Archived: Headroomgate Nursing Home

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care workers understood the risks associated with people's daily care needs and were aware of how to support people in a manner that maintained their safety and wellbeing.

Procedures for identifying and reporting safeguarding concerns had been significantly improved to help protect people who used the service from abuse.

Staffing levels in the day and through the night, had been increased to help ensure there were adequate numbers of staff on duty at all times, to provide safe and effective care.

Is the service effective?

Assessment processes had been reviewed to help ensure only people whose needs could be met at the home would be admitted.

People's health care needs were addressed within their care plans and examples were available to demonstrate that people were supported to access health care services when they needed them.

We received variable feedback about the standard of food provided at the home. Some residents felt it was very good and were pleased with the standard and variety of meals provided. However, others felt the standard of food had not been as good in recent weeks, which was also the opinion of two relatives we spoke with. We discussed this issue with the manager who explained that residents and relatives had recently had a large input into the development of a new menu which had been implemented days earlier.

A relative we spoke with complimented staff at the home on the way they had supported her family member who was at high risk of poor nutrition. She told us, 'They really watch what he eats and make sure it's enough. Since he moved to the home he has been very well nourished.'

Is the service caring?

We spoke with six people who used the service and five relatives. The feedback we received was on the whole, very positive. People told us they were happy with the approach of staff and the way care was provided. People's comments included: 'We couldn't ask for more. They could not have been kinder.' and 'I always feel very comfortable when I visit. It is a caring place.'

The manager was working to develop care plans so that they were more person centred. 'Maps of life' and 'one page profiles' were in the process of being introduced. These contained detailed information about people's personal wishes and the things that were important to them. Some of the care plans we viewed were still to be developed.

We saw an example of some changes made within the home that had affected the wellbeing of one resident. Whilst we could see that the resident had been involved in the decision, we found that the situation could have been managed in a better way, so as to reduce the stress and anxiety of the resident involved. We discussed this with the manager at the time of the inspection.

Is the service responsive?

One relative told us the home had been extremely responsive to her loved one's needs. She explained that there had been a lot of changes to her family member's needs, due to a deterioration in his health. She was highly complimentary about the way staff had responded to this and confirmed that she had felt involved throughout the process.

The manager had made efforts to gather the views and opinions of people who used the service and their representatives. This included the arranging of a satisfaction survey, which had recently been conducted. In addition, the manager was in the process of holding individual meetings with residents and their relatives to discuss the service and future plans.

Is the service well led?

The new manager showed a clear understanding of the concerns we had previously identified and was able to describe in detail, her clear plans for improvement. It was evident that the manager had a good understanding of her role and the responsibilities of a registered manager.

We received very positive feedback about the new manager from relatives of people who used the service, staff and community professionals. People expressed confidence in her to ensure the service was operated effectively and that people received safe and effective care.

Processes to monitor safety and quality had been reviewed and improved. The manager was able to give us a number of examples of issues she had identified and addressed, demonstrating the processes were effective.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Safe

Processes for identifying and managing risks to the safety and wellbeing of people who used the service were not always effective. This meant that people who used the service were at risk of harm or receiving unsafe or ineffective care.

The needs of people who used the service were not taken into account when calculating staffing levels. This meant that there were not always adequate numbers of staff on duty to meet people's needs safely and effectively.

There was a failure to recognise safeguarding concerns and protect people that used the service from the risk of abuse.

We have asked the provider to tell us how they are going to meet the requirements of the law in relation to staffing levels, quality assurance, identifying risk and learning from incidents and events that affect people's safety.

We have discussed our concerns with other agencies including the local safeguarding authority and are working in partnership with them to help ensure the safety and wellbeing of people who use the service.

Effective

Some improvements had been made to the environment which meant it better met the needs of people who used the service.

There were some good examples of person centred care planning which took people's individual needs into account. However, care plan information was not always followed by staff.

Caring

Residents that we spoke with and were able to comment, spoke highly of the care workers at the home. One person said, 'The girls are smashing. They bring my meals up for me.' Another told us, 'The staff are very nice with us.'

Responsive

We saw evidence that the manager of the home had failed to refer issues, such as safeguarding concerns on to the relevant authorities, so the incidents had not been properly investigated.

Areas of risk that we identified during our inspection had not always been responded to effectively. This meant that people who used the service were sometimes placed at unnecessary risk.

Well led

The service had a quality assurance system in place. However, we found evidence that not all shortfalls had been identified. This resulted in shortfalls being allowed to continue where improvements could have been made.

Whilst the home's quality assurance system had been improved to incorporate an overview of events such as accidents, adverse incidents, complaints and safeguarding concerns, we found that these were not being monitored effectively and as such, important learning was being missed.

During this inspection we identified a number of risks to people who used the service, such as those in relation to their care needs. We found evidence that the manager had failed to identify these risks or take action to address them. This meant that the systems for assessing and addressing risks to people were not adequate.

