Consort House Nursing Home

Consort House Nursing Home is a nursing and residential care home. It is registered to provide accommodation and personal care and accommodation for up to 58 older people. The service supports people with nursing needs, physical disabilities, mental health and/ or dementia. At the time of the inspection there were 47 people living at the service.

The service is on three floors, with access to upper floors via a shaft lift. All bedrooms have en-suite facilities. There is an outside garden area.

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

People lived in a service which had a strong, visible person-centred culture. People were at the heart of the service. Staff were motivated to deliver high quality care by the providers embedded values of: “compassion, care, competence, communication, courage, and commitment”. People told us staff were very kind and caring, and they were treated with dignity and respect.

People told us they felt safe living at the service. Overall, people and relatives told us there were enough staff to meet their needs, however others, including staff felt there needed to be more. The registered manager and provider had taken pro-active action to improve staffing numbers, and retention but stressed this was an ongoing area that required improvement.

We therefore recommend, as part of the providers overall governance framework, they listen to people and staffs continued feedback about staffing levels and act as required.

People told us they felt staff had the skills and experience to meet their individual needs and staff were complimentary of the training and support they received.

Assessments of people's needs were comprehensive, expected outcomes were identified and care and support, was regularly reviewed. The service worked with agencies to ensure people’s care and support needs were met and co-ordinated.

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.

People who had risks associated with their care, had these managed consistently and safely. People lived in a service which was clean and free from odour, and the environment was assessed for risks. The design and decoration of the service took account of dementia best practice, and people’s bedrooms were personalised.

People were highly complimentary of the food, and people’s nutritional likes, and dislikes were known and catered for. People were encouraged and empowered to keep active and socially stimulated.

People and relatives felt confident to complain, and to speak with the registered manager at any time. There was an open culture where by all safety concerns which were raised were valued and used as learning and improvement.

People had care plans in place regarding their health and social care. Care plans were individualised, so staff knew how people wanted and wished their care and support to be delivered. People’s medicines were managed safely, and they received them as prescribed. People were supported with dignity and compassion at the end of their life.

People and staff told us the service was well managed. Staff were proud and motivated to work for the organisation. There was constructive engagement with staff, and people who used the service to ensure a safe and quality service.

The registered manager and staff engaged positively with stakeholders to help build seamless experiences for people. External professionals and stakeholders were positive about the management and leadership of the service, and of their proactive engagement.

Since our last inspection, a new governance framework had been created to help effectively identify where improvements were required.

The registered manager and provider were highly passionate about continuous development and admitted when things went wrong, which demonstrated the requirements of the Duty of Candour (DoC), to be open, honest and transparent.

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 18 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good.

At this inspection we found the service overall remained Good but improvements were required in well-led.

Why the service is rated good:

People told us they felt safe. They also told us there were enough staff to meet their individual needs and support them with their social interests. Since our last inspection there had been improvements in the response time in answering people’s call bells and to how people’s medicines were managed. People lived in a clean environment, free from odour.

People were cared for by competent staff who knew how they wanted and needed to be supported. People told us the meals were nice, but people who required assistance sometimes had to wait for staff to become available. So following our inspection immediate action was being taken to enhance the overall dining experience for people and to review staffing levels at this important time. 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.

People were treated with kindness and they and their families were encouraged to be involved in decisions relating to their care. People’s privacy and dignity was respected. People were cared for and supported at the end of their life by compassionate and trained staff.

People received care which was personalised and they had access to external healthcare professionals to help promote their health and wellbeing.

People’s complaints were used positively and as an opportunity to improve the service. The service was well led by a registered manager and provider who were open and approachable. People and staff chatted happily with the manager and had lots of opportunities to share their views. People’s personal records were not always locked away; however at the time of our inspection the registered manager took action. The provider’s quality monitoring systems were not always effective in identifying areas which required improvement; therefore the registered manager told us action would be taken to rectify this.

Further information is in the detailed findings below.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People had been cared for with dignity and respect in an environment that was safe, clean and hygienic. Equipment was well maintained and therefore people were not subject to unnecessary risk.

There were enough staff on duty to meet the needs of the people living at the home. People told us they felt safe. One said "I accidently pressed my emergency call button, eight members of staff appeared at my door in what seemed like seconds, that was very reassuring.'

Consort House had proper policies and procedures in place which gave regard to the Mental Capacity Act 2005 and the deprivation of liberty safeguards. Relevant staff had been trained in safeguarding vulnerable adults from abuse, so staff understood how to safeguard the people they supported.

Recruitment practice was thorough. Policies and procedures were in place to ensure unsafe practice was identified and people were protected.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. We spoke with six people who used the service, comments included: "the staff are absolutely lovely, I cannot fault them, they are always very respectful of my dignity.'; 'I can't think of anything I have asked for, that I haven't got.' and 'I can't complain at all, this is a first class place.'

Appropriate steps were taken to ensure valid consent was given to care, treatment and support and where people could not give consent, relatives and advocates were consulted. A new approach to writing care records had been introduced by the new registered manager. This ensured people who used the service were involved in writing them. Special dietary, mobility and equipment needs had been identified in all five care plans we looked at and the people we spoke with told us their care records reflected their current needs.

There were details of how people who used the service could access additional support from an advocacy service if they needed it. The details were displayed clearly on an information board within Consort House.

Is the service caring?

People were supported by kind and attentive staff. One person said "Staff are lovely, very caring and always helpful." Another stated 'Staff are loving, caring and compassionate.' We observed staff comfort people who used the service, staff showed genuine warmth, patience and gave encouragement when supporting people.

People were assessed before they received care. Care plans were person centred and highlighted people's hobbies, interests, skills and diverse needs. Care plans and risk assessments were regularly reviewed.

