Inglewood Residential Home

Inglewood Residential Home is a residential care home registered to provide accommodation and personal care for up to 20 people. Support is provided to older people and people living with dementia. At the time of inspection there were 18 people in the service.

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

People felt safe and staff had good knowledge of safeguarding processes. Staff had mostly been recruited safely. We found one staff member did not have a current Disclosure and Barring Service (DBS) certificate at the time of inspection. The provider acknowledged this as an oversight and immediately completed an application to reduce risk. There was a system in place to monitor staff contact with people in the form of daily logs. Care plans and risk assessments identified people’s support needs and staff had a good understanding of the support people needed.

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 treated with kindness and compassion. People felt well supported. People were listened to and could express their views. People’s privacy and dignity was maintained.

People’s and their relatives were involved in the review process. People’s personal preferences were identified in their care plans. People were involved in decisions about their care.

People received person centred care. People, relatives and staff expressed confidence in the provider and deputy manager. People, relatives and staff were given the opportunity to provide feedback. Some audits took place to ensure the quality of the service was maintained.

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

Rating at last inspection

The service was last Inspected on 09 March 2021 with an overall rating of ‘Requires Improvement’, and there were multiple breaches of regulation. At this inspection we found some improvements had been made and the provider was no longer in breach of regulations 9, person centred care and 12, safe care and treatment. However, not enough improvement had been made with regards to regulation 17, good governance and they continue to be in breach.

At this inspection we only looked at the ‘Safe, Responsive and Well led’ key questions. This was because our planning did not identify any concerns about the other questions.

This service was registered with us on 13 December 2010.

Why we inspected

This was a planned inspection based on the previous rating and the breaches found.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance at this inspection.

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

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.

Inglewood Residential Home is a residential care home providing accommodation and personal care people for up to 20 people aged 65 and over. At the time of the inspection 18 people were living at the home. The accommodation is provided over two floors, there are two communal areas on the ground floor.

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

This inspection found that improvement was needed to ensure people were protected from the risk of infection. We found that Government Guidance on COVID-19 was not consistently followed. We also found some areas of the home had worn fittings such as the handrails and some of the doors.

People received support to take their medicines. People were supported by staff who were aware of how to safeguard people from abuse and had good knowledge on how to recognise and respond to concerns.

People and staff told us activities to meet the needs of people living at the home could be improved. At the time of the inspection 17 of the 18 people living at the home were living with dementia; however, we found that appropriate activities had not been considered. We also found that information was not available to people in formats that supported their understanding.

We have made a recommendation the provider seeks guidance on best practice for dementia care.

Relatives told us that communication to maintain regular contact with their family member had been well supported during the pandemic.

We found that although the provider had quality monitoring systems in place, they had not always been effective in identifying issues and ensuring that action was taken in a timely way.

The provider had not notified CQC as required that care was provided for people living with dementia.

People and relatives said staff were caring and we saw positive interactions that supported this. We also received positive feedback from two healthcare professionals we spoke with about the care provided.

The management team acknowledged where improvements were required, they were open to the inspection and demonstrated a willingness to address any concerns and make the improvements required.

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 Good (Published on 22 January 2020).

Why we inspected

The inspection was prompted due to concerns about poor infection prevention and control (IPC) and whistleblowing concerns. A decision was made for us to inspect and examine those risks.

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.

We reviewed the information we held about the service. We only looked at safe, responsive and well led during this inspection. We did not look at the key questions of effective and caring. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service as deteriorated to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well led sections of this full report.

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

Enforcement

We have identified breaches in relation to Regulation 12 (safe care and treatment), Regulation 9 (personalised care) and Regulation 17 (good governance) at this inspection.

You can see what action we have asked the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ People were supported to maintain contact with their families and friends by using video and telephone calls and closed window visits.

¿ Specific training around infection prevention and control for Covid-19 had been given to staff to promote awareness and reduce anxieties.

¿ Prominent and accessible signage was displayed around the home to explain what people should do to support their safety.

¿ Risk assessments had been carried out on people using services and staff who belonged to higher risk groups and actions had been taken to reduce the risks.

¿ The provider had ensured mental health services were available for staff to use if needed to support their well-being.

Further information is in the detailed findings below.

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

The provider carried out some audits of the service, however, further improvements were required in order to make them more robust. Staff told us competency checks were carried out but there was no evidence of this. Risk assessments did not always give clear guidance for staff to follow and monitoring of fluid and food intake was inconsistent. People and relatives spoke highly of the registered manager and staff team.

People told us they felt safe and received their medicines as prescribed. Safeguarding systems and practices protected people from abuse. People felt there was enough staff to meet their needs and our observations confirmed this. Personal protective equipment was used when required.

Staff were trained to meet people's needs and acted promptly to refer people to healthcare professionals when required. People received support to eat and drink meals of their choosing and specialist dietary needs were met. Recent work had been completed on the environment to adapt it for people living with dementia and further plans were in place.

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 spoke positively about the caring nature of the staff. We saw people were treated with respect and dignity. Relatives were made to feel welcome in the home and people were involved in decisions about their care. Staff supported people’s impendence where possible.

