Strathmore Nursing Home

Strathmore Nursing Home is a care home providing personal care to older people and people living with dementia. The service accommodates 32 people in one adapted building, over 3 floors. At the time of the inspection 28 people were using the service.

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

Systems for managing medicines were not always safe. Systems in place to monitor the running of the service were not always followed in a timely manner. Environmental risks were not always identified and mitigated effectively.

People’s personal information was not always stored securely. Systems for ensuring staff competencies were not always in place. We made recommendations about management of staff and protecting people’s personal information.

Staff were trained to recognise potential risks and signs of abuse. Risks to people's safety and wellbeing were assessed and reviewed by managers. Staff used personal protective equipment (PPE) appropriately when supporting people.

The provider had procedures in place to receive feedback on how to improve support. Lessons were learned when concerns were raised, and these outcomes were communicated to staff. Staff worked well in partnership with other agencies to deliver effective support.

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 and update

The last rating for this service was good (published 7 January 2020).

Why we inspected

We received concerns in relation to the management of medicines and staff competencies. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of the full report. The provider has taken action to mitigate the risks identified.

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

Enforcement and Recommendations

We have identified breaches in relation to managing medicines safely, environmental risk management, and the good governance of the service at this inspection.

We have made recommendations about improvements in monitoring of staff and the storage of personal data.

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.

Visitors were supported to wear PPE and sanitize their hands.

Visitors were strictly limited, even when visits are through the window.

Clear signage was displayed around the home.

Staff always wore full PPE within the home.

People with symptoms were isolated and barrier nursed.

Staff were supported to socially distance during breaks.

The service ensured tests had been carried out by the hospital prior to admission.

Isolation was in place for new admissions to help ensure the risk of cross infection was minimized.

There were designated areas for donning and doffing PPE.

Good, clear signage was visible around the home regarding donning and doffing PPE and handwashing.

Whole home testing was carried out.

Further information is in the detailed findings below.

Strathmore Nursing Home is registered to provide residential and nursing care for up to 30 people, over two floors. The home is situated in a residential area close to Bolton town centre. At the time of the inspection there were 26 people receiving a service.

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

People felt safe at the home. Systems were in place to deal with any concerns raised and all staff completed training around safeguarding adults and children. General and individual risk assessments were completed, reviewed regularly and updated as required. Health and safety checks were in place. Medicines were managed safely at the home. The home was clean and fresh, with no malodours present.

Staff were recruited safely and there were sufficient staff to meet the needs of the people who used the service. Staff training was on-going.

People’s needs were assessed thoroughly prior to admission. All relevant care plans were in place and these were reviewed and updated as required.

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 were well cared for and supported. Staff were kind and compassionate and displayed a good knowledge of the people they supported. People were treated with sensitivity and their dignity and privacy were respected at all times.

Care files included information about people’s preferences, wishes and choices. There were regular residents’ and families’ meetings and a monthly newsletter was produced. People’s communication needs were recorded and addressed by staff.

A range of stimulating activities were on offer and people were encouraged to follow their interests. The home welcomed visits from various local religious groups. The service worked well with other professionals and agencies. People were supported at the end of their lives according to their wishes.

People felt the registered manager was approachable and accessible and also felt they could raise any concerns at any time. There had been no recent complaints received by the service. A number of compliments had been received.

There were regular audits and checks throughout the home to help sustain quality of service provision. Regular questionnaires were completed by visiting professionals, family members and people who used the service to gain their feedback.

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 16 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.

Strathmore Nursing Home is registered to provide residential and nursing care for up to 30 people. The home is situated in a residential area close to Bolton town centre. At the time of the inspection there were 25 people receiving a service, three of whom were being nursed in bed.

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.

People told us they felt safe at the home. Appropriate individual and general risk assessments were in place and updated as required. There were sufficient staff to meet the needs of the people who used the service and staff were recruited safely.

There were appropriate safeguarding and whistle blowing policies in place and staff were aware of the procedures for reporting any issues and confident to follow the procedures.

There were safe systems in place for the management of medicines. Accidents and incidents were recorded and monitored and appropriate health and safety measures were in place.

Staff induction was thorough and there was a programme of on-going and refresher training.

Nutrition and hydration needs were recorded and people’s needs monitored and special dietary requirements adhered to. The meal time experience was unrushed and people were given the assistance they needed and choices of food and drink were available.

Consent forms were used and signed appropriately. The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us staff were kind and caring. We observed interactions within the home throughout the day and saw that they were friendly and respectful.

Visitors told us they were made welcome and people who used the service and their relatives were involved in all aspects of care planning. Staff were aware of the importance of dignity and people’s dignity and privacy was respected.

People’s wishes for when they were nearing the end of their lives were recorded. Staff had undertaken training in end of life care and the service endeavoured to respect people’s wishes.

Care plans included relevant health and personal information and were person-centred. Activities were offered in the form of group activities or one to one interactions, depending on people’s needs and preferences.

The complaints policy was on display and was outlined in the service user guide. The service had received a number of compliments, but no recent formal complaints.

The registered manager had an ‘open door’ policy and people who used the service, visitors, staff and other professionals found her approachable.

Team meetings were held regularly and there were regular staff supervisions. These helped ensure staff felt fully supported in their roles.

There were a number of audits and checks undertaken to help ensure continual improvement in service delivery. The home linked into a number of local groups to ensure they kept up to date with good practice.

We saw that efforts were made to include people who used the service in decisions around their care.

We looked at four care plans, which included information about health, care needs, background, likes and dislikes. There were appropriate risk assessments and monitoring charts which were reviewed and updated on a monthly basis.

We spoke with two people who used the service. One person told us 'The staff are polite and kind'. Another person said 'Strathmore have not nursed me back to health, they have loved me back to health.'

We spoke with three visitors at the home. One person told us 'Communication is excellent, I've been very pleased with the care that X has had.' Another visitor said 'I like the homely atmosphere.' A third person told us 'Staff are terrific, there isn't one who isn't helpful.'

The home had safeguarding procedures which were followed appropriately. Staff had an awareness of safeguarding issues and were confident of recognising, reporting and recording concerns.

We spoke with three staff members who felt they were supported in their employment, learning and development.

We saw the complaints procedure which was clearly displayed within the home. Quality assurance checks were regularly undertaken and issues highlighted and addressed in a timely way.