Archived: Needwood House Nursing Home

Needwood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Needwood House provides accommodation, personal and nursing care for up to 33 people some of whom are living with advanced dementia. At the time of the inspection, 32 people were using the service.

People’s experience of using this service:

We completed an unannounced inspection at Needwood House on the 05 March 2019. There was a registered manager in place who was present at the time of the inspection. 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.’

During our inspection we found, whilst people told us they felt safe we found people were not always protected from the risk of harm.

People were not always supported in a consistently effective way. We found people at high risk of choking and dehydration were not receiving timely review and risk assessments were not reflective of their needs. There were not effective systems in place to safely review the quality of the care being provided and highlight areas of risk.

Whistleblowers were not always supported to confidentially raise concerns regarding the service and the service did not always promote a culture of openness. Whistleblowing is the term used when someone who works for an employer raises a concern about risk or wrongdoing which creates a potential for harm to people who use the service, colleagues or the wider public.

People were treated in a caring way and staff had a good knowledge of the people they supported.

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 supported this practice. People were supported to be involved in decisions regarding their care where possible.

There were sufficient staff to support people. People did not have to wait for care to be delivered and when needed, people were supported on a one to one basis in accordance with their needs.

Staff were provided with training and supervision. Training was reviewed and additional training offered based on the needs of people living at Needwood House.

People were supported to receive their medicines in a safe and timely way by trained staff.

People were supported in a clean environment where good infection control practices were consistently applied.

People had access to adaptive equipment to maximise their independence and promote their dignity.

People were encouraged and supported to engage in social activities of their choosing both inside and outside of Needwood House.

Rating at last inspection:

At our last inspection on the 24 March 2016 we rated the service “Good”. At this inspection we found continued improvements were needed to ensure a consistent quality of care and the rating has declined to “Requires Improvement”. The service met the characteristics of “Requires Improvement” in the key questions of “Effective” and “Well led” and “Good” in "Safe", “Caring” and “Responsive”. This is the first time the service has been rated ‘Requires Improvement’ overall.

More information is available in the full report below.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

Needwood House provides accommodation, personal and nursing care for up to 33 people some of whom are living with advanced dementia. At the time of the inspection, 33 people were using the service. There was a registered manager at the service. 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 received their medicines when they needed them but some improvements were required to ensure medicines were recorded and managed effectively. Improvements were needed to ensure the registered manager’s quality monitoring checks covered all areas of the service to identify shortfalls and make improvements where necessary.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. People’s care was regularly reviewed to ensure it continued to meet their needs. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Where people were restricted of their liberty in their best interests, for example to keep them safe, this was authorised in accordance with the legal requirements.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People were supported and encouraged to eat and drink enough to maintain a healthy diet. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was an open and inclusive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. Staff felt supported by the provider and management team and were encouraged to give their views on the service to improve people’s experience of care.

As part of the inspection we asked the following questions:

Is the service safe?

People who used the service were supported in close proximity to each other within the communal areas. There were 32 people using the service and 24 staff most of whom were present within the communal areas for most of the day. To ensure that people who used the service remained safe the provider had arranged for them to be appropriately supervised. The provider had assessed each person's individual needs resulting in 14 people being supervised by a staff member on a one-to-one basis. Staff monitored people and were immediately available to respond to any episodes of challenging behaviour that people may display. A visitor told us: "There are always plenty of staff around and they respond really well when people become agitated or aggressive. The staff are good at making sure everyone comes to no harm." Where people were at risk of harm the provider had recognised this and made appropriate referrals to the relevant safeguarding bodies.

Is the service effective?

Each person had a care plan in place which had been developed from an assessment of the person's needs. Risk assessments and care plans were reviewed monthly to ensure that care and support remained effective. Relatives of people who used the service felt involved and informed. A person said: "I give this home a top rating. X receives excellent nursing care here."

Is the service responsive?

The provider responded to individual needs of people and referred people to relevant professionals where required for treatment, advice and support. Relatives felt that they were involved and were listened to. A person said: "If ever I need anything for X it is carried out. I made a suggestion the other day to make X more comfortable and it was done straight away."

Is the service well-led?

Staff we spoke with felt supported by the managers and providers. On-going training and supervision was provided to staff to equip them with the knowledge and skills to carry out their job. A staff member said: "I can go to one of the nurses or the manager and they are all helpful."

Relatives told us that they felt comfortable approaching the staff, manager and providers and knew that they would try and help. A relative said: "I get on very well with all of the staff and I know I could raise any concerns I might have. I have done this in the past and it has been addressed." The provider monitored the quality of services that people received and made improvements where required.

Another person told us: 'The food is gorgeous. They ask me what I want so you don't get anything you don't like. I can't find any fault. They look after me OK and I can have the choice of a bath or shower'.

We spoke with two families of people living at the home. They were both very positive about the care their relative received: 'She needs 1:1 care and that's what she gets. We are very lucky she is here.' 'He has done really well since he's been here. He has put on weight. The staff are good, they know everything about him.'

We observed that everyone was treated with consideration and respect. We found that care plans had been updated since our previous visit and reflected the care delivered. People's records had been re-organised and updated, with a summary file available for staff to read essential information about people's care.

Staff had acted in accordance with regulations when there had been an incident of aggression which involved two people who lived at the home.

We saw that the way people might use the spaces within the building had been reviewed. Some changes had been made which had increased people's well-being.

The people who lived at Needwood House could not tell us about their care. We spoke with three families during the inspection and to another family afterwards. Three families praised the care their relatives received. They described it as: 'Excellent' and told us their relative had settled well at Needwood House. One family of a person who had left the home told us they had been unhappy with their relative's care.

We saw that some staff provided considerate and respectful care to people. Other staff would have benefitted from guidance about the way they supported people.

When we looked at care plans we found thorough assessments and clear guidance about caring for people. The care we observed did not follow the guidance. Some care workers we spoke with did not know about information contained in the care plans.

We were aware that there had been instances of aggression between people who lived at Needwood House. We had received information that people who were mobile could not always be prevented from hurting other people. We found that the way the building was used contributed to people's vulnerability.

Some records we looked at during our visit contained inaccurate information.

Some people living in this home were mobile and wanted to move around the building. Some people had impulsive and unpredictable behaviour. People did sometimes experience falls and accidents. The relatives we spoke with described their relief that the staff at Needwood House could manage complex situations so that people could be maintained in a mostly calm and safe environment. We found that the managers at Needwood House always reported serious incidents to the adult safeguarding team and to us. There had been no incidents where staff had been found to be abusive or neglectful to people. A social worker told us she had always seen positive interaction between the staff and the people who lived there and that the staff "manage the client group well".