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Archived: Nyton House


Inspection carried out on 24 March 2015

During an inspection to make sure that the improvements required had been made

Nyton House is a care home registered to accommodate up to 23 people. This includes two people living in two adjoining flats. We carried out this inspection following an inspection in July 2014 when issues had been identified with the management of medicines. This was a focused inspection that looked at the management of medicines within the home.

We found that the registered manager had taken the steps needed that ensured that the management of medicines was safe.

Medicines were kept in a locked cupboard or trolley and the keys were kept safe by staff trained to administer medicines. appropriate arrangements were in place for the safe ordering, storing, administering and disposing of medicines.

You can see our judgement on the front page of this report.

Inspection carried out on 16 July 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We spoke with nine people who used the service, two visitors, three members of staff and the manager. During this inspection we looked at outcomes relating to people’s care and welfare, cleanliness and infection control, medication, staffing levels, and the home’s quality assurance processes. We used the information to answer the five 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?

We found that not all aspects of the service were safe. People were cared for by staff who were knowledgeable about their needs and had the skills to provide the support people required. However, appropriate arrangements were not in place in relation to the recording of medicines. Seven out of the 23 people’s medicines administration record (MAR) charts we looked at, had not been completed correctly. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the recording of medication.

We looked at five care plans which included the necessary information to inform staff as to the specific care people required. They also included risk assessments associated with specific elements of people’s care, such as falling or tripping and specified the action required to manage those risks.

There were effective systems in place to reduce the risk and spread of infection. The home was clean and well maintained. There was also a current infection control policy, which detailed the relevant infection control issues and guidance for staff.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Relevant staff had received training to enable them to understand when an application should be made. At the time of our inspection nobody in the home was subject to DoLS.

The manager ensured there were enough staff working at the home to meet people’s care needs.

Is the service effective?

The care plans we looked at were personalised to reflect people’s individual needs and their likes and dislikes. The people we spoke with told us they were happy with the care they were receiving and their needs had been met. One person said “the staff are gentle, kind and compassionate. They have made me feel valued and have helped me build up my confidence”. It was clear from our observations and from speaking with the staff that they knew the people they were looking after well and had a good understanding of their care and support needs.

Staff had received training to ensure they had the skills necessary to care for people. Staff told us about the care they were providing for specific people which matched information in the person’s care plan.

Is the service caring?

People were supported by kind and attentive staff. People said they had no concerns over how they were treated and they felt their privacy and dignity were respected. One of the visitors we spoke with told us staff understood their relative’s needs. They added “that was what was important to us. They do care; it is not just a job”. The records we looked at showed staff took account of people’s individual wishes and these were respected, when providing care. We observed care in the communal areas of the home and saw staff interacting with people in a positive way.

People's diversity, values and human rights were respected. We looked in people’s bedrooms and saw they were individualised and appropriate for the person’s needs. Staff respected people’s privacy and we saw them knock and wait before entering a person’s bedroom.

People’s wellbeing was enhanced through the availability of individual and group activities focussed on people’s preferences, interests and diverse needs.

Is the service responsive?

There were arrangements in place to respond to short term staff absences, which were managed through the use of overtime, the home’s own bank staff, the manager or agency staff when necessary.

We saw there was an effective compliments and complaints policy in place, which was published in the service users’ guide and posted on notice boards around the home. The manager showed us their complaints log and told us they had received three complaints since the beginning of the year. We saw these issues had been investigated and resolved appropriately. The people and visitors we spoke with told us they knew how to complain and thought their complaints would be listened to.

Systems were in place to ensure the manager and staff learnt from accidents and incidents. This reduced the risk to people and helped the service to continually improve. The home had up to date policies and procedures in relation to safeguarding and whistleblowing.

Is the service well-led?

There was a clear management structure. There were also procedures in place to monitor the quality of service provided with audits of care plans, medication administration records (MAR), accidents and incidents and infection control. Where an issue was identified remedial action was taken.

A regular questionnaire was sent out to people, their friends and families seeking their views on the service provided. The manager showed us the results of the latest questionnaire. We looked at the responses and saw the feedback was positive with 100 percent of people rating the service provided by the home as excellent.

Staff attended regular supervision meetings and there was an effective staff meeting structure in place, where staff could raise any issues or concerns.

