Archived: The Weir Nursing Home

People’s experience of using this service:

People who lived at the home as well as their relatives were pleased with the standard of care provided. They felt their needs were met by a kind and caring staff team.

Improvements had been made since the previous inspection. Some further improvement was identified as needing to take place regarding medicine management. Immediate action was taken to ensure improvements were made.

People felt safe living at the home and staff were aware of their responsibility regarding the reporting of potential abuse. Risks were identified, and plans were in place to keep people safe. Where equipment was needed to be used this was done safely. There were sufficient staff to support people and additional staff were available if needed.

Staff supported people to maintain their wellbeing by seeking medical advice if needed. People were supported with their dietary needs, people’s weight and fluid intake was monitored and any concerns identified and acted upon. Incidents and accidents were monitored to identify any themes and actions were taken to reduce reoccurrences.

People were supported by staff who were trained and supported by management. The provider had recruitment and induction procedures in place to ensure suitable staff were employed and were supported to provide safe and effective care. Staff were aware of infection control procedures to reduce the risk of cross infection.

Consent was obtained, and people were supported to make decisions about their day to day living in the least restrictive way possible. People were involved in their care. Care plans were in place and regularly reviewed to ensure they were up to date.

People were supported to engaged in things they enjoyed doing for fun and to maintain their interests.

End of life plans were in place and the management team were engaged in local initiatives to further develop end of life care planning. The management team kept up to date with best practice and shared these with staff to ensure they had up to date knowledge.

People and relatives felt they could raise any concerns they had and believed they would be listened.

Quality assurance checks were in place and continual improvement was sought by the management team. The registered manager wished to develop staff further including having staff champions.

Rating at last inspection: At the last inspection, on 25 April and 03 May 2018, the service was rated Requires Improvement (report published 07 June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Future inspections will be planned for future dates.

We found the service met the requirements for ‘Good’ in four areas and ‘Requires Improvement’ in one area. The overall rating was ‘Good’.

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

The Weir 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. This service provides accommodation and nursing care for up to 35 people. At the time of this inspection, there were 31 people living at the home, some of whom were living with Parkinson's disease , motor-neurone disease, and dementia.

There was a registered manager in post, who was present during our inspection. 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 last inspection undertaken in October 2016, we rated the service as Good. At this inspection, we identified concerns in relation to safe medicine management and the governance in relation to this. The service is now rated Requires Improvement.

Stock balances of medicines had not always been accurately maintained, which meant there were medicines unaccounted for. Where people were prescribed creams, these were not always managed safely, with the wrong creams found in people's bedrooms. As prescribed creams and liquid medicine did not have opening dates on, we could not be assured medicine in use was within its shelf-life period.

Language and terminology used in people's care plans and on staff notice boards was not always in keeping with the principles of the Mental Capacity Act. Whilst no unlawful restrictions were in place for people, terminology used did not always reflect this.

Although the registered manager, clinical lead and provider had quality assurance measures in place, these had not identified the shortfalls in medicine administration.

The provider had not assured all relevant notifications had been submitted to the CQC, as required by law. Where there were unexplained injuries to people, the CQC had not always been informed.

There were enough staff to meet people's physical and emotional needs. The provider adhered to safe recruitment procedures.

Safety and maintenance checks were routinely carried out at the home to ensure people's physical environment was safe. People were protected from the risk of infection.

Staff received ongoing training and development in their roles, and this training was also made available to people living at the home, and their relatives.

People were encouraged to maintain their health, and were supported with their eating and drinking needs. Orientation boards were used at the home to help people navigate and to know the date and time.

People enjoyed positive and respectful relationships with staff. People's individual communication needs and styles were known. People had access to independent advocates, as required.

People were encouraged to enjoy a range of social and leisure opportunities. Staff knew people well, both in terms of their health and wellbeing needs, and in relation to their personal preferences. Complaints, feedback and suggestions were acted upon.

People, relatives, staff and health professionals were positive about how the home was run. Staff felt valued and motivated in their roles. People were involved in decisions about the running of their home.

The Weir Nursing Home provides accommodation and personal care for up to 35 people. At the time of our inspection there were 29 people living at the home.

There was a registered manager in post. 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 and associated regulations about how the service is run.

People were kept safe by staff that knew how to recognise and report any concerns about people's safety. Staff understood people's needs and about risks and how to keep people safe. There were enough staff on duty to make sure that people got the right support at the right time. The provider completed checks to ensure staff were suitable and safe to work at the home.

People were positive about the support and care that they received. People were treated with dignity and respect and staff were kind and caring in their approach with people. People's care and support was centred on their individual needs.

People had their health needs responded to effectively. People were supported to access doctors and other health professionals when required. People were supported to have their medicines when needed. Medicines were stored and administered appropriately.

People were asked and gave staff permission before any care or support was given. Time was taken to make sure that people could make choices and decisions about the care and support they received.

People were supported by staff that had the skills and knowledge to understand and meet their needs. Staff had access to on-going training and support to meet people's specific health and wellbeing needs. Staff felt that they were able to contact the registered manager at any time if they needed support or guidance.

People and their relatives found the staff and management approachable and, willing to listen to their views and opinions. People knew how to complain and who to complain to.

Audits and checks were completed regularly to ensure that good standards were maintained. There were established links with organisations relevant to the care and support provided.

We saw that staff responded promptly to any requests for assistance. People told us that the staff were, "Kind, just so nice, nothing's too much trouble" and, "Always willing to help". Staff made sure that people were given choice and were encouraged to be as independent as possible. This meant that staff were compassionate and caring.

The home was a safe and comfortable place for people to live. The building had been adapted so that it was accessible for people using wheelchairs. The adaptations had been done without losing the character of the Georgian house.

The provider made sure that people were able to express their views of the service. People told us that they would feel comfortable raising any concerns, but stressed that they had never needed to. This meant that the service was effective and well led.