Background to this inspection
Updated
17 September 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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by two nurse specialist advisors, an Inspector and an 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.
Service and service type
The Leonard Pulham Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give 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 spoke with 16 people and four relatives and two friends of people living in the service. We spoke with the registered manager and the deputy manager, three nurses, three health care assistants and the maintenance worker. We received assistance from the administrative staff. A trustee from the board of trustee’s joined us for feedback at the end of each day.
We reviewed nine people’s care plans and 11 people’s medicines records.
We examined four staff recruitment records. We reviewed the training, supervision and appraisal records for the care staff team. Additional documents we viewed included safeguarding notifications, minutes of meetings with staff, and incident reports amongst others. 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.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at documents which we requested which included mental capacity assessments, duty of candour policy and a risk assessment.
Updated
17 September 2019
About the service
The Leonard Pulham Nursing home providing personal and nursing care to 34 older people. At the time of the inspection 30 people were residing in the service. The service is purpose built over two floors. People share facilities such as the lounge and dining areas.
People’s experience of using this service and what we found
People told us they felt safe living in the service. Improvements had been made to the how the service assessed and monitored risks related to care and the environment. Staff recruitment systems minimised the possibility of employees providing unsafe care to people. Medicines were safely stored and administered by trained staff. Systems were in place to ensure the service was safe.
People’s needs were assessed, and the environment was clean and well maintained. People were supported to enjoy their meals and their nutrition and hydration was monitored to enable people to remain healthy.
Staff were supported through training, supervision and appraisals as well as team meetings and daily staff meetings. Supervision wasn’t provided as regularly as the provider had wished, but this was being addressed by the recruitment of additional senior staff.
Staff were “Kind and caring.” Most people were happy to spend time with staff and interactions we observed were overall positive, meaningful, and respectful. We did observe one incident where a person who was unwell did not have their needs met in a timely way, but this was not the norm. This was because in addition to this incident people were not always offered a choice of what time they went to bed and got up in the morning.
Some people, relatives and staff told us there were not enough staff. The registered manager disputed this. We could find no evidence to support the concern apart from our observation that staff were very busy throughout the time we spent in the service. The registered manager agreed to explore people’s concerns more thoroughly.
People’s cultural, religious and dietary needs were acknowledged and where possible met. People’s preferences and dislikes were documented, however, more detail about people’s personal histories would assist staff to have a more holistic understanding of people.
The service supported people with communication and was compliant with the Accessible Information Standards. Accidents and incidents were clearly recorded, and investigations were undertaken to ensure the risk of repetition was minimised.
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.
The new management in the service had implemented audits to check the quality of the service, these had been completed and actions had been taken to improve the provision of care and support.
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 (28 January 2019) and there were multiple 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. This inspection was carried out to follow up on action we told the provider to take at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Leonard Pulham 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.