in the home. This was because they were living with dementia or too frail to give us detailed feedback about their care or about the staff. We saw the staff helped people to eat their meals, they distracted people's attention to ensure their safety. We saw people enjoyed the banter they had with the staff and gentle reminders were used by the staff when people forgot dates of events.

The three relatives of people who lived in the home told us the standards of care had improved since our last inspection but said there were staff shortages. One relative said 'the staff are very good and they work very hard.' Another said 'the staff try hard but they are always short staffed' and the third relative said 'overall the care is good but there is always something. The staff always seem very busy. If you need them for something you have to wait.'

The staff we spoke with also told us the standards of care had improved. They told us there had been significant improvements in the quality of the food. We were told people were eating better. These staff told us more staff had been recruited but while their induction was taking place staffing levels were not always maintained. The manager told us the ways the staffing levels were to be improved.

We looked at a number care plans and while more detailed information was needed the staff told us they had enough information to meet people's changing needs.

Staff received essential training to help them deliver care and treatment to people safely and to an appropriate standard. Staff attended basic dementia training which meant that staff had some insight into needs of people living with dementia.

Not all people who used the service were able to tell us how they experienced care provided by the staff. This was because they were living with dementia or were frail due to this; we were only able to gain limited verbal feedback about people's experiences of the service. We observed people's overall wellbeing and their interactions with staff as a means to make a judgement about service provision.

We observed people smiled at the staff and responded to the staff when they were being supported. For example people responded positively when they were helped to eat or to move around the home. One person agreed with their relative that they were happy living at the home. Another person told us they were not able to eat their meal because it was 'horrible.'

We spoke with eight relatives and three healthcare professionals visiting the home during our inspection days. Relatives of people living at the home said the staff were caring Healthcare professionals also said the staff were helpful and willing to improve standards of care.

We spoke with eight relatives visiting the home about the care and treatment provided to their relative living at the home. The comments from relatives of people who lived at the home ranged from 'excellent' to 'not so good.' Three relatives of people living at the home said the care their relative received from the staff was good. One of these relatives said 'Staff are kind and very caring, my relative is happy here. The staff have asked me to give a talk on the type of dementia my relative has. It's very rare.' The other four relatives raised concerns about the turnover of staff and how this impacted on consistency of care. They added that people were not having the attention they needed with personal care and at times they needed to ask staff to give their relative the attention they needed. People who lived at the home were placed at risk because the delivery of their care was not appropriate and safe.

The staff employed at home did not receive an induction that prepared them for the role they were employed to perform. Staff were not properly supervised to provide care and treatment to people who lived at the home.

We spoke with six relatives of people living at the home. We were told staffing levels had increased which meant people were receiving their care at appropriate times. They said there was a programme of activities and entertainment. One family member said more improvements were needed with the delivery of personal care and moving and handling techniques used by the staff.

Two relatives told us the relief manager took their complaints seriously, took action and resolved them to a satisfactory level.

We saw staff used a positive and gentle approach towards the people they supported. We saw staff encouraged people to eat and we saw staff joined in the organised entertainment.

When we spoke to staff about the delivery of care they told us the staffing levels had increased and people were receiving their care in a timely manner. Staff showed a lack of knowledge about the care needs and preference for the people they supported.

Healthcare professionals said the staff were open to new methods of moving and handling, but were not using the lifting equipment available in the home appropriately.

The relatives we spoke with made positive comments about the staff. They knew how to complain and would approach the manager or deputy with their complaints. One relative told us they were invited to review meetings and were kept informed of important events such as accidents and medicine changes. Two relatives raised concerns about insufficient staffing to help people drink and eat their meals.

We spoke to five staff about the delivery of care and they told us it was difficult to meet the needs of the people at the home because they were short staffed. They told us they were not able provide adequate levels of personal care and to help people eat and drink their meals at the appropriate times.

People were placed at risk of isolation because there was a lack of social and mental stimulation. Although we saw two staff in the first floor lounge interacting with people, the majority of people were asleep most of the time. We saw one member of staff wearing earphones, while delivering care which showed a lack of attention for the person they were assisting.

We asked one person if they liked the home and they said 'Yes I love it here.' Five relatives told us about their observations of they care provided by the staff and overall, relatives made positive comments about the staff and the care delivered to people. One relative told us they went to the home everyday and the staff accommodated their wishes to participate in the delivery of care to their family member. A third relative told us 'my relative is cared for in bed on alternative days, all the other times they are in the lounge with the same CD playing in the background'

When we looked around the home we saw there were areas that needed cleaning and repair.

The home environment did not help to promote the needs of people with dementia. There were few visual clues to help people find their way around the home, or to help them find points of interest around the home.