Singleton Nursing & Residential Home Limited

We found the following examples of good practice:

An enclosed meeting room was created for people to meet with family and friends. This was accessed separately from the home to minimise the risk of infection spread. A visitor coordinator role was created to facilitate visits and communicate with family and friends.

The registered manager provided personal protective equipment to visitors and residents.

People and staff were supported with regular testing for COVID-19.

There were risk assessments in place for people and staff who fell into high risk groups.

The registered manager had planned how to manage an outbreak of COVID-19 in the home, including isolating in rooms and zoning areas.

Singleton Nursing Home is registered to provide accommodation, nursing and/or personal care for 36 people, some of whom may have dementia. At this inspection, there were 31 people living in the service. The service was part way through major building works, which when complete, will provide an additional 14 bedrooms as well as additional lounges and other facilities.

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

People and visitors were positive in their feedback. Their comments included, “I would recommend this home, it’s the best money I have spent in my life.” And, “I like it because they listen to me. We have a chinwag every so often to make sure everything is okay and how I want it. A visitor told us, “The staff are marvellous, you honestly couldn’t hope for better.”

Our observations showed people were safe. Staff knew what their responsibilities were about keeping people safe from the risk of abuse. There were enough staff and the provider followed safe recruitment practice.

People received the support they needed to stay healthy and to access healthcare services. Each person had an up to date care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Medicines were managed safely, but occasionally the storage temperatures were higher than they should be. However, identified by staff and addressed by the use of an air-conditioning unit. Staff followed policies and procedures for safe administration of medicines. Only trained staff gave medicines and their competency to do this was checked regularly.

People continued to receive care from staff who were well supported. Staff received one to one supervision and annual appraisals together with induction and ongoing training. A member of staff told us, “The manager and deputy provide a lot of support and consistency.”

Staff understood the importance of promoting people’s choices and provided the support people required as well as promoting and maintaining independence. This enabled people to achieve positive outcomes and promoted a good quality of life. One person told us, “I like to do some things for myself, they give me the time I need and encourage me to do all I can every day.”

Staff were caring and knew people, their preferences, likes and dislikes well. We received good feedback from people, relatives and social care professionals about the quality of care provided by staff.

We observed people’s rights, their dignity and privacy were respected. People continued to be supported to maintain a balanced diet. Staff monitored nutritional needs and supported people to eat safely and at their own pace.

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. We saw that People participated in activities, pursue their interests and maintained relationships with people that mattered to them.

The service continued to be well led. Effective quality audits remained in place and continuous improvement and learning were embedded in the day to day running of the service. Everyone we spoke with were positive about the registered manager and staff.

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 (Report published on 11 November 2016).

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.

Singleton Nursing and Residential home provides accommodation and personal care with nursing for up to 36 people some of whom may be living with dementia. At the time of our inspection 33 people were living at the service.

The service had 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required to the local authority

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including GPs and dentists.

Staff were attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them. These activities were diverse to meet people’s social needs. People knew how to make a complaint and complaints had been resolved efficiently and quickly.

The service had a number of ways of gathering people’s views including using questionnaires and by talking with people, staff, and relatives. The registered manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to drive improvements.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We found that the company had comprehensive procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make any specific decisions about where they lived or the care that they needed had been appropriately supported by their family members or advocates, and by health and social care professionals, to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

We found that medication management had reliable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained nursing staff.

Staff training records showed that all of the staff had completed mandatory training, which included subjects such as fire awareness, moving and handling, infection control and food safety. Most of the care staff had also carried out training for National Vocational Qualifications/Diplomas levels 2 or 3 in health and social care, or were studying for these. This meant that people were cared for by staff who had sufficient training to enable them to provide safe and effective care.

Is the service effective?

We saw that people had care plans in place which had been discussed and agreed with them. These plans were kept updated, and reflected people's changing needs. They gave the staff clear directions about how to care for each person individually.

We found that the nursing staff referred people appropriately to their GP and other health and social care professionals. This meant that people had the care and treatment that they needed.

Is the service caring?

We talked with people living in the home and with three relatives. All of the people that we talked with spoke highly of the care and treatment given to them by the staff. Some of their comments included: 'It is one hundred per cent good here'; 'It is perfect, I am very happy living here'; and 'Nothing is ever too much trouble for the staff, and they make it really homely.'

We observed that there was a relaxed atmosphere, and saw that people were able to go where they wanted to and do the things they wanted to do. One person said 'There is never any need to get bored in here, there is always plenty to do if you want it!'

We saw that staff treated people with respect and dignity, and showed gentleness and kindness.

Is the service responsive?

We saw that staff were attentive to people's needs, and answered their call bell alarms promptly.

The service carried out residents' meetings, and the minutes from these showed that people's viewpoints were listened to. Changes were made in the home as a result of the discussions.

Care plans showed that the nursing and care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people. This meant that their health needs were being met.

Nurses had different areas of responsibility in the home as well as carrying out general nursing duties. This meant that they were able to keep up to date with specific subjects such as wound care or medication. They provided other nursing staff with information or changes related to those subjects.

Is the service well-led?

The manager had systems in place to provide ongoing monitoring of the home. This included care plan reviews, and checks for the environment, health and safety, staff training needs and medication management.

The manager had an open door policy, and people knew that the manager or deputy manager were always available and willing to talk with them about any specific concerns.

We found that staff had individual supervision meetings on a regular basis, and staff meetings every six to eight weeks. This meant that staff knew that they could raise different ideas and any concerns; and took an active part in working with the management for the ongoing development of the home.

People living in the home and family members were provided with yearly questionnaires. This enabled the management to assess if the home was running well in different areas, and if any changes were indicated that could bring about further improvements.

We spoke to four people individually and a group of five people during lunch, two relatives, a visitor, a care professional, two staff and the deputy and manager of the service. People told us that they were invited to visit the service to look around prior to moving in and that "All sorts of information had been made available to them" regarding the service. People told us they were treated with dignity and respect by staff.

People said they were involved in their care planning and that their care plans had regular monthly reviews. People told us they felt care was given safely and they could talk to the manager and staff about any problems they had. People were confident the service would deal with any concerns promptly.

People and their relatives were invited to express their views and opinions on their visits to the service and through regular surveys.