Is the service responsive?

An activity co-ordinator was employed by the home to ensure a range of activities were available for people to partake in. A new role was being introduced to assess people on an individual basis who were unable to leave their rooms. This meant the home were able to support the expressed interests of all people who used the service.

We spoke with six people who used the service; they all knew how to make a complaint if they were unhappy. One person said they had made two complaints and were very satisfied with the outcome. They commented, 'I explained to the registered manager my concerns and they were actioned and put right straight away, they were good as gold about it, it was no problem.'

We looked at the complaints procedure of Consort House and found that all complaints recorded had been dealt with in an open, thorough and timely manner. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

Consort House worked well with other agencies and services to make sure people who used the service received their care in a joined up way. For example, during our inspection we observed one person had their care needs reassessed by a continuing healthcare professional following a referral raised by the staff at Consort House. The person was assessed as requiring one to one care and this was actioned immediately so the person's needs were met.

Accidents and incidents were investigated and recorded and any actions were carried forward. Audits were conducted and actions were allocated to individuals or teams with completion dates set. We saw that these were followed up and completed. This demonstrated the home continually looked to improve. They identified areas they fell short in and addressed them promptly.

We noted the registered manager was in the process of completing a year long pilot course entitled, 'Registered care home managers leadership programme' run by Plymouth City Council. The registered manager told us that they continued to place emphasis on professional development in order to improve the service that Consort House could offer.

Consort House is a large nursing home providing complex care for people with high levels of nursing needs. At this inspection there were 51 people at the home. We visited the home over three days during this inspection. We talked with eight people who lived at the home, ten members of staff, one visiting health professional and one visitor to the home. We visited five people who were nursed in bed several times throughout the inspection.

People told us that staff were all kind and caring. People's care plans mostly contained detailed information about their needs, further development of care plans to include more personal detail was on-going .

We saw that some people's care needs had been monitored and action taken as a result to ensure any changes in the person's needs were met.

People told us that most staff were skilled enough to meet their needs. They said some staff were better than others. People said sometimes there were not enough staff on duty and they had to wait until staff were available.

Quality monitoring arrangements were in place to monitor the service being provided. We saw changes taking place to the systems and practices of the home as a result of this monitoring. Due to changes in staff the management of the service continues to be monitored by CQC until it becomes more established.

Some records contained enough detail to ensure that all staff would be aware of people's care choices and preferences when providing their care.

People spoke highly of the staff with comments including "I have done a fair bit of falling but they (staff) do their absolute best. I am comfortable"; "Very good. I have a daily wash which I like. Polite, respectful and friendly staff" and "It's alright. I am asked every day whether I want a bath but you wait for everything and call bells are always going."

People's hygiene needs were being met and the home was odour free. Most people had drinks available and were able to call for staff to attend them. However, care workers could not hear the bells when in people's rooms. Visiting health care workers said they could not always find appropriate staff when needed. They had both positive views and concerns about the care provided.

There had been a medicine error over several days. Not all people's care plans reflected their current needs or had sufficient detail in how to meet those needs. This had put people at risk of pressure sores and falls. Monitoring was not adequate, examples being vulnerable pressure areas, positioning of people in bed, correct use of equipment, content of oxygen cylinders and people vulnerable when they stayed in their room.

Consort House is a nursing home providing complex care for people with high levels of nursing need. At this inspection there were 54 people at the home. We talked with four people who lived at the home, ten members of staff and two visitors to the home. We visited three people who were nursed in bed, several times throughout the inspection.

People told us that staff treated them with kindness and respect. People's care plans did not all contain detailed information about their needs and, in some care plans various important documents were not fully completed. This meant that staff did not have clear guidance about the care people needed or how to provide that care.

We saw that some people's care needs had been monitored but no action taken as a result to ensure the person's needs were met.

People were cared for by staff who had received training to provide them with the skills to provide the care needed. People said there were enough staff available on each shift to meet their needs, however they told us that sometimes they had to wait until staff were available.

Quality monitoring arrangements were in place and were mostly well managed.Care plan audits were not effective as they did not identify shortfalls in the management of care plans and monitoring of care.

Some records were better completed than others. In some cases records relating to people's care needed further detail to ensure that all staff would be aware of people's care choices and preferences when providing their care.

People said the staff treated them with respect and looked after them well. People told us they were able to express their preferences regarding their care. However a lack of staff at times meant people did not always receive the care they needed when they wanted it. One person told us they had to wait over a week for a bath and there were times when people had to wait a long time for the call bell to be answered.

We found that staff were knowledgeable about people's care needs, medicines were managed safely, and staff co-operated with other care providers to ensure people received the support they needed. However people's care plans did not contain detailed information about their needs and, in some cases, various important documents were blank or not fully completed. This meant that staff did not have clear guidance about the care people needed or how to provide that care.

Some records were up to date and complaints were managed appropriately. Quality monitoring arrangements were not effective as they did not identify shortfalls in the service where improvements were needed.

All of the people we spoke with were happy with the service provided. We saw that people were spoken to by staff in an attentive, respectful, and caring way. We saw that staff and people using the service knew each other and chatted in a relaxed way. The one to one care provided was supportive and well organised.

People using the service told us that the staff were 'always kind and caring', ' they are a good bunch here ' and ' staff are great'.

One person told us 'some are better than others'.

We pathway tracked three people who use the service. Pathway tracking means we looked in detail at the care three people received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them.

People said that they would feel able to complain if they needed to. The manager is new to the role but not new to the home and is not yet registered with CQC.

We found that auditing systems have been put in place and efforts made by the management of the service to monitor and address issues identified.