Close House Nursing and Residential Care Home

We found the following examples of good practice.

• Measures were in place to support visitors to safely access the service and prevent them from spreading infection during their visits. Alternative arrangements were in place to support people to maintain contact with their loved ones when face to face visits were not possible.

• Staff and people were supported to maintain social distancing. Furniture had been moved to support people to be able to stay two meters apart where possible.

• People’s wellbeing was at the forefront of the care they received. Staff told us they explained and reassured people about the changes to care that had taken place during the pandemic. This included supporting people to understand staff wearing facemasks.

• Staff had received training in the appropriate use of PPE and were able to correctly explain how they put in on and took it off.

• Quality assurance audits were completed to ensure safe infection control practices were being followed and to identify any improvements. Staff told us they were supported to raise any concerns or anxieties and had access to a helpline for additional support.

Further information is in the detailed findings below.

Close House is a residential care home providing accommodation and personal care to 22 older people, some of whom have nursing needs.

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

People felt safe living at Close House with support from very caring staff, who knew them well. People’s privacy and dignity were protected, and staff were respectful.

People’s care needs were assessed. Any risks to their health, safety and well-being were identified and reduced. Medicines were managed well. People’s current needs were met, and the records reflected this. Any accidents or incidents were investigated and reported as required.

Staffing levels were very good. Staff were well supported to provide high quality, person-centred care to people. Staff recruitment remained safe and staff training was up to date. Competency checks were carried out to ensure staff remained suitable for their role.

Activities were arranged, and people were supported to pursue their own interests and hobbies.

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.

Independence was encouraged by staff, and people were involved making decisions about their care. We have made a recommendation about the provider’s process of obtaining proper legal consent, and the associated documentation.

The management team achieved high standards through continuous improvements to the service. The quality and safety of the service was monitored through regular checks and audits.

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

After the previous inspection, the provider sent us an action plan to show how they would rectify our concerns.

We returned to complete a full comprehensive inspection. We found the provider was now meeting the regulations.

Medicines were managed safely overall with people receiving their prescribed medicines on time.

Close House Nursing and Residential Care Home is situated on the outskirts of Hexham in a rural setting with extensive views across open countryside. It provides residential and nursing care for up to 22 people, some of whom are living with dementia. At the time of our inspection there were 20 people living at the service with empty rooms expected to be filled in the near future.

The service had 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. The registered manager was also the registered provider which he shared with his wife. He had taken over the family business from his mother who had originally set the business up and which we were told had been the first care home to open in Northumberland.

People we spoke with told us they felt safe living at the home. Family members also confirmed that they felt their relative was safe. Staff we spoke with had a good understanding of safeguarding procedures. They also knew how to report any concerns they had. The provider had a system in place to log and investigate safeguarding concerns.

Checks on the safety of the home were undertaken to ensure that fire equipment and other safety issues were monitored. People had personal emergency evacuation plans to allow staff to support them appropriately in the event of a fire. Risks regarding people’s care needs were also assessed and reviewed. Accidents were recorded and monitored by the provider to ensure that no trends were forming.

The provider had a system to review people’s needs and this information was used to determine appropriate staffing levels. Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people at the home.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the registered persons were complying with their legal requirements. Two people were subject to a DoLS authorisation.

We found that people’s health care needs were assessed. People and/or their representatives were consulted about their care and support. Records confirmed people's preferences. Care and support was planned and provided in accordance with their needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists, opticians and other health professionals. Visiting health professionals told us staff were proactive in supporting people’s health needs.

People told us they liked the food made available to them and were given opportunities to choose a variety of meals. Anyone who required special diets were supported by staff and referred to the speech and language team as necessary.

Since the last inspection, the provider retained good systems for supporting staff to remain skilled and supported in their work which meant they were able to appropriately meet the needs of the people they cared for.

People and their family members told us they were well cared for and were treated with dignity and respect. We saw positive interactions between people and the staff who cared for them.

There was a range of activities which people could be part of if they so wished. Some people preferred to remain quiet in the comfort of their own room and this was respected as their choice. Staff ate meals with people who lived at the home in order to maintain a homely and socially inclusive feel.

A complaints process was in place and information about raising concerns was displayed around the home. The registered manager told us there had been no formal complaints but demonstrated how these would have been thoroughly dealt with and addressed. We confirmed by looking through records that this was the case.

The registered manager undertook regular checks on people’s care and the environment of the home. Staff felt management were approachable and supportive. There were regular meetings with staff and interactions with people and their relatives, to allow them to comment on the running of the home. Records were up to date and stored mostly electronically on the providers IT system.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and we found that people looked clean and well cared for.

We found that safeguarding arrangements were in place at the service and staff we spoke with had a working knowledge of these matters.

We found that there were infection control systems in place and these were adhered to.

There were enough qualified, skilled and experienced staff to meet people's needs.

Care records contained accurate and appropriate information and could be accessed in a timely manner.