Speirs House

Speirs House is a care home providing personal and nursing care for up to 36 people. At the time of our inspection, there were 33 people receiving support with personal care. The service supports older people living with dementia and having nursing needs. The home is arranged over 1 floor.

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

Although staff knew how to identify and report abuse, some safeguarding incidents at the service were not escalated in a timely manner to keep people safe. This was a breach of Regulation 13.

There was a lot of change for the better made at the service since our last inspection. However, more improvement was needed to oversee the quality of care being provided. Although staff's recruitment was safely undertaken, the DBS checks were not repeatedly carried out to check staff's fitness for the job. We made a recommendation about this.

Records in relation to the mental capacity assessments and people's cultural and religious needs required reviewing. A new system for monitoring staff's performance on the job is to be implemented by the provider.

People felt safe because staff knew their care needs well. The staff team was stable and there was enough staff to meet the needs of the people they supported. Risk assessments were in place to guide staff on how to mitigate the potential risks to people. People received their medicines as prescribed. Staff were aware of how to effectively manage risks associated with infection control.

The home environment felt welcoming. Staff effectively shared information within the team to support people's well-being. Staff felt well supported in the job and received training relevant to their role.

There was a stable management team at the service to monitor the care being delivered to people. People told us they had effective communication with the management team. Staff were caring and kind to the people they supported, and their choices were adhered to.

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 28 June 2022) and there was a breach of Regulation 17 (Good governance). At this inspection enough improvement had been made and the provider was no longer in breach of Regulation 17 (Good governance). However, we found a breach of Regulations13 (Safeguarding service users from abuse and improper treatment).

You can read the report from our last inspection, by selecting the 'all reports' link for Speirs House on our website at www.cqc.org.uk.

Why we inspected

This inspection was prompted by a review of the information we held about this service and when the service was last inspected.

This was a focused inspection and the report only covers our findings in relation to the Key Questions Safe, Effective and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Speirs House is a ‘nursing home’ providing care to up to 36 people. 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. The service provides support to people living with dementia, mental and physical health needs. At the time of our inspection there were 31 people using the service.

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

People did not receive safe care consistently. We received mixed feedback about the quality of care provided at the service. Comments included, “We do need more staff here. It is a lot of work for the number of staff that are usually on duty.”; “I feel safe because I have a call-bell. There is always someone around” and “I do feel that my relative is safe here.”

We identified a breach of regulations in relation to good governance. People were at risk of avoidable harm due to a lack of adequate oversight on the quality of care provided and the management of the home. Staff knew how to identify and report abuse. However, safeguarding incidents at the service showed staff did not understand their responsibilities to escalate concerns to keep people safe.

People had experienced poor care delivery because of high staff turnover and use of agency care staff. Staff were recruited safely and underwent induction before they started the job. However, agency care staff did not receive adequate induction which caused people to experience poor care delivery.

People received their medicines when required and any errors were identified and resolved. Staff did not always support people to access health services in a timely manner. Staff received training required for their roles. However, staff morale varied due to the turnover and changes in management.

The provider did not always effectively use the systems in place to monitor and drive improvement in the quality of care. Changes in management caused anxiety in people using the service, their relatives and staff. The provider had put plans in place to improve care delivery and we needed to see consistent and embedding of good practice and a stable management team.

Staff followed the provider’s processes in line with best practice guidelines regarding the prevention and control of infection including those associated with COVID-19.

People were involved in planning for their care. Care plans were reviewed and updated to ensure people received care appropriate to their needs. Staff had guidance which they followed to support people with their needs and choices. The provider worked with other agencies and social and health professionals to meet people’s needs.

People were treated in a manner that promoted their dignity and maintained their confidentiality and privacy. People knew how to make a complaint.

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

The last rating for this service was good (published 09 January 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to good governance at this inspection.

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.

We found the following examples of good practice:

The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infection. There was another entrance with testing available to separate visitors from residents and staff.

The provider enabled residents to keep in touch with family members and people's friends through regular phone calls, emails and video conferencing. The residents liked to use mobile video calls to speak to their relatives.

Staff had successfully adhered to infection control and COVID policies so that no challenges or difficulties had been experienced throughout the pandemic in relation to staffing in this service.

All visitors were asked to complete COVID-19 lateral flow test. All visiting professionals on the national testing programme were asked to show proof of their recent COVID-19 negative test.

On entry all staff and visitors were provided with Personal Protective Equipment (PPE). This was to ensure the safety of staff and people. People were supported to see their family in the garden during summer and markings were done in the garden to ensure social distancing.

To ensure people's well-being the provider performed monthly wellbeing assessments using a tool and people's mental state was monitored. If there was a decline in the mental state of people, they were offered extra support.

The home had multiple clean areas for staff to don and doff (put on and take off) PPE.

Our observations during the inspection confirmed staff were adhering to PPE and Infection Control guidance.

The provider had ensured residents who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing.

Further information is in the detailed findings below.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to be protected against abuse as staff were aware of how to identify, respond to and escalate suspected abuse. Staff confirmed they were confident to whistleblow should the provider not take appropriate action.

People continued to be protected from available harm as the provider had systems and processes in place that identified risks and gave staff clear guidance on how to support people when faced with those risks.

People’s medicines continued to be administered in-line with good practice and as the prescribing Pharmacist intended.

The provider continued to ensure there were adequate numbers of suitably vetted staff to keep people safe. Records confirmed, staffing levels were at safe levels to meet people’s needs.

