Archived: Rushey Mead Manor Care and Nursing Home

Rushey Mead Manor Care and Nursing Home provides nursing and personal care to up to 50 older people, some of whom are living with dementia and/or physical disabilities. The home is multicultural and Asian languages are spoken there as well as English.

At the time of our inspection there were 36 people using the service.

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

Although people and relatives were satisfied with the care and nursing provided, and the home had improved since our last inspection, further improvements were needed to ensure people received a good service in all areas.

There was a continued lack of oversight and governance systems to monitor the home. The providers had a new quality assurance system in place, but this was not yet fully implemented. Improvements were needed to record keeping across the home to ensure it was well-organised and comprehensive.

People felt safe at the home and staff knew how to protect them from harm. However, risk assessments were not always fit for purpose. Staff were knowledgeable about people’s care needs, but personalised care plans were not always in place as required.

The premises were being updated and improved to ensure they were suitable for people, but further work was needed to bring the environment up to an acceptable standard.

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; however, the policies and systems in the service needed reviewing to ensure they supported this practice.

The area manager and acting manager said they would address all the outstanding issues and implement a programme of improvement involving people, relatives, and staff.

The home was well-staffed, and the staff employed were suitable for their roles and had appropriate training. The staff were caring and had a good understanding of people’s cultural needs and preferences and how to meet these.

Menus were well-planned with English and Indian dishes and the meals served met people’s cultural and other dietary requirements. The home’s activities organiser provided individual and group activities for people which they enjoyed.

The home had an open and friendly culture and people and relatives said the managers and staff were approachable and helpful.

Rating at last inspection

The last rating for this service was requires improvement (report published 21 June 2018). 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. However, further improvements were needed for the home to obtain a rating of Good.

Why we inspected

This was a planned inspection based on the previous rating.

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

Rushey Mead Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Rushey Mead Manor provides nursing and residential care for up to 50 older people, some of whom are living with dementia and/or physical disabilities. The home caters for people from a range of cultural backgrounds. It was purpose built with accommodation on three floors and a passenger lift for access. The service has lounges, a dining room, and gardens. When we inspected there were 43 people living at the home.

The home had a registered manager. This 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. At the time of our inspection the registered manager was not at the home.

Improvements were needed to the way medicines were managed. Care plans and risk assessments were not always fit for person and people were not always receiving personalised care in line with their preferences and requirements. The oversight, monitoring, and day to day running of the home had been ineffective and failed to identify shortfall in the service provided.

People told us they felt safe living at the home and said they had confidence in the staff. They said the home had a happy and friendly atmosphere and the staff were caring and treated them with compassion and kindness. Staff encouraged people to make choices about their daily lives and communicated with them, where possible, in their preferred language. People said they could get up and go to bed when they wanted and follow their own routines.

The management team were in the process of updating and improving the home’s staff training programme. People told us the staff were well-trained and gave us examples of staff supporting them in a skilled and effective way. Staff helped to ensure people’s medical needs were met and accompanied them to appointments were necessary.

People said they were satisfied with the food served. Improvements were being made to the menu to help ensure the full range of people’s dietary needs was met on a daily basis. The premises were in need of redecoration and improvement to make them more suitable for people’s needs.

Staff understood the importance of people consenting to their care and support. Relatives said they could visit when they wanted and were made welcome by staff.

The home had an activities programme and we saw some group activities taking place. These included an indoor ball game, colouring pictures, and singing religious songs. Activities staff were being re-trained to help ensure they had the skills and knowledge they needed to provide suitable and accessible activities to everybody who wanted them.

People and relatives said they would speak to staff if they had any concerns about people’s care. The home’s complaints procedure, which was displayed in the reception area, was being improved and updated to make it more user-friendly and readable.

At the time of our inspection visit the home was undergoing a period of rapid change. A new management team was in place. They acknowledged the home needed to improve and had begun to make positive changes to the way it was run. People, relatives and staff were involved in making decisions about the home and the management team were approachable and easy to contact.

Rushey Mead Manor provides nursing and residential care for up to 50 older people, some of whom are living with dementia and/or physical disabilities. The home caters for people from a range of cultural backgrounds. It was purpose built with accommodation on two floors and a passenger lift for access. The service has lounges, a dining room, and gardens. When we inspected there were 45 people living at the home.

