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Inspection carried out on 5 February 2019

During a routine inspection

About the service: The service is a nursing home that provides care and accommodation for up to 28 people. At the time of the inspection the home was fully occupied.

People’s experience of using this service: Improvements in medicine management had occurred since the last inspection.

The service was exceptionally well-led and people benefitted from the management team and staff promoting excellence at the service. Research was implemented to develop the standards of care provided for people. The service was a key participant in projects to promote and support people's independence. Staff wellbeing was promoted so they remained healthy and were able to support people living at the service. The management style was exceedingly open, friendly and inclusive. A very positive approach was taken by the management team and staff to make sure people received a person-centred service and developed positive relationships. People and their relatives told us they were very happy with the service they received.

Staff were caring, kind and compassionate and with respected people’s privacy and dignity. People decided who they wanted to deliver their care and the rotas reflected people’s expressed wishes. There was a person-centred culture and staff were highly motivated. Relatives told us the management team and staff provided excellent caring responses to their loved ones and to themselves.

People were protected from the risk of harm and abuse. There were safeguarding procedures to guide staff in the action to take should they suspect abuse has occurred. Risk assessments were in place to identify hazards and plan ways to reduce risk to people’s health and wellbeing. Staff were recruited safely and there were sufficient staff to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received training, supervision and support. This enabled them to feel confident and skilled when meeting people’s needs.

Staff supported people to meet their health and nutritional needs. People who came in from hospital or home to receive rehabilitation were supported and encouraged to develop and increase their independence. This enabled some people to go back to their own home. Staff worked with health care professionals to make this happen.

People were part of their community and accessed local social activities.

Rating at last inspection: The service was rated good overall at the last inspection. The last report was published on 30 July 2016.

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

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule and will return within a year from the publication date of this report or sooner if we receive information of concern.

Inspection carried out on 20 June 2016

During a routine inspection

This inspection took place on 20 and 23 June 2016 and was unannounced.

Fulford Nursing Home provides nursing and personal care for up to 28 older people. It is an independent, family-owned business. The home has accommodation on three floors and a communal dining room, living room and conservatory sitting room on the ground floor. All floors can be accessed by a lift. The accommodation includes a small number of double rooms. The home also has an outside courtyard garden and seating area which people using the service and visitors can utilise. At the time of our inspection there were 24 residents using the service. As well as people living at the home on a permanent basis, the home takes referrals from the local NHS Rapid Assessment and Treatment Service, for people who required a short stay, with a focus on rehabilitation before moving back to their own home.

The service is required to have a registered manager, and at the time of our inspection there was 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 found that people’s needs were assessed and risk assessments were in place to prevent avoidable harm. The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. There were sufficient numbers of suitable staff to keep people safe and meet their needs.

There were policies and procedures in place to ensure people received their medication, but these were not always consistently followed. For example, the date of opening was not always recorded on some medications which had a limited shelf life once opened, and the stock count of some medication was inaccurate. We have made a recommendation about this in our report.

Staff completed a range of training to help them carry out their roles effectively and the majority of staff were up to date with their training. Some staff that were overdue their medication refresher training were booked to complete this training the month after our inspection, so systems were in place to ensure everyone had the necessary up to date knowledge and skills they required.

The registered provider sought consent to provide care in line with legislation and guidance. Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the principles of the MCA.

People were supported to maintain good health and access healthcare services. We saw evidence in care files of contact with healthcare services, such as GPs, the community mental health team, podiatrists, the tissue viability nurse and the community dentist.

There was generally positive feedback about the quality and variety of food available, and people told us they got sufficient to eat and drink. Care plans contained information about people’s nutritional needs and preferences, and the cook we spoke with was knowledgeable about people’s dietary needs. Food and fluid monitoring charts, for people identified as being at high nutritional risk, contained insufficient information to effectively monitor people’s food and fluid intake. We have made a recommendation about this in our report.

Most people told us that the staff who supported them were kind and caring. We saw that interactions between staff and people using the service were positive, respectful and friendly and staff were knowledgeable about people’s needs and preferences.

