Inglefield Nursing & Residential Home

Inglefield Nursing and Residential Home is registered to provide accommodation and nursing care for up to 49 people, including people living with cognitive impairments and physical needs. There were 43 people living at the home at the time of the inspection.

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

People were supported by staff who were kind, compassionate and caring and who understood their likes, dislikes and preferences. People were happy living at Inglefield Nursing and Residential Home and told us they felt safe.

There were clear processes in place to monitor risks to people, which helped to ensure they received effective care to maintain their safety and wellbeing. Recruitment practices were effective and there were sufficient numbers of staff available to meet people’s needs. People were protected from avoidable harm, received their medicines as prescribed and infection control risks were managed appropriately. Systems were in place to monitor incidents, accidents and near misses. These were recorded, acted upon and analysed to identified themes and trends.

People’s established care plans were accurate and contained detailed information about people’s needs and abilities. However, information gathered about people’s needs when they moved to the home was minimal.

People were supported to access health and social care professionals if needed and were happy with the food provided. Staff had received appropriate training and support to enable them to carry out their role effectively. They received regular supervision to help develop their skills and support them in their role.

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.

People said that the staff were caring and kind and they were treated with dignity and respect. People were involved in planning their care and the support they received.

The service had a strong focus on inclusion and the prevention of social isolation and offered people a range of personalised activities.

The management team were open and transparent. They understood their regulatory responsibilities. People and their relatives said the management team were open, approachable and supportive. There were effective governance systems in place to identify concerns in the service and drive improvement.

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 October 2018). At this inspection we found improvements had been made and the overall rating for this service is now Good.

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.

Inglefield Nursing & Residential Home is a ‘care home’ and is registered to accommodate up to 49 people who require nursing or personal care. At the time of the inspection 39 people were accommodated at the home. People in care homes receive accommodation and personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection. This home provides a service to older people some living with dementia or mental health needs.

The home 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.

At our last inspection, in July 2017, we identified breaches of Regulations 10 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always treated with consideration and quality assurance systems were not always effective. At this inspection, we found action had been taken and there were no longer any breaches of regulation. However, further improvement was still required.

Although new quality assurance procedures had recently been put in place, these needed further development and time to become embedded in practice and bring about the necessary improvement.

People had mixed views about the adequacy of staffing levels. Although we found these were adequate to meet people’s essential needs, we could not be assured that people’s call bells were always responded to in a timely way.

Recruitment procedures were not followed consistently, so the provider was unable to confirm that all staff employed were suitable.

Medicines were generally managed safely, although medication administration records had not been completed fully, some medicines could not be accounted for and there was a lack of information about when and how ‘as required’ medicines should be given.

People’s rights and freedom were not always protected. Although staff said they acted in people’s best interests, they did not always document decisions they had taken on behalf of people. There was no process to ensure applications were made to renew legal restrictions imposed on people’s freedom and staff did not know which people were subject to such restrictions.

People told us staff were competent and provided effective care; however, some staff training was out of date. Although nurses usually followed best practice guidance, we found they did not take a consistent, evidence-based approach to supporting people with diabetes.

Staff demonstrated a good awareness of the individual support needs of people living at the home. However, people’s care plans did not always support staff to deliver care in a personalised way; they lacked information about the support people needed when they became agitated and people’s end of life wishes and preferences had not been recorded.

Staff were appropriately supported in their role through one-to-one sessions of supervision, staff meetings and observations of their practice. Although some staff appraisals were overdue, plans were in place to complete these.

There was an open and transparent culture where visitors were welcomed. However, written information had not been provided to the family of a person who came to harm.

Individual and environmental risks to people were usually managed effectively and there were systems in place to protect people from the risk of infection.

People told us they felt safe living at Inglefield and staff understood their responsibilities to safeguard people from harm.

People's nutrition and hydration needs were met and most people were satisfied with the quality of their meals.

Some adaptations had been made to the environment to make it supportive of the people who lived there and further enhancements were planned.

People were supported to access other healthcare services and information was made available when they were admitted to hospital, to help ensure the continuity of their care.

People consistently told us they were treated in a kind and compassionate way and we observed positive interactions between staff and people. Staff encouraged people to be as independent as possible and involved them in discussions about their care.

People had access to a range of activities based on their individual interests, including on a one-to-one basis.

There was an accessible complaints procedure in place. People told us they felt able to raise concerns and were consulted in a range of ways about the way the service was run.

Staff communicated effectively between themselves. They told us they were happy and motivated in their work and demonstrated a willingness to learn from mistakes.

