Risby Hall Nursing Home

Risby Hall Nursing Home is a residential care home, providing personal care and accommodation as well as nursing care for up to 34 older people, including people living with dementia. The home was across extended ground floor accommodation which was wheelchair accessible. There were 26 people living at Risby Hall Nursing Home when we inspected the service.

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

There were enough, suitably recruited staff who worked well as a team to ensure people received the care and support, they needed.

Staff had a good understanding of how to recognise and report potential harm or abuse and were confident the manager and provider would take action in line with local safeguarding procedures.

Risks were generally well managed and mitigated against. Improvements were needed to ensure where people were at risk of developing a pressure ulcer any equipment in place to help was being used correctly. For one person, not all appropriate mitigating action was being taken where they had lost weight. Both of these concerns were addressed quickly by the manager to ensure people were safe.

Staff received an induction and ongoing training and support to fulfil their role and extend their knowledge.

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 happy living at Risby Hall Nursing Home and with the care they received. People felt safe and well-treated by staff. Staff were kind, considerate and treated people with respect and dignity.

People had plans of care in place which considered their preferences. Information was accessible to people in different ways and according to their needs to support them to make a decision. Activities and social opportunities were available to people. Complaints were managed in line with the provider’s policy. People's end of life wishes, and preferences were recorded.

Quality assurance and monitoring systems were in place to help drive improvements at the service. Some of these included seeking the views of people who used the service and others. People, their relatives and staff were positive about the approach of the new manager.

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 Outstanding (published 28 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

The last inspection to this service was in October 2014 and it was rated good overall but concerns were identified with the safety of the service in relation to medication practices. Following the inspection the provider sent us a detailed action plan telling us how they would address this. The provider has consistently provided good outcomes for people using their services and is happy to engage with us to demonstrate continuous improvements.

The service provides accommodation with nursing for up to 34 mainly older people some of whom may have a diagnosis of dementia. At the time of our inspection there were 32 people using the service.

The service had 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.

We found the service was very well managed with a number of outstanding features. We observed a good rapport between the manager and deputy manager. However the manager had recently returned after a period of absence and the deputy manager was about the go on extended leave. They told us how they planned to cover the duties undertaken by the deputy manager in their absence. The service had a full complement of nurses with the necessary skills to meet the needs of the people using the service. This meant people received continuity of care from highly skilled staff. In addition there was a well-established management team who regularly supported and audited the service to ensure it provided high quality care. The providers were constantly seeking new and innovative ways to improve the outcomes for people using the service. There was a full complement of staff and the providers actively over recruited to ensure they did not have vacant posts. This also meant new staff were supernumerary until they felt confident to work independently.

The service was brightly decorated and stimulating for the people living there. The communal areas of the service were clean and well-furnished with a homely feel. People’s rooms were individualised, with personal items such as ornaments, photos and furniture. The outside area was accessible with paths and benches, and had different areas of interest such as a memory garden.

There were lots of planned activity for people and we saw that the service was responsive to the needs of individuals. Care was personalised around individuals need and staff were visible and caring.

The service had good recruitment processes and staffs performance and conduct was monitored to ensure all staff were delivering care to the highest and expected company standard.

There were enough staff and they were managed to meet the assessed needs of people using the service. The staffing levels meant people received personalised, timely care and opportunities for regular engagement. People were kept stimulated and engaged and the providers helped ensure that people continued to live as full a life as possible and to have their wishes fulfilled.

People received their medicines as intended and there were clear processes to support staff to be able to undertake this task safely.

People felt safe and the staff were trained in key elements of their role to promote people’s health, safety and well-being. They did so in conjunction with the nurses on duty and other health care professionals. People’s needs were assessed and reviewed in line with people’s needs. This helped ensure people received the support they needed.

Staff delivered effective, compassionate care based on people’s wishes and feelings. People were encouraged to be involved in decision about their care but where they were unable staff acted lawfully and in line with the Mental Capacity Act 2005. The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when implemented correctly ensures that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process.

Staff developed meaningful, caring relationships with people and their extended families. These relationships enhanced people’s well- being and helped people feel valued. The values of the organisation were evident and staff were working to them. The service celebrated diversity and equality of opportunity and promoted this each day.

People were supported to eat and drink enough for their needs and meal times were a pleasant experience and promoted people’s well-being. Risks to people in relation to nutrition and hydration were carefully monitored and staff regularly encouraged people to drink and have regular snacks to help promote their weight.

The service took into account people’s feedback and was continuously trying to improve the service and provide an inclusive service. The service collated complaints and compliments and showed how they responded to these in a timely way. The providers were supportive of the management and trusted them to manage the service.

Some people were not able to tell us about their experiences at the home because of long term conditions which affected their ability to communicate with us.. We spent time observing the interaction between staff and people using the service. People were supported appropriately with their manual handling needs, meals and fluid intake. Staff skilfully intervened with minor conflicts that arose between individual residents. We observed people being occupied in meaningful ways with lots of positive social engagement and people being treated with affection.

We inspected four people's records. These were person centred and told staff how to meet people's needs in a way that respected their wishes and preserved their dignity. Daily notes were informative and identified changes to people's needs. However these changes were not identified in the care plans and although we saw evidence that records were reviewed it was not clear how changes in need or potential risk were recognised and addressed. We found the risk assessments gave poor attention to detail and we could not find risk assessments for falls for everyone where we would expect them to be in place.

Practices in medication had improved and we noted that staff had received additional training and their competencies had been reassessed to ensure they were suitably skilled to administer medication safety. We noted some gaps in recording but felt this was more an issue of record keeping rather than people not receiving their medication safely.

We inspected five staff records and found staff selection and recruitment processes thorough and ensured that only staff who had been properly vetted worked at the service.

There were systems in place to obtain the views of people using the service and demonstrated that they were proactive in identifying areas for improvement.

Another person told us, 'It's very nice. The staff are lovely and look after me well. If I ring the bell, they always come quickly'.

On the day of our inspection there was a very relaxed, homely atmosphere at the home, with people who lived there and the staff getting on well and enjoying each other's company. Staff treated people with respect and supported them to remain as independent as possible.

Care records were personalised and gave staff clear guidance on meeting each person's individual needs. Potential risks to people had been assessed and plans put in place to minimise the risks.

There were sufficient numbers of staff on duty to meet the needs of people who lived at the home. Staff had been through a thorough induction process and had received a wide range of training to equip them to do their job well. Training included safeguarding vulnerable people: staff we spoke with knew how to recognise if people were at risk of harm and to whom to report any concerns. People knew how to complain should they have needed to.

However, medicines were not managed well enough to ensure people received their medicines safely and as they were prescribed.