Nelson House

Nelson House is a residential care home registered to provide accommodation and personal care. Support is provided to older people and people living with mental health difficulties. At the time of inspection there were 17 people living at the home.

Nelson House accommodates up to 21 people in one adapted building. There are usually two care staff on day shifts including a senior carer as well as the registered manager and a cook. Nights are covered by two staff, with management on call if required.

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

There were no individual COVID-19 risk assessments for people living at the home or staff, and infection prevention and control policies (IPC) had not been followed. There were no appropriate areas to remove personal protective equipment (PPE). The provider had not completed environmental audits to check that environmental risks were assessed and mitigated. Audits for cleaning were not completed at the home. No cleaning spot checks, or audits were completed to verify that cleaning tasks were completed.

There is no evidence of formal supervisions taking place, and the provider was not following their own policies to ensure that supervision was timely and relevant for staff. There was a lack of oversight of staff recruitment procedures to ensure appropriate pre employment checks were completed and recorded in staff files. One staff member had a European passport copy and ID on file.

Systems were not in place to ensure staff reviewed care plans on a regular basis in accordance with the providers policies.

The provider was not following their own policies to monitor and record accidents and incidents.

There was inconsistent monitoring of people’s views of the service. The last residents meeting was held in August 2021.

Medicines audits were not occurring.

The training matrix identified that staff had no refresher training in end of life care or diabetes.

People, relatives and staff knew who the registered manager and provider were, and felt able to approach them regarding concerns. People told us they felt safe and staff knew how to recognise and report safeguarding concerns.

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

Rating at last inspection

The last rating for this service was good (published 22 May 2018).

Why we inspected

We received concerns in relation to Infection Prevention and Control measures. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

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 will take further action if needed.

We have identified breaches in relation to regulation 12, safe care and treatment in relation to concerns around infection control and regulation 17, governance in relation to poor performance management, at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. 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 keep in contact with their family members through physical visits, garden or driveway visits and regular phone calls.

The provider had made adaptations to the home to create a visiting ‘Pod', with glass screen, voice intercom and separate access, which minimised the risk of the spread of infection. A bedroom had also been re-purposed to provide a dedicated ‘donning and doffing’ station for staff to ensure social distancing could be achieved.

Staff supported people to access healthcare appointments and arrangements were in place when people need to attend hospital and return to the home safely.

The registered manager and staff had worked closely with public health and infection control professionals to effectively manage an outbreak in January 2022.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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The inspection visit took place on 12 and 13 April 2018 and was unannounced. The inspection took place in response to some concerns raised with us around people’s safety and that people were not receiving appropriate support to keep them safe. During the inspection we found no evidence that people were not being adequately cared for.

There was a registered manager in post and they were present during the 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.

People continued to receive care that made them feel safe and they received medicine as required. Staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to/follow.

People continued to receive effective support from staff with a sufficient level of skills and knowledge to meet their specific 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 support this practice. People were assisted to access appropriate healthcare support and received an adequate diet.

The care people received was provided with compassion and dignity. People were supported to express their views and be involved as much as possible in making decisions about their support needs. Staff supported people to have choices and independence, wherever possible. People’s diverse needs were recognised and staff enabled people to access activities should they so wish.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised and care plans contained information about the person, their needs, choices and cultural needs. Care staff knew people’s needs and respected them. People were able to speak openly with staff and tell them if they were unhappy or wanted to make a complaint.

The service continued to be well-led, including making detailed checks and monitoring of the quality of the service. People and staff were positive about the leadership skills of the registered manager. Arrangements were in place to obtain views on the service from people, staff and their relatives.

We found that people were involved in making decisions about their care treatment and support. We saw that people were supported in their chosen lifestyles and the choices they made.

We saw that people's care records contained detailed information about their needs and that they had access to a range of health and social care professionals to support them. Care and treatment was planned in a way to ensure each person's personal safety and wellbeing.

People using the service did not indicate that they had any concerns about their wellbeing or safety and were able to tell us what action they would take if they had any concerns.

Regular checks were in place to ensure the premises were secure, safe and adequately maintained.

Although some statutory training had been undertaken, the provider was not able to demonstrate that all staff had access to appropriate training or that they were supervised regularly to monitor their progress and performance. This meant that staff were not supported in their responsibilities to deliver care and treatment to an appropriate standard.

We saw people who use the service are supported to make choices about the care and support that they receive. Relatives are involved in this where people are not able to express their desires. This ensures people's needs as well as choices are considered and planned.

People had care plans in place which reflected both their care and their specific health needs. Plans detailed risks to people, and how these are met. For example we saw people who had specific health needs such as fragile skin and risk of weight loss had the support they needed to keep healthy.

We found that staff had training so that they could give people their medications safely.

There is enough skilled staff to look after people's needs. We saw people did not have to wait for care or support.

Systems are in place to monitor the quality of service provided, and people who live there are involved in this process.