The registered provider compl

Inspection carried out on 24 July 2014

During an inspection to make sure that the improvements required had been made

Our inspector visited the service to check on the progress the provider had made in relation to regulation 12: infection control. The visit enabled the inspector to answer the question 'Is the service safe' with regard to infection control?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the manager and staff supporting people and from looking at records.

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

Is the service safe?

We found that the service had improved greatly with regard to compliance with the regulation on infection control. New equipment and infection control items, such as disposable hoist slings, disposable mop heads, commodes, bed mattresses etc. had been purchased.

Cleaning schedules had been produced in greater detail and records of all the cleaning that had been completed had also been maintained more thoroughly and accurately.

Equipment (lifting hoists, suction machine) and peoples' personal mobility items (wheelchairs, walking frames) had all been cleaned and included on the cleaning schedule.

New working regimes had been established and implemented and staff practices had improved greatly with regard to ensuring people that used the service were safe when it came to reducing the risks of harm from infection.

Inspection carried out on 6 May 2014

During a routine inspection

We carried out this inspection to answer our five questions; 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, speaking with people who used the service, speaking with visitors, speaking with the staff who supported them and from looking at records.

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

Is the service safe?

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes. People told us that they were consulted about their care.

The home had basic systems in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints, concerns and whistleblowing. These systems may benefit from review as they can help to reduce the risks to people and help the service to continually improve.

Records were in place detailing how people should be cared for. Records were stored securely so that the information remained confidential and accessible only to those who needed them.

We found that people were not prevented from the risk of infection because appropriate guidance had not been followed and there were inefficient systems in place to reduce the risk and spread of infection.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. This meant that staff were able to deliver care in a way that supported people. Some of the systems to gain feedback from people may benefit from review.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded and care and support was being provided in accordance with people's wishes.

Is the service responsive?

We saw that the home had responded to suggestions made within questionnaires and people were confident that the home would respond to any concerns if they were unhappy.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff confirmed that the management were supportive. Meetings were held so that people could air their views.

Inspection carried out on 4 September 2013

During a routine inspection

People's needs were assessed and their rights were respected by staff. We saw that people made their own decisions or were supported by staff to do so. People�s diversity, values and human rights were respected

We saw that people had individualised care records and risk assessments in place which helped staff to understand and meet people's needs. Everyone we spoke with told us they were happy with the care and support they received. One person we spoke with said �The care is good I get the help I need.� A relative said �I look at the care plans with the nurse.�

People�s nutritional needs were assessed and monitored. The food served looked appetising. People had a choice of meals and could have wherever they wanted, even if this was not on the menu. One person we spoke with said �The food is okay. They know what I like and don�t like.� A relative said �There is a choice of food every mealtime. X is putting weight on and enjoys the meals.�

Equipment was provided which helped the staff to meet people�s needs. This was regularly maintained to protect the health and safety of all parties.

A complaints policy and procedure were in place. People we spoke with said they felt able to make a complaint. However, everyone we spoke with said they had not needed to do so. A relative said �I have never had occasion to complain. If I did it would be taken on board. They have all said right from the start if you are not happy with anything just come and tell us.�

Inspection carried out on 13 November 2012

During a routine inspection

People's needs were assessed and their rights were respected by the staff. A relative said �I did come and look round. I did not think there was any need as I had heard such good things. It was the place for my XX.� People made decisions for themselves or with help from staff about how they wanted to spend their time. A person said �The staff know what I need a hand with. The staff knock on the door before coming into my bedroom.� We saw that staff treated people with dignity and respect.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. We saw staff helped people to maintain their independence. A person said �The staff do what I want them to do. The staff are professional.� A relative said �The care is good I cannot fault it.�

There were policies and procedures in place to help to protect people from abuse. Any issues raised were referred to the local authorities safeguarding of vulnerable adults team. This helped to protect people. A person we spoke with said �I feel safe here.�

People we spoke with could not tell us about how staff were recruited. However, people said: �The staff are all nice.� And �The staff are very professional.� We saw that thorough recruitment processes were in place.

People's views were being sought about the quality of the service provided. We saw that the management team acted upon any issues to make sure that people remained happy with the service they received.