Archived: Nethercrest Nursing Home

Below is a summary of what we found. The summary is based on our observations during the inspection. We spoke with thirteen of the 36 people who used the service, six staff and the registered manager.

We found that the provider had made the necessary improvements with respect to ensuring people received their medicines when they needed them. We saw care records required further improvement to show how people's needs should be met safely.

Is the service safe?

People we spoke with told us they were very happy at the home. People said that the staff met their care needs and they felt safe when staff supported them. One person told us, 'The staff are lovely; they are kind, patient and take the time to treat us well'. We found that people were happy with the care they received.

We saw that plans were in place which identified people's needs such as how to reduce risks of falling or fragile skin. However, where people had specific health needs care plans varied in the amount of detail and guidance they provided. We also saw that although information was available about how to reduce risks such as falling or fragile skin, there were gaps in the records. This meant it was not always possible to see that people had care provided consistently to avoid further risks to their welfare. We saw there were systems in place to prioritise improving those care plans for people who had specific health risks and this work was on-going. We found the manager was working with support from the provider to make the improvements.

Effective systems were in place to ensure that people's medicines were managed appropriately. People had their medicines on time and plans detailed how people's medication should be provided. We saw systems were in place to guide staff in the safe handling of medicines. Checks had been made on staff competencies to do this safely. The manager had robust weekly checks to ensure there was a supply of people's medicines and to check records were completed properly. One person told us, 'I always have my medication when I need it, I have no complaints'. We saw people had plans in place to ensure they had safe and effective pain management when they needed it.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. We saw the manager reviewed all incidents and guided staff where improvements were needed.

We saw that checks had been carried out on staff before they commenced working. The manager understood and had used disciplinary action to make sure that unsafe practice is identified and people are protected.

We saw examples of staff providing consistent safe care. We saw two incidents of poor staff performance where staff had not safely delivered people's care. We saw the manager had taken appropriate action in response to these concerns.

We saw that where people lacked capacity decisions had been made in their best interests. Staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). At the time of our inspection no applications had needed to be made.

Is the service effective?

People had their needs and wishes assessed and had been involved in choosing how they were supported.

Arrangements were in place so that people had access to health care professionals so that their medical needs could be met. People had the equipment they needed to manage such things as fragile skin and health conditions.

The manager had introduced a number of checks to ensure people's needs were being effectively met. Staff had training, were 'observed' and provided with guidance to ensure they delivered people's care effectively. Staff told us they had meetings to discuss and reflect on their practice and performance. A staff member told us, 'There have been a lot of improvements and changes in the way we work, record information and deliver care, I think things are much better'.

Is the service caring?

We saw that staff interacted regularly with people to chat or reassure them. We saw that staff noticed people, anticipated their needs and responded to them. There was an evident caring approach; confirmed by the people living there. One person said, 'The staff are the best, there might be one or two not so keen but there's always someone you can rely on'.

We saw that the manager was aware and taking action in response to staff who did not demonstrate a caring or competent approach. People said staff took an interest in them and the things they wanted to do. One person said, 'We've had a lot of nice things happening, it's good to have something to look forward to'. We saw a variety of activities was on offer for people to enjoy.

Is the service responsive?

We saw that staff regularly asked people about their care experiences as well as the things they wanted to do. We saw examples of where people's comments had been addressed by staff, such as changes to menus, arranging trips out and bringing in community amenities such as the ice cream van weekly and a visit from the armed forces.

We found that the manager had worked with people, their representatives and other external agencies to ensure people's needs were responded to properly.

We saw that staff were well informed of changes to people's care needs. We saw there were systems to monitor accidents and incidents to identify how staff could improve responses.

Is the service well-led?

The service had a quality assurance system in place. We found the monitoring of the service had significantly improved. Records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and had been involved in carrying out audits. This meant staff's understanding of standards had been enhanced and helped to ensure that people received a good quality service.

The manager had external management support to ensure that any issues related to providing care, could be addressed with priority. There had been staffing issues which had impacted on the manager's capacity to make the improvements needed.

People we spoke with told us they were happy with the care they received. One person said, "It is a nice home, staff are very nice and work hard”. People told us there had been improvements in activities since our last inspection. One person said, “They have a worker now who does activities with us, we need that and enjoy it”.

We found the choice of food for people at mealtimes had improved and we saw that staff actively consulted people about what they liked to eat. One person said, “They do offer me choices because sometimes I don’t eat well, the food is generally good”.

We found that people’s medicines were reviewed and changes made when necessary. The manager told us, “We have had some people’s medicines reviewed by their doctor because they were refusing to take them’’. This shows that the service helped to ensure people were given medicines based on their current needs and lifestyle. We found some people’s medicine records had not been accurately completed. It was not always possible to determine if people had been given their prescribed medicines.

Improvements had been made to ensure staff had received appropriate training and supervision necessary to do their job. People we spoke with told us that they had confidence in the way care staff delivered care. We saw several compliments from relatives. One relative said, "I was very satisfied with my mum’s care and all the staff treated her with respect and took good care of her”.

There had been some, albeit slow, progress on improving people’s care plans and risk assessments so that they reflected people’s specific health care needs and their personal preferences. The majority of care plans and risk assessments required re-writing to ensure sufficient information was available to guide staff.

We looked at an additional area related to records because during the course of the inspection we found that monitoring records for people at risk of pressure sores or dehydration were not consistently completed. Records for monitoring people’s fluid intake were inadequate and did not evidence that people were offered or given drinks regularly. Records were not appropriately secured to ensure people’s confidentiality. The lack of appropriate records meant we could not be sure people had the care they needed to avoid further risks to their health.

We saw that considerable improvements had been made to the way the home is monitored. This included a new system of regular audits into care practices as well as seeking people’s views.

People’s care and support were not always delivered appropriately. Care plans contained detailed information to guide staff but were not person centred and did not indicate the likes and dislikes of people.

We saw people’s nutritional needs had been assessed to include input from a speech and language therapist to establish and identify any risks. We found there was a limited choice of food and people were not consulted about what they ate. One person said, “You never know what you are going to eat until they bring it to the table.”

People appeared comfortable and relaxed around staff and each other. People we spoke with all said they felt safe. Staff we spoke with knew what to do if they suspected somebody was at risk of harm or abuse.

Some staff had not received the training and supervision necessary to do their job. People told us that they had confidence in the care staffs ability to deliver care and support suitable to the needs of the individual. One relative said, “I feel my relative is well cared for and staff treat them with respect and dignity.”

There was not an effective system to regularly assess and monitor the quality of service that people receive.

A member of staff told us ‘’ We make sure we check that medicines have been given,"

We found that improvements had been made to ensure that medicines were managed safely.

We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender. People told us that staff asked them for their consent before carrying out care. One relative said, “They are very good like that.”

We found that people received care that met their needs. People had regular access to see other health professionals, when needed. One person said, “It is alright here.”

We found that arrangements around the handling of medication were not appropriate to ensure that people received their medication as prescribed.

We found that there were enough staff to look after people at the home. Records showed that staff received regular training to improve their skills and knowledge.

People we spoke with knew how to complain. One person said, “I have told the manager before and she has sorted it out.” We found that people's comments and complaints were taken seriously.