Innisfree Residential Home

Innisfree Residential Home is a residential care home providing personal care to up to 28 people. At the time of our inspection there were 26 people using the service.

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

The provider had made improvements across the service and previous breaches in regulations had been met. Governance systems had been reviewed so shortfalls were identified and actions taken to continually develop the service.

Staffing had improved to ensure people received support from a consistent team who knew them well. People were supported by staff who were kind, caring and respected their choices. The home was clean, tidy and well maintained.

Care plans reflected people’s preferences for care and support. Assessments and associated protocols made sure risks were managed whilst promoting people’s independence. Medicines were managed safely. The provider was continuing to develop the activities provided to offer a wider variety of options.

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.

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 (17 April 2020) where five breaches of regulation were identified. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Clear procedures were in place for staff and visitors on entry to the service to minimise the risks of COVID-19 transmission. This included taking people’s temperatures, completing a declaration form and wearing appropriate personal protective equipment (PPE).

A visiting policy outlined current systems, this was updated regularly. Information was displayed for visitors to explain the procedures in place. The service ensured visitors took a lateral flow test and confirmed the results before allowing visitors to enter the service. A specific area for visitors had been set up which supported social distancing and had ventilation.

There were plentiful supplies of (PPE). Staff had been trained on hand hygiene, infection prevention control and donning and doffing. This is the putting on and taking off of PPE. Posters gave visual guidance. Staff knew when different levels of PPE were required.

Regular COVID-19 testing was carried out for people and staff in line with government guidance. Where people lacked capacity to make specific decisions, appropriate assessments had been conducted.

Staff socially distanced from their colleagues and supported people where possible to maintain social distance. Staff breaks and meals were taken individually and away from people.

Activities had continued. People had been supported to maintain relationships through window visits, video and telephone calls.

The provider had considered how to admit people safely to the service. Rooms were available with a separate entrance to the home to enable the required isolation period to be completed.

The provider had specific risk assessments and policies in place in relation to COVID-19. A contingency plan detailed how the service would respond to an outbreak. Staff were knowledgeable about the different procedures in place.

Further information is in the detailed findings below.

People's experience of using this service: People and relatives told us that staff were caring and kind.

The provider and senior staff had completed audits on the home to support quality checks. However, these checks had not identified and prevented shortfalls in the quality of service provision.

The provider had failed to notify the commission of statutorily notifiable events.

There were not enough staff to meet peoples' needs; this had affected the quality of service provision. Staff training was provided and included some training specific to people's needs. Staff recruitment procedures were followed appropriately. Staff had received supervision but not as often as required.

Care plans were not consistently person centred and there was a lack of detailed guidance within peoples' risk assessments for staff to follow.

Medicines were stored safely. Improvements were required in relation to medicine administration and documentation. People had not always attended their medical appointments. Health outcomes and requirements from appointments were not recorded in a structured way.

The service did not provide people with regular access to the local community and activities were lacking for people that did not partake in group activities.

People were not supported to have maximum choice and control of their lives. People’s mental capacity and best interests had not been considered and documented in line with the Mental capacity Act.

People were supported for by a staff team who were kind and caring. Staff had good relationships with people.

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 8 March 2017).

Why we inspected: This inspection was scheduled based on the previous rating.

Enforcement: We have identified five breaches in relation to person centred care, governance, risk assessments and medicine management, staffing, and mental capacity and consent at this inspection. Please see the action we have told the provider to take at the end of this report.

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

Innisfree Residential Home is registered to provide accommodation and personal care for up to a maximum of 28 people. The service specialises in the care of older people living with dementia. There were 23 people using the service at the time of the inspection.

Innisfree Residential Home has a registered manager. 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 ran the service with passion and commitment, in close partnership with the registered provider. There were many examples of how their understanding of the needs of people living with dementia had improved those individual’s lives. People lived in a homely, friendly and caring environment, which had adaptations which helped maintain their independence. The quality of the service was closely monitored, with the registered manager fully informed of how staff provided people’s care and support.

People benefitted from a staff team which were well trained. However, they were not adequately trained in the complications of one health care condition, which had the potential to put people at risk. The registered manager arranged the training immediately.

Staff felt supported in their work and said they could take any question or concern to the registered manager. The service was actively recruiting new staff. People had no concerns around staffing numbers. Staff felt they could meet the needs of people using the service in a timely manner and we found people’s needs were being met.

Staff had a good understanding of how to protect people from abuse and protect their legal rights. People received their medicines as prescribed.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service had sought appropriate advice and was meeting people's legal rights in relation to MCA and DoLS.

People received a balanced, nutritious diet and commented about the food positively. People said they had a choice of meals and there was food and drinks available at all times. Staff ensured people who were on specialist diets had their needs met. Where they had concerns about people’s dietary intake they took action and involved health professionals.

The service worked in partnership with health care professionals to meet people’s health care needs. Health care professionals said they were contacted appropriately.

People’s views were sought through day to day conversation with staff and observation, resident meetings, care plan reviews and a yearly survey of opinion. Where a need for improvement was identified an action plan was produced, with timescales for the improvement.

People had a wide variety of activities available to them. These included entertainment, outings, arts and crafts, helping with domestic and gardening chores and quizzes and puzzles. Staff had developed good relationships with people. The layout of the home offered different options for people, such as a cosy sitting room or the conservatory for arts and crafts. There were examples of how staff knowledge and empathy had enriched and improved people’s lives, such as removing well established fears and providing support following bereavement.

