Hendford Nursing Home

Hendford Nursing home is a care home provides nursing, accommodation and personal care for up to 34 people with a range of care needs, including the frailty of old age. At the time of the inspection, 26 people were living at the home. The home accommodated people in one building.

We found the following examples of good practice.

The service arranged clear areas for testing of visitors and professionals to the service. For example, vacant rooms had been converted to testing rooms so that this could be conducted privately for visitors.

Staff were experienced in the infection, prevention and control processes to support new admissions to the service. The provider organised personal protective equipment (PPE) training externally which included practical donning and doffing assessments.

The service had provided information for people on the Covid-19 virus, social distancing and other infection control procedures. The service also provided face to face visiting opportunities safely through several methods. For example, an area of the communal area was converted to provide a safe barrier for visitors to speak with people with external access away from other people.

Risk assessments had been completed to support people living with dementia, and others, to remain safe when there were risks identified in maintaining isolation and social distancing. This included furniture being laid out in communal areas to facilitate social distancing without causing people distress. People were encouraged where possible to have meals in their eating area in a staggered manner to avoid overcrowding.

There were procedures ready so that if a person received a positive covid-19 test, staff could put zoning and isolation practices in action straight away.

People’s experience of using this service: People were supported by staff that were caring and treated them with dignity and respect. Staff understood the needs of the people they supported. Through conversation staff told us how they aimed to achieve positive outcomes for people.

Risks of abuse to people were minimised. Assessments of people’s needs identified known risks and risk management guidance was produced for staff which they understood. The service had appropriate safeguarding systems and processes. Staff understood safeguarding reporting processes and the registered manager had a detailed oversight of current and historical safeguarding matters.

There were effective systems that ensured the service was safe. Health and safety checks, together with effective checks of the environment were carried out by dedicated staff.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood their role and were confident when performing it through a continual training package. Staff at the service worked together with a range of healthcare professionals to achieve positive outcomes for people and followed professional advice to achieve this.

There were systems in place that ensured people who were deprived of their liberty were done so with the appropriate legal authority. We identified that the service needed to make improvements in how they applied the principles of the Mental Capacity Act 2005 and associated guidance. We have made a recommendation about this within the report.

The standard of decoration varied with some parts of the service showing signs of wear and tear. The registered manager told us they had a program of redecoration alongside works planned to improve the environment for people.

People's concerns and complaints were listened to and responded to. Accidents, incidents and complaints were reviewed to learn and improve the service.

People’s relatives commented positively about the registered manager and the quality of care their family member received. Quality monitoring systems included audits, observation of staff practice and regular checks of the environment to ensure people received good care.

Rating at last inspection: Good (Report published November 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Hendford Nursing Home provides accommodation for up to 34 older people who require nursing or personal care, and those living with the experience of dementia. At the time of our inspection, 24 people were living at the service. This was because the whole of the first floor was being refurbished and new admissions were being restricted until the completion of the work. A new extension had been completed at the time of our inspection and we saw that this provided a comfortable living space for people.

There was a registered manager in post at the time of our inspection. 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.

The provider had systems in place for the management of people’s medicines and staff had received training in the administration of medicines. However, in some cases, the amount of boxed medicines did not correspond with the medicines administration record (MAR) charts.

The risks to people’s safety were identified and managed appropriately and people were cared for safely.

There were regular health and safety audits which indicated that all areas of the home were checked for safety and any areas requiring maintenance were identified.

There were enough staff on duty to keep people safe and meet their needs in a timely manner, and the provider had contingency plans in place in the event of staff absence.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

People’s nutritional and healthcare needs had been assessed and were met.

People who used the service were cared for by staff who were suitably trained, supervised and appraised. The registered manager sought guidance and support from other healthcare professionals and attended workshops and conferences in order to cascade important information to staff, thus ensuring that the staff team were well informed and trained to deliver effective support to people.

The provider acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s capacity was assessed and they, or their representatives, had consented to their care and support. Processes were being followed to ensure people were deprived of their liberty lawfully.

Staff were caring, treated people with dignity and respect and took into account their human rights and diverse needs. People and relatives told us that people were safe and happy at the service.

Assessments were carried out before support began to ensure the service could provide appropriate care. Care plans were developed from the assessments and reviewed regularly. These were clear and comprehensive and written in a way to address each person’s individual needs, including what was important to them and how they wanted their care to be provided.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. Relatives were sent questionnaires to gain their feedback on the quality of the care provided.

A range of activities was provided which included regular outings. These were varied and took into account people’s likes and dislikes, their backgrounds and any particular interest they had.

People, relatives and professionals we spoke with thought the home was well-led. The staff told us they felt supported by the registered manager and there was a family atmosphere and a culture of openness and transparency within the service.

The provider had effective systems in place to monitor the quality of the service to ensure that areas for improvement were identified and addressed.

We made a recommendation in relation to the safe management of medicines.

It was not necessary on this occasion to speak with people who used the service. We spoke with the person in charge who showed us the changes that had been made to ensure they now met the regulation related to infection control.

Prior to the inspection we had received an action plan from the registered manager. This confirmed the steps that had been taken by the home to meet our compliance action.

We found improvements had been made to the service which ensured that people's risk of infection was minimised.

We found that people and relatives (where appropriate) were asked their consent before any care or treatment was offered. We found that the service had copies of forms on people's care plans that identified where they or their representatives had signed to provide their consent.

People and relatives we spoke with felt the staff were caring. One person told us 'They (staff) all work very hard' whilst a relative told us 'They (staff) are very kind.' We found that the care that was provided to people was in line with their individual needs.

Although the service was mostly clean and tidy there were areas around the home where there were concerns around infection controls. The service had monitoring systems that identified what areas had been cleaned however these had not been completed for at least three weeks.

We found that the design and layout of the premises was fit for purpose and met the needs of people who received care. For example each person's room was appropriate for their needs.

We found that the service had an effective complaints procedure. All of the people and relatives that we spoke with told us that they would speak to the manager if they had any concerns. They told us that the concerns were always addressed.

We spoke to three members of staff who were able to tell us about recent training they had undertaken.

We were unable to speak to most people who used the service as they had complex needs which meant they were unable to tell us their experiences. We spoke to one person, one health care professional and three relatives of people who lived at the service who all told us that they felt that people who used the service were well looked after and cared for by staff. We also carried out observations throughout our visit and saw that staff treated people kindly and with dignity.

We found that care plans were up to date and there were risk assessments for each person who used the service. We saw that assessments for people who were at risk of pressure sores.

We noted that people were being supported to eat in an appropriate manner and were being offered suitable eating aids where needed.

We looked at staff files and saw that there was information missing in relation to their previous employment and in one case there was information missing to confirm that the member of staff had a right to work in the United Kingdom.

The manager showed us a copy of the staff training matrix which identified that not all of the staff had received up to date mandatory training.