Archived: Radbrook Nursing Home

Radbrook Nursing Home is a residential care home providing personal and nursing care to up to 63 people. The service provides support to people over the age of 18 years. The home’s Cherry Tree Household supports up to 16 people who are living with dementia. At the time of our inspection there was refurbishment work being completed to a new wing of the home and there were 47 people using the service.

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

Improvements had been made since our previous inspection. Although we received some mixed feedback about staffing levels, there were enough staff to safely support people. Staff were recruited safely to the home. Risks to people were assessed and planned for to support them to stay safe. Staff practice helped to minimise the risk of cross infection. People’s medicines were administered and managed safely. The provider had systems in place to make sure lessons could be learnt from accidents, incidents and when things went wrong.

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.

Staff had received training to give them the skills and knowledge to understand and support people's individual needs. People were supported to eat and drink in line with their needs. People’s health needs were met and referrals were made when people needed other health care support or staff were worried about a person’s health. The home’s environment was clean, comfortable and gave people and their visitors access to communal and private spaces.

People were supported by staff who they told us were kind and caring. Staff had developed good relationships with people and supported them to make choices and retain their independence. People were treated with dignity and respect.

People's care was reviewed regularly to ensure the plans in place met their current needs. People had the opportunity to discuss and put in place their end of life wishes if they wanted to. Complaints received had been investigated and responded to in line with the provider's policy.

Staff and managers had created a positive and open culture. People and their relatives were happy with the care provided. Staff were clear about their roles and responsibilities; they felt supported by management and involved in the development of the service.The provider had effective quality assurance systems in place which were used to monitor the quality and safety of the service.

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 18 September 2019) and there were breaches of the regulations. 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

The inspection was prompted in part due to concerns about the admission of people to the home. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern.

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 COVID-19 and other infection outbreaks effectively.

Please see the safe and well-led sections of this full report.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Radbrook Nursing Home can provide personal and nursing care to 43 older people, some of who are living with a dementia type illness. The accommodation is provided in one adapted building over two floors. At the time of the inspection the service was undergoing a full refurbishment and had 32 people living at the home.

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

People and their relatives told us there was not always enough staff available at certain times of the day. The service used an assessment tool to determine the levels of staff required based on people’s level of need. However, we saw people during the inspection waiting long periods of time for support. Staff told us they felt more staff were needed during busy times of the day.

Where people required support with eating and drinking, referrals had been made to Speech and Language Therapists (SALT). However, we saw some people not being supported appropriately with eating and drinking due to staff deployment.

The provider’s quality assurance checks had not highlighted the issues found during this inspection regarding deployment of staff, people’s dining experience and governance records.

Staff knew how to safeguard people from abuse. Risks to people’s health needs were assessed to provide staff with guidance on how to keep people safe although some records were not fully up to date with current health needs. Medicine management was effective. The registered manager used information following accidents and incidents to reduce the likelihood of future harm.

Staff received training and supervision to support them to effectively carry out their roles. 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 were able to participate in a range of activities if they chose to do so. The service worked with a range of professionals to best meet people’s needs.

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 11 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches in relation to the quality monitoring of the service and deployment of staffing to ensure the provision of effective, person-centred care.

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

Follow up

We will request an action plan from 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.

Radbrook Nursing Home is registered to provide accommodation with nursing care for up to a maximum of 43 people. There were 42 people living at the home on the day of our inspection. Some people were living with dementia

There was a registered manager in post. They were not present during the inspection due to being on annual leave. 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 protected from harm and abuse by staff who had been trained in how to recognise and report abuse. Staff were aware of the risks associated with people’s needs and how to minimise these. There were enough staff to safely meet people’s needs. People were supported to take their medicines safely and accurate records were maintained. Staff monitored people’s health and arranged health appointments as needed.

People were supported by staff who had the skills and knowledge to meet their individual needs. There was an open and positive working culture where staff felt well supported by the management team and peers. Staff sought people’s consent and respected their wishes. Where people were unable to make decisions for themselves these were made in their best interest by people who knew them well.

People were pleased with the quality and choice of food available to them. People were provided with equipment and support to eat their food independently. People’s nutritional needs were routinely assessed, monitored and reviewed. Where there were concerns about people’s dietary needs specialist advice was sought and followed.

People received care and support that was personalised to their individual needs and preferences. Staff spoke with and about people with warmth and respect. Staff treated people with dignity and promoted their independence. People were able to spend their time as they wished. People were pleased with the range of activities offered.

The registered manager was open and approachable. The provider had a range of checks in place to monitor the health, safety and wellbeing of people living at the home. The registered manager sought the views of people and staff to make improvements to the service.

People felt able to raise concerns with staff or management and were confident that these would be dealt with promptly. The provider had a clear complaints procedure that was followed by staff.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found.