We have asked the provider to tell us how they are going to meet the requirements of the law in relation to protecting people from the risks of unsafe care by means of effective operation.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the Service Safe?

Infection control guidance was in place but not always followed. Standards of cleanliness and hygiene were not adequate in all areas. This meant people were not adequately protected against the risks of acquiring infectious conditions. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the prevention and control of infection.

The needs of people who used the service were not fully taken into account when making decisions about the number of staff the home required. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing levels.

Processes to ensure the competence and suitability of people with responsibility for leading shifts were not adequate. This sometimes resulted in agency nurses with no prior knowledge of the service or residents, being in charge of the home.

Risks to the health, safety and wellbeing of residents were not always identified or managed well.

There was no system in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes.

We have asked the provider to tell us how they are going to meet the requirements of the law in relation to quality assurance, identifying risk and learning from incidents and events that affect people's safety.

Is the Service Effective?

People's needs were not always taken into account in terms of their accommodation. There were no names on bedroom doors or signage to assist people in recognising their bedrooms. However, there was some useful signage on the ground floor of the home.

In some cases, we found residents' call bells were out of easy reach, some being at the opposite side of the room to people's beds and chairs.

Care plans were in place for most residents, which covered their assessed needs but staff were not always fully aware of the information within them.

Staff did not always follow individual risk assessment guidance, which meant residents were at risk of receiving unsafe care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the provision of safe and effective care for people who use the service.

Staffing levels were not always adequate to meet people's needs safely. People were at risk because they were sometimes left unsupported in circumstances where they should have been provided with 1:1 support. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring there are adequate numbers of staff on duty to meet people's needs safely.

Is the Service Caring?

We spoke with some residents during our visit. One resident told us, 'They (the staff) seem very good. They are always popping up to me to see if I am alright.' This person also felt staff had a good understanding of his needs and was satisfied with the care provided. Another resident we chatted with complimented staff on their kindness. She said, 'They are patient and kind. I trust them.'

A number of residents were not able to give us their views but we observed them being provided with support. We saw that staff approached people in a kind and respectful manner and responded to their requests where possible.

We received variable feedback from relatives of people who lived at the home. One relative expressed satisfaction with the home and felt his loved one was well cared for. However, we also spoke with a relative who had recently moved their family member out of the home because they felt his basic care needs were not being met.

During our visit we looked at the three bedrooms, which were shared by residents. None of these rooms had privacy screens and when questioned, staff confirmed that there were no privacy screens in the home for use. This meant the privacy and dignity of people who used the service was not protected.

We viewed a number of care plans and found some examples of person centred information, which detailed people's individual preferences and things that were important to them. However, in some cases, this sort of information was lacking, particularly in relation to activities. There were no records of activities held within the home and we did not see any information for residents about the activities programme.

Care plans were in place for most residents which provided an overview of their care needs and risks in areas such as falling, developing pressure sores or medical conditions such as Epilepsy. However, staff were not always aware of the guidelines to keep people safe or did not follow them.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people receive safe and effective care.

Is the service responsive?

A relative we spoke with told us that he found the staff and manager approachable and said he was confident any concerns he raised would be dealt with effectively.

We saw evidence that the manager of the home referred issues, such as safeguarding concerns on to the relevant authorities, which helped ensure incidents were properly investigated.

However, areas of risk that we identified during our inspection had not always been responded to effectively. This meant that people who used the service were sometimes placed at unnecessary risk.

Some of the people who used the service had complex behavioural needs associated with their diagnosis of dementia. We found that the manager had failed to respond to this by ensuring staff training in the area of challenging behaviour was provided to all staff.

There was no system in place to make sure that the manager and staff learned from events, such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant that the response to such incidents was not always effective.

We have asked the provider to tell us how they are going to meet the requirements of the law in relation to responding to risk and events that affect people's safety.

Is the service well led?

The service had a quality assurance system in place. However, we found evidence that not all shortfalls had been identified. This resulted in shortfalls being allowed to continue where improvements could have been made.

The home's quality assurance system did not incorporate an overview of events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant that potential learning from such incidents would not always be identified.

We identified a number of hazards in the home. These included potentially harmful substances, unsafe hygiene standards and a broken radiator cover stored in a bathroom. This meant that the systems for assessing and addressing risks to people were not adequate.

Agency nurses were sometimes rostered on as shift leaders. There were no formal systems to provide detailed induction or assess the competence of shift leaders prior to them being left in charge of the home.

We have asked the provider to tell us how they are going to meet the requirements of the law in relation to protecting people from the risks of unsafe care by means of effective operation.

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved relatives, where possible to ensure people received the right care and support.

We spent time in areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. We spoke with people about the care and support they received. They said they were happy living at the home and said that staff were polite and kind.

This home cares for people with a range of dementia conditions and conversation with most residents was limited due to their dementia condition. We therefore spent much of the time in the communal areas making observations of how people were being cared for.

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. We spoke with one person about the care and support they received. They said they were happy living at the home and said that staff were polite and kind.