Inspection carried out on 9 January 2014

During a routine inspection

We spoke with eight people living in the home, three staff and the manager. We also spoke with four relatives on the telephone following the inspection.

People told us they were happy in the home and that they had choices in the care they receive. One person told us "It is excellent here, they can't do enough". Another told us "I am happy here, they look after me very well and they are polite and respectful".

Relatives told us that the "Home was marvellous", "They have a welcoming and honest approach", "The staff are marvellous" and that "They bend over backwards to ensure good care". One other relative told us that the improvement in their family member in this home was remarkable in comparison to the previous home they were in.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us "I am very happy here and staff always ask before any care is given".

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Recruitment procedures ensured that people were looked after by staff who were appropriately qualified to do the job.

The provider had ensured that records were accurate, up to date and stored securely.

Inspection carried out on 12 February 2013

During a routine inspection

We spoke with three people living in the home individually in their rooms and we spoke with a group of five people sitting in the dining room. All people spoken with told us they were very happy living in the home. They told us they had choices in daily living and that they were happy with the activities. We were told by one person that there was good food and a good atmosphere in the home.

Another person told us that they "could bring up any problem and it would be fixed" and another person told us "It is excellent, the best home ever".

We spoke with three relatives who were extremely complimentary about the home. One told us "The care is 100%, there is continuity of care and that the staff go over the top to help people". Another relative told us "it is a home from home and that there was an excellent caring staff. The home offers good old fashioned care". A third relative told us that the home caters to people's individuality and that the activities and seasonal events on offer meet the needs of people living in the home.

Care needs were assessed and met by a trained and competent team.

People were safeguarded from abuse.

Medicines were being handled appropriately in the home.

The service had quality assurances systems in place to ensure the effective running of the home.

Inspection carried out on 13 February 2012

During a routine inspection

We spoke to six people in private and spoke to three relatives of one person.

People confirmed that were assisted with care and support which they were satisfied with.

Two people said that staff responded promptly when they asked for help by using the call point in their rooms. One person commented there was sometimes a delay when they asked for help by using the call point adding there were not always enough staff.

Staff were said to be polite, kind and friendly. One person said, “The staff are very good. They check on us at night time.” Another person said, “We are treated very nicely.” People said that staff were skilled in offering reassurance and consulted with people. One person added, “The staff are good at communicating. They ask you what you want. They talk to you and consult.”

People said they were able to choose how they spent their time and that this included times for going to bed and getting up as well as a choice of food.

A range of activities were said to be provided and people said they played cards, board games, and, that musical entertainment was provided. People also said they were taken on outings. One person said that he/she would like to attend more outings than had been so far provided. One person commented, “The staff engage with residents which helps keep our brain active. They always have something to talk about. They help me walk to the dining room.” Another person commented how staff involved them in scrabble and quizzes, that a priest visited the home and that classical guitar was played on Saturdays. Comment was made that people enjoyed carols sang by a local school choir at Christmas.

People said they felt able to raise any concerns or improvements they felt were needed. One person said, “The home has an atmosphere where I feel free to say what I want.” Another person said there were informal discussions about the home where they were encouraged to express their views.

Inspection carried out on 7 December 2010

During a routine inspection

People told us that they like living at Nyton House. Comments from people included: ‘I like it here and I am very happy,’ and, ‘I feel very safe here.’ Each of the 4 people spoken to said that they are treated very well. Staff were said to respond to requests for assistance, for instance when they use the call points in their rooms. Comment was made that the service provides enough staff to cater for people’s needs, although one person said that staff cover was ‘a bit thin on some days.’

People said that they receive help from community health services when needed. Personal preferences and routines were said to be acknowledged. For instance, breakfast was said to be provided according to the choice of food the person wants as well as at the time and location chosen.

People told us that they have access to activities such as outings, entertainment, games and religious services. One person said how he/she was able to practice his/her gardening skills in the grounds and that this was very rewarding.

People are aware of the complaints procedure and commented that any complaints are dealt with straight away.

People said how much they like the environment and that the home is always kept clean.

At the time of this Compliance Review we received information from social services of their investigations into several allegations of abuse dating from spring 2010, including concerns that the service was involved in carrying out nursing procedures, which it is not registered to provide. These investigations had not been concluded at the time of this review.

Reports under our old system of regulation (including those from before CQC was created)