Rushden Park

Rushden Park is a nursing home providing personal and nursing care to up to 68 people in one purpose-built building. At the time of our inspection there were 35 people using the service.

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

Improvements had been made in relation to identifying and managing risks to people. However, further development was required. Daily checks completed by the management team had not always identified areas of improvement and potential risks to people.

People's care plans had improved detailing people's likes, dislikes and preferences however, people's communication needs were not always recorded. We have made a recommendation about meeting the communication needs of people with a disability or sensory loss.

Staff had received training in safeguarding and understood the signs of abuse and how to report any concerns. The provider and manager had recruited more staff since the last inspection. Staff told us the increase in staffing levels meant they had more time to support and talk to people. Records showed there had been a reduction in accidents and incidents since the last 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 supported this practice.

Staff had been provided with training to ensure they had the relevant skills and knowledge to carry out their roles effectively. People at risk of malnutrition and dehydration were monitored and encouraged to eat and drink.

People we spoke with told us that staff were kind and caring and we saw staff respected people's privacy and dignity. Improvements had been made to ensure people did not suffer from social isolation. We observed people spending time in the communal areas and accessing the community. People's care records showed they were supported to access health care services and professionals where required.

Systems were in place to record and monitor complaints from people and/or their relatives. Regular meetings had been put in place to give people and their relatives the opportunity to provide feedback on areas of improvement within the service.

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 inadequate (published 7 April 2023) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was in continued breach of 1 of the regulations.

This service has been in Special Measures since 7 April 2023. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

At this inspection, we have identified a continued breach in relation to governance and oversight and we have made a recommendation about meeting the communication needs of people with a disability or sensory loss.

Please see the action we have told the provider to take at the end of this 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.

Rushden Park is a nursing home providing personal and nursing care to up to 68 people. At the time of our inspection there were 58 people using the service.

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

There was a lack of effective oversight and monitoring. This had resulted in poor outcomes for people using the service. Complaints made by people and relatives were not always responded to and investigated without delay.

People were not protected from risks. This included risks associated with urinary catheters, pressure care, constipation, specialist feeding regimes/interventions and environmental risks. Safeguarding systems and processes did not always protect people. We were not assured safeguarding concerns reported by staff were recorded and investigated appropriately by the registered manager or provider.

People were not always supported by enough staff to meet their needs. Staff told us there was not always enough staff on shift which had an impact on people’s care. Staffing levels had an impact on the support people received with their food and drinks.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Not all staff had received training to ensure they had the necessary skills and knowledge to meet the needs of the people they supported. Staff received regular supervision meetings. However, we were not satisfied these were effective in supporting staff. There was no system in place to monitor and observe staff practice to identify areas of development.

People experienced task led care which resulted in their dignity not being promoted or protected. People were not always supported to maintain their independence and have the opportunity to take part in activities and access the local community.

Staff had access to people’s care plans and risk assessments however, we were not confident these were read, understood and followed by staff.

The home was clean and tidy, and measures had been taken to reduce the risk of the spread of Covid-19 and other infections.

People were able to choose their meals from a daily menu and staff ensured people had access to drinks by placing them within reach. Staff worked in partnership with health and social care professionals to maintain people's health. For example, the local GP and the district nurse regularly visited to provide clinical care to people.

The provider was open and transparent during and following the inspection and developed an action plan to address the concerns found during the inspection.

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

Rating at last inspection

The last rating for this service was Requires improvement (published 26 January 2022).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk, staffing levels and management oversight. This inspection examined those risks.

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.

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

Enforcement

We have identified breaches in relation to safe care and treatment, staffing levels and training, safeguarding, consent to care, personalised care, management of complaints and managerial oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The registered manager had taken steps to ensure staffing was sufficient to fully meet people’s needs. Staff had worked flexibly and had gone above and beyond during a difficult situation, working extra shifts and often taking on new responsibilities to ensure people received safe care and support.

Safe arrangements were in place for visitors to the service. This included the completion of risk questionnaires, hand sanitisation and wearing a mask.

Staff and essential care givers engaged with a programme of regular testing according to government guidance and we saw this taking place on the day of our visit. Staff and visiting professionals were asked to provide evidence of their vaccination status against COVID-19 prior to entering the home.

We saw PPE was accessible within the home and staff used it in accordance with the most up to date guidance. Information about the correct use of PPE and handwashing guidance was displayed throughout the home.

Isolation, cohorting and zoning was used to manage the spread of infection. This meant people self-isolated in their rooms when necessary.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.

Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe. All staff had completed training in relation to infection control, and recently received training about the correct use of PPE including donning and doffing.

Rushden Park is a nursing home providing personal and nursing care for up to 68 people. At the time of inspection, 52 people were being supported by the service.

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

People had individual risk's assessed with strategies in place to mitigate risks. However, staff did not always follow the strategies.

Some people’s care needs were not met in a timely manner. Staff told us there was not always enough staff on shift.

Checks were in place to ensure the environment was safe.

Medicines were administered and stored safely.

People were protected against infection. Staff wore appropriate personal protective equipment (PPE) and the home was clean.

Auditing and oversight of care records required improvement.

We received mixed feedback from staff regarding the registered manager and the support they received.

People and relatives spoke positively about the care provided and people were supported to stay in contact with their loved ones.

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

Rating at last inspection

The last rating for this service was good (published 17 January 2020).

Why we inspected

We received concerns in relation to staffing levels, pressure care and food and fluid management. 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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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.

We found the following examples of good practice.

• There was a strict procedure when essential visitors accessed the service. The staff took temperatures of visitors, supplied them with Personal Protective Equipment (PPE), were escorted to wash their hands and given a track and trace form to complete, which was kept on site for 28 days.

• There was a ‘Covid-19 go to station’ which contained all update to date information on the virus and changes to guidance. This was to ensure all staff had access to up to date information.

• Staff has access to Personal Protective Equipment (PPE) and were observed wearing this in line with national guidance.

• Where staff had returned from work following a period of shielding, the Registered Manager completed a return to work induction with them. This was to give staff up to date information, refresh their essential training and offer support regarding their return.

• The service was cleaned with chloride cleaning solution to reduce the risk of spread of infection. The service was well-maintained.

• Staff washed their hand regularly, this was observed during the inspection.

• A visiting room had been set up to facilitate indoor visits during the winter months. There was a protocol for visitors to adhere to. This included, accessing the room from an outdoor area, wearing PPE and social distancing from their loved one, with the use of a plastic screen.

Further information is in the detailed findings below.

Rushden Park is a residential care home which was providing personal and nursing care to 46 people aged 65 and over at the time of the inspection. The service can support up to 68 people in one purpose-built facility.

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

Staff understood their roles and responsibilities to safeguard people from the risk of harm. People were supported to access relevant health and social care professionals.

People received their care at the agreed times. People’s medicines were managed in a safe way. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care which mitigated known risks.

People received care from staff who knew them well. Staff had a good understanding of people's needs, choices and preferences. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. Staff gained people's consent before providing personal care.

People were involved in the planning of their care which was person centred and updated regularly. People were supported to express themselves, their views were acknowledged and acted upon. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

Activities were varied and people were supported to take part in as much or as little as they chose. Pastoral care and community involvement were valued.

Staff were employed using safe recruitment practices. Staff received training to enable them to meet people’s needs and were supported to carry out their roles.

The management team continually monitored the quality of the service, identifying issues and making changes to improve care.

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.

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

Rating at last inspection

The last rating for this service was Good (published 11 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

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 support this practice.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professional when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure was in place and accessible to all. Complaint had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Further information is in the detailed findings below

People told us that they had been consulted about their care, treatment and the support available to them. One visitor said, 'I went around several homes before finding this one. This home has staff that care.''

We found that people were supported well and encouraged to make choices about how they spent their day. A person said, 'I enjoyed watching the fireworks from my bedroom window but did not want to go into the garden. And that was ok by the staff.'

We found that there was a varied selection of activities for the residents to pass the time. We saw, for example people engaged in a 'gentleman's club' playing dominos. Visitors told us that they found the care very good and were satisfied that their relative was looked after well.

We saw that there were good arrangements in place to protect people from harm.

The provider carried out adequate checks before they employed new staff.

The provider had systems in place to monitor the quality of the service provided.

Relatives who visited the home told us that they found the care at the home good and that staff attended to people's needs in a respectful and dignified way. A visitor said, 'This is a nice home, clean and airy and my relative always looks clean and well looked after.' Another person told us, 'It's a superb building, purpose built, the majority of the staff are good. It's a good home, I'd live here.'

We saw that there were robust systems in place to protect people from harm. Staff told us that they felt well supported by their manager and we saw evidence of a robust training programme.

We saw that the provider had adequate quality assurance systems which made sure the safety and comfort of the people they cared for were maintained and any problems quickly resolved.