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. At the time of our inspection the service did not have a registered manager, however the manager had submitted an application to register with CQC and this was being processed.

People and relatives told us the culture at the service was open and friendly. There was sense of community spirit and we saw that people, relatives and staff got on well with each other. People told us they were happy at the service and there was lots of laughter and positive comments when we discussed the service with them.

People told us the manager and staff were friendly and approachable. They said the manager often sat with them, shared sweets, and asked how they were and what they thought of the service. They said that if they had any concerns they would tell the manager or a staff member and they felt they would be listened to and action taken in response.

During our inspection visit we observed that staff kept people safe. We saw them assisting people to move about the service safely, have meals and drinks, and take their medicines on time. All the staff knew how to protect people from harm and who to go to if they had concerns about any person’s well-being.

People told us there were enough staff on duty to keep them safe and meet their needs. During our inspection staff were always available to assist people. Both nursing and care staff were employed at the service. Staff also worked closely with local healthcare professionals to ensure people’s needs were met.

The staff were well-trained and had the knowledge and skills they needed to work at the service. For example, they had recently attended a course in dementia care to help them work effectively with people diagnosed with this condition. Staff told us the manager was supportive, had an ‘open door’ policy, and they could approach her at any time for advice.

People told us they liked the food provided. The kitchen staff prepared a wide range of cuisine to ensure people’s dietary needs were met. They catered for Asian vegetarian, halal and non-halal, English, diabetic, and soft diets. We saw there were jugs of fresh water in all communal areas to encourage people to drink fluids to protect themselves from dehydration.

We observed many caring interactions between staff and the people they supported, and people and relatives said the staff were caring and kind. Relatives told us they were always made welcome when they visited the service.

People using the service spoke a range of languages including Gujarati, Hindi, English, Punjabi and Urdu. All staff spoke English and most spoke some Asian languages. During our inspection visit we observed staff talking with and reading to people in their first languages.

People told us the staff provided them with personalised care. Staff were familiar with the information in people’s care plans. They knew people well and this helped to ensure they provided them with responsive care and support. Care plans were regularly reviewed to take into account people’s changing needs.

The service had an activity co-ordinator and we observed an organised activity taking place in the afternoon when a group of people listened to Hindu music and then staff read to them from a Hindu religious booklet. We could see that people had enjoyed this activity and taken an active part in it. Other faiths were also catered for at the service and a range of religious festivals celebrated.

The premises were undergoing refurbishment when we inspected. However the provider had not identified that some areas were in need of immediate attention and more thorough cleaning.

We reviewed the care records of five people and found them to be comprehensive and up to date. The staff ensured they completely understood the needs of people. The provider had taken steps to ensure all staff understood the requirement to ensure appropriate action took place in order to make judgements in the best interest of any person who lacked the capacity to make their own decisions regarding their care.

The physical environment has been significantly improved and as a result is safer for people and staff. This programme of improvement is planned to continue in order to ensure all area's within the location are both safe and welcoming spaces for those using the service and the staff who care for them.

We still have concerns that the number of nurses employed is not sufficient to meet the needs of people, the majority of who require complex nursing support. On duty nurses spend a disproportionate majority of their time administering medication. This limits their delivery of appropriate nursing support, the supervision of non nursing staff and the expected reviews and maintenance of care plans.

During our visit we expanded the scope as a result of earlier assurances by the provider not being fulfilled. We found the environment to be potentially hazardous and the expected standards of maintenance and repair had not been carried out. We also discovered the security and safety of people using the service, staff and others could not be guaranteed. The rear entrance to the location was not effectively secured and as a result any unauthorised person would be able to gain easy access to the home and its immediate surrounds.

We also found care plans did not include the choices and wishes of people using the service. In some care plans we could find no evidence of people using the service being involved.

The staff on duty during our visit were busy and some appeared overwhelmed during key periods such as meal times. We spoke to some staff and they told us that they thought the home needed more staff for each shift because more people with nursing needs now lived at the home.

The interim manager had raised concerns with the provider. This manager but had not felt sufficiently well supported in their role and so had decided to resign from the post and not take on the role permanently.