There were activities for people to take part in if they wished which reflected their own interests. The provider had a complaint process which people were aware of to share any concerns. End of life wishes were discussed with people and recorded in their care plans.

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 29 June 2017).

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.

People continued to receive safe care. People told us they felt safe. Staff had a good understanding of the action they should take where there was suspicion a person was at risk of harm or abuse. Risks to people’s safety had been assessed and care and support was delivered in a way that kept people safe from harm. There were adequate numbers of safely recruited staff to meet people’s needs. People received their medicines as prescribed.

The care people received continued to be effective. People received support from staff that had the skills and knowledge to meet their individual needs. People were asked for their consent before care was provided. People’s capacity had been assessed and recorded so staff knew how to support people when making choices and decisions. People were happy with the food and drink they received and were supported to maintain a healthy diet. People had access to appropriate healthcare professionals when they required.

People continued to receive support that was kind and caring. People’s choices were respected and their dignity and privacy maintained. People were encouraged to be as independent as possible. People were supported to maintain relationships that were important to them.

The service people received continued to be responsive to their needs. People were involved in the planning and review of their support needs. Staff were aware of people’s individual care needs and supported them according to their preferences. Where people had any issues or concerns they knew how to make complaints and said these would be responded to.

The home continued to be well-run. People and staff expressed confidence in the provider and registered manager. Staff were aware of their roles and responsibilities. Systems were in place to assess and monitor the quality of service people received which included seeking feedback from people and their relatives about the quality of service provided.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?'

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with five people using the service and one of their relatives, three care staff supporting them and looking at three care records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

All of the people we spoke with who used the service and one of their relatives told us that they felt safe. Safeguarding procedures were in place and care staff understood their role in safeguarding the people they supported. All of the care staff we spoke with were aware of the provider's whistleblowing policy.

The provider had appropriate policies and procedures to protect people's rights and choices and gain their consent to the care and support they received. The provider's policies reflected the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Care staff had received training in how to protect people's rights and understood legal requirements.

Care staff knew about risk management plans and we saw that they supported people in line with those plans.

The manager ensured that care staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way. The care staff had the training and support required to ensure that people's needs were met.

The home was clean and hygienic. The registered manager made regular checks to ensure the risk of infection was controlled.

Systems were in place to make sure that the manager and care staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

Is the service effective?

People's health and care needs were assessed with them and where people wanted family members were involved. All of the people we spoke with told us they were involved in the care planning and reviews of care. We saw that care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the care staff.

Care staff received the appropriate training to meet the diverse needs of people who used the service.

Visitors confirmed that they could visit when they wanted to and spend time alone in privacy if they wished.

Is the service caring?

People were supported by care staff that were kind and caring. We saw that care staff gave people encouragement and were patient with them. One relative told us, 'I visit my relative regularly and the staff are kind and caring'.

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to engage in different activities each day.

All of the people we spoke with were aware of the home's complaints procedure and knew how to raise concerns. One person told us, 'They are responsive to any requests you make'. The provider sought the views of people about their care and acted on them.

Where care staff had noticed people's changing needs, their care plans had been updated to reflect this.

Is the service well led?

The service had quality assurance and risk management systems in place. Records seen by us indicated that shortfalls in the service were addressed promptly.

The care staff were well supported to ensure they had the skills and knowledge to carry out the care people needed. Care staff were given feedback about their performance so improvements could be made where needed.

All of the care staff we spoke with told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Care staff told us the home was well organised and they felt supported by their manager.

We found that care was planned and personalised to meet people's individual needs.

We saw that there was choice on the menu and people told us that they could always have something else if they wanted it. We saw that drinks were offered frequently throughout the day.

We had some concerns about the processes taken to control the risk of infection. Some areas of the home had become resistant to cleaning (which meant that they looked dirty after they had been cleaned). The cleaning schedules were not detailed enough to ensure that the home was cleaned efficiently.

We saw that recruitment processes were designed to ensure that the service only employed people who were of good character to care for the people who lived at the service.

We saw that people who used the service were encouraged to use the complaints procedure for daily events. This meant that the complaints procedure was effective as people who lived at the service were able to access it and use it.

18 people were in residence when we visited. We used different methods to help us understand the experiences of people who used the service. We spoke with seven people who lived at the home, four relatives, three staff members and the registered manager. We also spent time observing the care provided in the home.

We saw people had the necessary equipment in place to provide a safe environment, e.g. a stair lift. We witnessed staff knocking on bedroom doors before entering. This meant people's privacy, dignity and independence were respected.

People were consulted about their care, and where able, gave consent to the treatment and support they received. Relatives told us they were informed about any changes in their relative's condition. This meant that people received the care they needed.

People spoke well of the home. One relative said, 'The manager and staff here are very good'.

People were protected from abuse. Staff understood the signs of abuse and were able to explain how to report any suspicions of abuse.

We checked the number of staff on duty and found that people who used the service had their needs met by sufficient numbers of appropriate staff.

We saw that the service had a quality assurance system in place ensuring that people received safe and appropriate care that met their needs.