The registered manager’s commitment to the care of people living with dementia had extended to family and the local community. This had included training opportunities for people’s family members in how dementia affected their loves ones. Also, helping to improve facilities and services within the community for people living with dementia.

People’s needs were assessed in detail. Their care was planned in detail, with their involvement. Care plans and records were easily accessible and used by care workers toward providing person centred care of a high standard.

Complaints were investigated in detail and people fully informed of the findings. There had been only one complaint in 2016.

The provider was meeting their regulatory responsibilities, for example, by keeping the CQC updated so that the service can be monitored.

Our inspection of 8 July 2014 found that not all aspects of the service were safe.

Staffing levels were not always sufficient to ensure that people were cared for safely. There were times during the day when some people's individual needs meant staff would not be available to assist any other people in the home. The provider wrote to us on 1 September 2014 and told us how they would achieve compliance with the regulation.

During this inspection, we found that improvements had been made. The provider had ensured that there were sufficient staff to keep people safe and meet their health and welfare needs.

Is the service well led?

Our inspection of 8 July 2014 found that not all aspects of the service were well led.

Staffing levels had not been assessed to meet people's needs and there was no evidence that staff levels in the home had been calculated to reflect people's assessed needs. The provider wrote to us on 1 September 2014 and told us how they would achieve compliance with the regulation.

During this inspection, we found that improvements had been made. The provider had undertaken a dependency assessment to help ensure the home had sufficient staff on duty to meet people's needs. The provider had ensured staff feedback had been obtained to help ensure staffing levels were appropriate.

People who lived at Innisfree Residential Care Home spoke highly of the staff employed at the home. They told us they felt they were treated with dignity and respect by the staff at the home and felt safe within their environment.

Where people had identified risks, for example with mobility or skin damage, an assessment had been completed and a plan to guide staff on how to support the person safely was in place. These assessments were reviewed regularly which ensured the information in them was current.

Staffing levels were not always sufficient to ensure that people were cared for safely. There was no evidence that staff levels in the home had been calculated to reflect people's assessed needs. There were times during the day when some people's individual needs meant staff would not be available to assist any other people in the home.

Is the service effective?

People and their relatives told us they were involved in care planning and decisions about their daily living. This was reflected in people's care records. We saw the home had a system to review people's care needs on a monthly basis to ensure changes in people's needs were identified.

We received positive comments about the staff employed at the home and the level of care that people received. One person told us, 'They (the staff) look after me here, they are great.' Another person when asked about the care and staff said, 'They are brilliant, I can't speak highly enough.' One person's relative told us, 'I'm happy with the care they provide, the staff seem good here.'

Staff said that information was shared about people to ensure any changes in a person's care needs were highlighted. This was demonstrated through handover documentation and daily recordings.

Is the service caring?

People gave positive feedback about the staff at the home and the level of care they received.

We saw that people received the support they needed and people told us their needs were met by staff.

Is the service responsive?

We saw that the service involved other healthcare professionals as required. The home was involved in a project named the Residential Home Support Team project. The aim of the project was to avoid or reduce unnecessary and unwanted emergency admissions to hospital. This meant that people who lived in the home had regular access to medical support.

Is the service well led?

One aspect of the service was not well led as staffing levels had not been assessed to meet people's needs and action had not been taken to rectify shortfalls.

There was not a dependency assessment of people's needs that ensured sufficient staff were on duty to meet people's needs.

We saw that there were systems in place to monitor the quality and safety of the service provided. This included resident and relative meetings to gather the views of the people who lived at the home and their relatives.

Accidents and incidents that occurred in the home were recorded and reviewed by the registered manager to establish any trends and take necessary action.

We spoke to a number of staff who told us "The staff are very aware of resident's safety" "The training is very good here" "If I had a concern it would be dealt with effectively" "I have no concerns" "That could be my Mum sat there, that's how we look after people here" "Last week a number of us went on an all day first aid course and it was really good" "The manager is wonderful" "The managers door is always open" "The food selection is really good and they can always have what they want"

We spoke to a visiting community nurse who told us "The team are supportive and absolutely fabulous" "Really good communication" "No concerns" "If they have any problems they let us know" and "We come twice a week on Tuesdays and Fridays"

We observed people being treated with respect and dignity. Individual preferences were recorded and acted upon. People living in the home appeared happy and relaxed. We observed numerous one to one conversations between staff and residents with staff clearly attentive and actively listening to people.

Staff were respectful towards people using the service. People indicated they felt comfortable and at ease in their conversations with staff. People spoke positively about the service saying they were treated with respect and were happy to live at Innisfree. One person said "They treat you nicely here. They don't make you feel embarrassed."

We saw that staff had developed good relationships with people and were knowledgeable about their individual care needs. Peoples' care files showed that care and support was planned and provided to help ensure people's safety and welfare.

People told us they had good relationships with the staff and said they "felt safe". All the people said they were happy in the home but due to their care needs several struggled to explain what action they would take if they became unhappy.

People told us that staff treated them as individuals and could make changes to their daily routines. One person said 'I know what I like and don't like and can make changes.'

We went around parts of the home and looked at various records that showed how staff were able to meet peoples' needs.

People told us that they felt involved in the decision making in the home and we saw that people participated in regular group meetings.