Is the service safe?

People living in the home told us they felt safe because their rights and dignity were respected. People confirmed that they were involved in making decisions about any risks they may decide to take in their daily lives. One person said, 'Radbrook provides a sense of safety and security, especially at night.' Another person said, 'It's the way staff are with me that makes me feel quite safe.'

We spoke with staff who said they knew what to do if concerns about abuse were raised and they were aware of the provider's policies and procedures. This meant that people were protected from potential abuse.

The registered manager showed us an effective system to manage accidents and incidents and learned from them so they were less likely to happen again.

The staff and the registered manager understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards and put them into practice to protect people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people living in the home were protected from bullying, harassment, avoidable harm, abuse and breaches of their human rights.

When people were at risk staff followed effective risk management policies and procedures to protect them. This meant that risks to individuals were managed well so that people were protected and their freedom was supported and respected.

Is the service effective?

People living in the home told us that they could express their views about their health and quality of life. They said these were taken into account in the assessment of their needs and the planning of their care and treatment. People told us they had been involved in the assessment of their needs prior to living at the home. The care records we looked at reflected people's current individual needs, choices and preferences.

Staff we spoke with demonstrated that they had the skills and knowledge to meet people's assessed needs, preferences and choices at all times. People we spoke with said they felt confident discussing their health needs with staff. They said their health was regularly monitored to identify any changes that may require additional support or intervention such as referral to the GP or physiotherapy. We looked at records that showed referrals were quickly made to health services when people's needs changed. Records noted that relatives were kept informed. A relative had told us, 'I am kept informed of all aspects of mum's care and that's what her wishes are'. Another relative said, 'I am kept fully informed and updated at all times and I am confident mum is receiving appropriate, dignified and gentle care day and night.'.

Staff told us they received effective support, supervision and training. The registered manager had an ongoing workforce development plan that encouraged staff to develop and promote innovative practice. This meant that people received effective care from staff who had the knowledge and skills necessary to carry out their roles and responsibilities.

Is the service caring?

People living in the home told us that they were treated with kindness and compassion and that their dignity was respected when receiving personal care. We observed as staff went about their work that people were shown kindness and compassion in day to day care. People explained how their individual needs were met, including needs around age, disability, religion and belief. Staff we spoke with knew the people they were caring for well including their preferences and personal histories. This meant that caring positive relationships were developed with people living in the home.

Records were stored in the office so that people were assured that information about them was treated in confidence. Staff we spoke with described how they promoted respectful behaviour and positive attitudes. This meant people's privacy and dignity was respected and promoted.

People and their relatives were given the opportunity to complete a survey about life in the home. Regular resident meetings and informal groups were encouraged. This meant people and those that mattered to them were encouraged to make their views known about their care and support, and these were respected.

Is the service responsive?

People said that they and their family were encouraged to make their views known about their care and support. One person explained how staff made sure that they had the time they needed to make decisions about their life. Care records detailed how people's individual needs were regularly assessed and met.

Staff spoke about how they would record any assessment when a person's capacity was considered under the Mental Capacity Act 2005. If a person did not have capacity, decisions were always made in their best interest. The way staff interacted with people showed that they actively sought and listened to people's views and decisions. This meant people were supported to express their views and be actively involved in making decisions about their care and support.

People who lived at the home attended meetings so that they could put forward their views for activities that were important and relevant to them and they were protected from social isolation. People were very much enabled to maintain relationships with their friends and relatives. Staff we spoke with recognised the risks of social isolation and loneliness and worked hard to balance the risk against this and how people wanted to live their life. This meant that people received personalised care that was responsive to their needs.

Is the service well-led?

Discussions with the registered manager and staff showed there was an emphasis on fairness, support and transparency and an open culture in the home. The registered manager operated a clear set of values that included involvement, compassion, dignity, respect, equality and independence which were understood by all the staff we spoke with. This meant that the service promoted a positive culture that was person centred, open, inclusive and empowering.

Robust quality assurance and governance systems were in place and used to drive continuous improvement. There were effective arrangements to continually review health and safety, safeguarding concerns, accidents and incidents, medication, care plans and complaints.

The management team had links with external practitioners that acted as sources of best practice. For example, the local medicines management team were conducting a review of medication practice in the home. This meant that the registered manager demonstrated good management and leadership.

Staff we spoke with knew and understood what was expected of them. Effective processes were in place for staff to account for their decisions, actions, behaviours and performance. This ensured that responsibility and accountability was understood at all levels. A staff member told us, 'There is a strong focus on training for staff at all levels.' A visitor said , 'Managerially the home is very very good.'

Most people told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were usually available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'Good staff, good food and a nice room'.

The provider had developed a system whereby they can monitor how well the home was meeting the needs of the people who live there.