The service had clear guidance for staff in mitigating the risk of cross contamination. Staff confirmed they had access to adequate amounts of protective equipment to manage infection control.

People continued to be supported by staff that had undergone a comprehensive induction process to ensure their competency was assessed. Staff received on-going training to effectively enhance their skills and experiences. Staff also reflected on their working practices, through regular supervisions and annual appraisals.

The service was aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA). People's consent to care and treatment was sought prior to being delivered. 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 continued to be supported to access a wide range of food and drink that met their dietary needs and requirements. People with specific specialist requirements were catered for. People were supported to access a wide range of healthcare services to monitor and maintain their health and well-being.

People were supported by staff members that treated them with respect and were aware of the importance of maintaining their privacy and dignity. Staff had sufficient knowledge of the importance of encouraging people to remain as independent as possible.

People’s care plans were person centred and contained adequate information to guide staff in delivering care and support that met their needs in line with people’s wishes. Care plans were reviewed regularly to reflect people’s changing needs.

People were supported to access a wide range of activities both in the service and in the local community.

People were aware of the provider’s complaints policy and how to raise their concerns. Complaints were managed in such a way to reach a positive resolution in a timely manner.

People spoke positively about the registered manager and management team as a whole. The registered manager was a visible presence within the service and people confirmed they felt she was approachable.

The registered manager continued to undertake regular audits of the service to drive improvements. Issues identified during the auditing process were actioned in a timely manner.

People, their relatives, healthcare professional and staff’s views continued to be sought through regular house meetings, quality assurance questionnaires and a comments box. Views gathered were reviewed and where possible action taken to implement positive changes.

Further information is in the detailed findings below.

Speirs House provides accommodation, personal care and nursing for up to 35 older people. There were 33 people living at the home on the day we visited.

The home had a registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that people were able to speak to the registered manager or deputy at any time.

Staff were familiar with risks people faced and knew how to manage these, but the new systems the provider used to store details of the risks and management plans were not operating very well on the day of the inspection. As a result all the necessary information about the management of risks was not easily retrievable. The registered manager took action to remedy these IT concerns after our inspection and sent confirmation of this.

We saw that regular checks of maintenance and service records were conducted to make sure these were up to date.

There were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Personal care was provided in the privacy of people’s rooms. People were supported at the end of their lives and had their wishes respected.

People’s needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints. People told us they felt happy to speak up when necessary. From our discussions with the registered manager and deputy, it was clear they had an understanding of their management role and responsibilities and the provider’s legal obligations with regard to CQC.

The home had policies and procedures in place and these were readily available for staff to refer to when necessary. The provider had systems in place to assess and monitor the quality of the service. Weekly, monthly and annual health and safety and quality assurance audits were conducted by the home.

People told us that they liked the service and said "staff are caring", "I am well looked after", "my needs are well catered for", "staff care and look after us", "there's a good atmosphere here" and "plenty of activities". We received mixed comments about the food, some people thought it "very good", others that it was "good" and one said it was "awful". One person said "the food is just like home made".

Staff told us that there had been improvements in the last few months. They said that they had the training and support they needed to carry out their role. Staff were aware of who to report to and how to raise issues or concerns.

We saw that the furniture and furnishings were clean. The atmosphere was calm and relaxed and staff interacted with people in a kindly manner and were responsive to their needs.

People said "staff come when I call", "I have all I need in my room", "staff listen and give me the help I need" and "staff are lovely". Visitors had been informed of the safeguarding concerns and actions the provider had taken to improve things at the home.

Staff told us that they had completed training in safeguarding and where aware of their responsibility to report concerns and issues to the manager and or the local authority. One member of staff said "there's been changes, which are good". All staff said there were enough staff to meet the needs of the people who live at the home. Staff had attended staff meetings and been informed of the safeguarding concerns and actions being taken to improve the services provided.

We saw that the providers action plan for improving the services was displayed on a noticeboard near the entrance of the home. Another copy of the action plan was displayed in the staff office and staff we spoke with knew it was there and what was being done to make sure the required improvements were made.

Staff showed detailed knowledge of people's needs and how they should be met.

People said "I'm happy living here" and "I have all I need in my room". Comments about the food were positive. Relatives said that they had visited and chosen the home and were generally happy with the care and support provided. Although two people said the recent staff changes were affecting the quality of care given and said "while agency staff are available, they do not provide the same level of care and do not know the little things that previous staff did to make life better here".

Staff said there were enough staff to meet the needs of the people currently living there, while nurses said having another nurse on duty would ensure emergencies were dealt with and allow them to review and update care plans. Staff said they had training that helped them carry out their role.

We found improvements were needed in safeguarding people who use the service, the storage and recording of medication, staff training and processes to check competency, recording and updating of care plans, the arrangements for seeking the views and opinions of people who use the service and responding to them, practices to protect people from the risk of infection, the decor of communal areas and some bedrooms and for there to be a manager who is registered with the Care Quality Commission.

Comments about the food were positive including "the food is very good", "I enjoyed lunch", "the food is good", "we are given a choice of food" and "we have enough to eat".

People told us "the staff are very very lovely", "staff listen and help", "staff are kind" and "there are enough staff". Relatives said "the staff are lovely, always smiling", "I am made to feel welcome", "they keep me informed and up to date", "it's very good here" and "staff provide the care and support needed".

There were mixed comments about activities with some people saying they had enough to do while other people said they stayed in their rooms. People did say that they missed being able to go to the local shops, bank and post office since the driver had been off work.