The inspection was conducted on 12 and 13 July 2017 and was unannounced. There was a registered manager in place. 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 out last inspection, in October 2015, we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe infection control procedures were not always followed; medicines were not always managed safely; and environmental risks were not always managed effectively. At this inspection we found action had been taken, although some further improvement was still needed.

Infection control procedures had improved and all areas of the home were clean. However, not all staff were up to date with their infection control training and some did not use individual hoist slings when supporting people to transfer; this posed a risk of cross infection.

Most individual and environmental risks to people were managed effectively. However, on one of the inspection days, staff took six minutes to locate specialist equipment which might have been needed in an emergency; and a known trip hazard in a person’s room had not been addressed. In addition, measures taken to reduce the risk of people developing pressure injuries had not been recorded to ensure staff followed them consistently.

An extensive programme of audits was conducted by the registered manager and a representative of the provider. However, these had not always been effective in bringing about improvement.

People’s dietary needs were met and they praised the quality of the meals, although we found the mealtimes were rushed and staff did not always show consideration for people they were supporting to eat. Some staff talked amongst themselves while others used inappropriate terminology when talking about people. However, other staff interacted positively with people.

Staff took a task-focused approach to the delivery of some aspects of people’s care and people told us their preferences were not always met, such as the time they went to bed. We have made a recommendation about this.

People told us they received effective nursing and personal care. Induction procedures for new staff were robust; however, some staff had not completed refresher training in essential subjects such as food hygiene and fire safety.

Staff told us they were supported in their work by managers and had one-to-one sessions of supervision, although only four had received an appraisal of their performance in the past year.

Care plans were reviewed regularly and provided comprehensive information to enable staff to meet people’s essential care and support needs. However, one person’s care plan lacked information about the support they needed when they became agitated.

A limited range of activities was provided, although these were not always well attended and were still being developed to meet people’s individual interests.

There were usually enough staff to meet people’s essential needs, although some people felt staff were rushed.

Safe recruitment procedures were followed to help ensure only suitable staff were employed. However, appropriate checks had not been completed for a volunteer who supported people with activities.

Staff protected people from the risk of abuse and the registered manager conducted thorough investigations into allegations of abuse.

People received their medicines as prescribed from staff who were suitably trained. They were supported to access other healthcare services when needed.

People’s rights and freedom were protected in line with legislation. They were involved in planning their care and support; and their privacy was protected while personal care was being delivered. At the end of their lives, people received appropriate care to have a comfortable, dignified and pain free death.

The provider sought and acted on feedback from people. People knew how to complain about the service and the registered manager conducted thorough investigations into all complaints.

There was a clear management structure in place. Staff were organised, understood their roles and worked well as a team. They told us Inglefield was a “happy place to work”.

There was an open and transparent culture. Visitors were welcomed at any time; CQC were notified of all significant events; the home’s previous rating was displayed prominently; and staff enjoyed positive working relationships with other health and social care professionals.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

We also looked at the care plans and associated records of care for six people. Care plans were signed by the person or on their behalf by a family member. Two family members told us they were involved in their relative's care. Discussions with staff showed they knew people well. One person said of the staff, 'They oblige you in every possible way.'

People we spoke with praised the quality of the care provided. One person said, 'They look after me very well'. A family member told us they were 'very happy with the care' provided to their relative. Risks were identified, assessed and managed through care plans and communication was effective between staff.

There were effective systems in place to reduce the risk and spread of infection. People told us they were satisfied with the standards of cleanliness in the home. One person said, 'I've got a lovely bed and everything's clean'.

There were sufficient staff to meet the needs of the 42 people living at the home. We looked at duty rosters, which showed staffing was organised in a way that ensured people's needs were met. For example, an additional late shift had been introduced to accommodate the wishes of people who preferred to go to bed later in the evening.

People's personal records were accurate and fit for purpose. We found they were comprehensive and centred on the person. They were reviewed at least monthly and updated when a person's needs changed. Records were kept securely and could be located promptly when needed. They were kept for the appropriate period of time and then destroyed securely.

We also looked at the systems used by the provider to assess and monitor the quality of service that people received. We found that the provider conducted regular surveys of residents and their families and consulted with people about how the service could be improved. Improvements had been made following these consultations, including an increase in the level of activities that people could access. We looked at the provider's internal audits, including their arrangements for auditing medication. This identified two issues that had been addressed. We also looked at the most recent complaints that had been made. We saw that these had been investigated and appropriate action had been taken.