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Nether Place Nursing Home Good


Inspection carried out on 19 October 2017

During a routine inspection

Nether Place Nursing Home is a period property that has retained many of its original features and has been extended and adapted for it’s purpose. It is situated in a residential area on the outskirts of Keswick. Accommodation and nursing care for up to 32 people is provided over two floors with access to the upper floor by a lift. There is a small six bedded unit for supporting people who are living with a dementia. On the day of the inspection there were 24 people living there.

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.

Inspection carried out on 6th February 2015

During a routine inspection

This unannounced inspection took place on the 6th February 2015. We last inspected Nether Place Nursing Home (Nether Place) in October 2013. At that inspection we found the service was meeting all the regulations that we assessed.

Nether Place is a period property that retains many of its original features alongside a newer extension. It is situated in a residential area on the outskirts of Keswick. Accommodation is on two floors and there is a small six bedded unit for supporting people who live with dementia

The service is run by a registered manager. 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 who used the service felt safe. The staff had been trained in safeguarding vulnerable adults and were able to demonstrate their knowledge of this subject.

At the time of our inspection there were sufficient staff to provide support to people in a timely manner. Pre-employment checks had been carried out on all staff.

Medicines were managed appropriately and safely.

Staff had been adequately trained in supporting older people.

People’s right to consent to care and treatment was respected. Where people did not have the capacity to make some or all of their own decisions arrangements were in place to act appropriately and lawfully in their best interest.

People told us that food was good in the home. The staff, including the chef, were aware of people’s nutritional needs as identified in assessments that had been carried out by the service.

The building was undergoing extensive refurbishment at the time of our visit. We saw plans were in place to create more communal spaces, develop a ‘tea room’ and increase the size of the dementia unit.

People were cared for by staff that knew them well and treated them in a warm and friendly manner. People’s privacy and dignity was upheld.

Care plans were based on comprehensive assessments and were regularly reviewed to ensure that they were fit for the purpose of meeting people’s needs.

People who used the service and their relatives could raise concerns or complaints in a variety of ways. This included speaking informally with the manager or submitting a written complaint.

The manager ensured Nether Place was delivering quality care by regularly auditing and checking different aspects of the service. The manager regularly spent time with people who used the service and frequently worked alongside staff. She had a clear vision of what the service would look like in the future.

Inspection carried out on 4 October 2013

During a routine inspection

We returned to Nether Place to follow up five areas of non compliance. We had concerns about the way people were respected and looked after at the home. Other issues included how people's nutritional needs were met, the amount of staff and the support they received and the way the provider measured the quality of their service.

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.

Inspection carried out on 9 January 2013

During an inspection looking at part of the service

On our last two inspections of this service in May 2012 and October 2012 we judged that the provider was not meeting the required standards in a number of areas. We were particularly concerned about the standards of care and welfare of people in the home and the standard of record keeping . We told the provider that action was needed to make improvements so that people received the support they needed. This visit was to check on these two areas in particular.

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.

Inspection carried out on 1, 10 October 2012

During an inspection looking at part of the service

We spoke to people who used this service they made the following comments:

�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.

Inspection carried out on 3 May 2012

During an inspection looking at part of the service

Relatives and visitors to the home told us that staff kept in touch with them on a regular basis. One person said that 'the lines of communication are good and staff keep me up to date'. These people also told us that they were 'happy' and 'pleased' with the care their relative received at the home.

One of the people we spoke to who uses this service told us that they were 'generally able to look after themselves.' They did not refer to their care plan or the support they received from staff.

Some of the people we spoke to commented on the timing of the evening meal. One person said '4pm is a lttle early for tea' and another person said 'the food is acceptable but tea is too soon after lunch'.

People told us that they were 'happy' with their own rooms and others told us about the redecoration that had taken place in some parts of the home.

The visitors we spoke to were mostly complimentary about the staff and we received comments such as 'the staff are wonderful', 'we couldn't ask for better' and 'the staff try their best.'

We also received comments that were not so favourable about staff, particularly about the numbers on duty. People told us that there were times when their relatives had waited 10 to 15 minutes for their nurse call bells to be responded to.

One resident told us that 'some of the staff are lovely, others are not so.' They did not wish to elaborate on whether this related to their attitude or their caring skills.

Inspection carried out on 8 November 2011

During an inspection in response to concerns

People we spoke to during our visit were generally satisfied with the care and support they received. Some people told us the staff were always busy but did help them.

One gentleman told us that

�The staff are nice, I am looked after. I am not aware of care plans�. He also said that �I don�t go out much� when asked about being able to go outside.

Comments about meals included,

�I enjoy my lunch�.

�I am always given enough and can have more if I wish�

We were able to speak to some relatives on the day of our visit and their comments about the staff and care provided were favourable.

Comments included,

" I am happy with the care my relative receives and I can always speak to her in private if I wish"

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