Nether Place Nursing Home

Nether Place Nursing Home is a care home providing personal care and nursing for up to 32 older people and people living with dementia. At the time of our inspection there were 22 people using the service.

Nether Place Nursing Home accommodates people across 2 separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

People were at risk due to shortfalls in safety across the service. Risks linked to nursing staff had not been robustly assessed to keep people safe. Staffing levels were not always sufficient to meet people’s needs or for the size of the service. Staff had not always received training to enable them to support people effectively and carry out their roles.

People were at risk as fire safety was not managed safely; staff did not always know how to respond in the event of a fire. The provider was working to make improvements to fire safety.

Systems were not always in place to ensure people received their medicines properly and safely. Medicines were not always being administered to people as directed, this was addressed during the inspection.

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 did not always support this practice. We have made a recommendation about the recording of Deprivation of Liberty Safeguards (DoLS) conditions.

People were at risk of harm because of a lack of oversight of the service by the provider. The service had been without a registered manager for over 6 months. The provider did not have effective systems in place to monitor quality and safety at the service and had not identified the issues we found during the inspection. The provider had started to make improvements following our inspection, these changes had yet to be embedded.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 13 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing and good governance. We issued a warning notice for the breach of good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection in February 2015 the service was rated Good. At this inspection we found the service remained Good and we have made some recommendations to the registered provider.

There was a registered manager in post. A registered manager is a person who has registered with the (CQC) 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.

Medicines were being administered and recorded appropriately and were being kept safely.

During the inspection we deemed that there were sufficient numbers of suitable staff to meet people’s needs. However people told us mixed comments about their experiences of staffing levels.

Staff had completed a variety of training that enabled them to improve their knowledge in order to deliver care and treatment safely.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people.

We found that some bedroom door locks could be locked form the inside that would mean they could not be opened from the outside in the event of an emergency. We have made a recommendation that these be changed.

The schedules in place for cleaning were not always effective as we found equipment and some areas of the home required better cleaning.

When employing fit and proper persons the recruitment procedures of the provider were robust in ensuring suitable people had been employed.

People’s rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

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 supported to maintain good health and appropriate referrals to other healthcare professionals had been made.

There was a clear management structure in place and staff were happy with the level of support they received.

People living in the home were supported to access activities and pastimes of their choice that were made available to them.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate the safety and quality of the home. However we found the policies and procedures in use were not all in line with current legislation. We have made a recommendation that these are updated.

Further information is in the detailed findings below.

During this inspection we spoke with people who used the service. People told us that the home had improved and that they were now receiving a a good service. One person said, "I'm quite happy here." Another told us, "It's a good place to live" And another added, "They're looking after me!"

We found that the home was now being managed by a new management team who had made many improvements. We observed that people's dignity was being respected and that improvements had been made to the way their care was planned and recorded. People's nutritional needs were being met because assessments were being carried out and the outcomes were being acted upon. We noted that staffing levels were sufficient to meet people's needs in a timely manner and they were being supported. The management team had a system in place to measure the quality of service the home provided.

People in the home we spoke with said they were being well cared for and had been asked how they would like to receive their care. One person who had arrived in the home a few weeks ago told us they had been happy with how they had been introduced and settled into the home. They said, "The care staff are very good, they help me at the right pace and are kind and considerate."

We noted an overall improvement to how the home carried out care planning and assessing individual risks for people. New systems and policies had been introduced that ensured that people's care and treatment was assessed and any risks identified at an early stage to allow for more timely interventions. Staff were receiving clearer instructions on how to deliver care and treatment to people. We saw that staff had improved how they introduced new people into the home. Care plans and records held on people were much better organised and recorded.

Staffing levels had been increased in the home to aid and sustain these improvements.

'I have my breakfast in bed every morning' and 'The food is quite nice but it is not like in your own home'.

'The meals are all made for you, they are very good'.

One person told us; 'staff help me when I go to bed and when I get up. They usually come to me when needed, although sometimes I have to wait'. Another said that they were 'not feeling well'. They told us that staff would call the doctor if necessary.

Activities and entertainment were provided that people could join in if they wished. Some of the activities and entertainments were provided by people from outside of the home.

One person told us that they 'liked to go out shopping' but, they added; 'I never get out much these days and there are two or three things I need now, I rely on staff to take me out.'

We found that people were provided with a choice of suitable food and drink, but they were not always supported appropriately with their nutritional needs.

People's personal records including medical records were not updated regularly enough to reflect changes in condition and to ensure safe and appropriate care was given at all times.

There was little evidence to confirm that staff at the home received appropriate training and professional development support.