All inspections: Nesfield Lodge - Care Quality Commission

This inspection took place on 23 November 2015 and was unannounced.

Our last inspection took place on 6 October 2014, at that time we found the service was not meeting the regulations relating to consent. The registered person did not have suitable arrangements in place to show they were acting in accordance with the Mental Capacity Act (MCA) 2005. On this visit we checked and found that the home was meeting the required standard.

Nesfield Lodge provides care for up to 44 people. There were 39 people living at the home at the time of the inspection. At the time of the inspection, the service had a registered manager. 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 we spoke with told us they enjoyed living at Nesfield Lodge and were very complimentary about the staff who supported them. They told us they felt safe, enjoyed the food and received good support with their health needs. The home had recently introduced a new device called ODE. (This is an innovative new product for use around the home, using fragrances to promote appetite to offer discreet reminder of mealtimes throughout the day this has been created for people living with dementia, including alzheimer’s.) The home had been using this with two people in order to help them put on weight. Through the provider’s auditing systems we saw both people had an increase in appetite which subsequently meant they had both put on weight.

People consented to care and had the freedom to make their own choices. People were relaxed in the company of staff. Staff interactions were friendly, respectful and caring. Visiting relatives were happy with the standard of care and told us the service was well led.

People’s individual care plans included information about who was important to them, such as family and friends. We saw people had varied individual interests they engaged in and were supported to be involved in a lot of activities in the home.

Staffing levels were sufficient to ensure people were supported with all their care needs and activities. The home had a variety of activities within the home and in the community to ensure that people were stimulated throughout their day. This included a five pet ‘hen coop’ area directly outside the ground floor lounge. This provided a source of enjoyment for several of the people living at the home, especially one person who spent a significant amount of time outside when previously they had been reluctant to do so. This meant that the home was providing a stimulating and meaningful activity to people in the home.

Staff understood how to safeguard people and knew the people they were supporting very well. Medicines were managed consistently and safely through an online system.

People lived in a safe environment. Rooms were decorated to individual taste and people could choose what items to keep there. The homes décor was vibrant, light and had meaningful pictures, many with textured finishes. People used the textures and hand rails to help find their way around the home.

Information for people was displayed in the home, this included leaflets about people’s rights, standards people should expect and customer surveys results.

Staff we spoke with told us they were well supported by their colleagues and management. The staff received appropriate training, supervision, appraisal and observations around their practice which meant that staff had the right skills and knowledge for their role.

Everyone we spoke with was complimentary about the registered manager. Staff told us the home had made positive changes over the last year. People had the opportunity to comment on the service and influence service delivery.

This inspection, which was unannounced, took place on 6 October 2014. At our previous inspection of November 2013 we found the service to have met the regulatory requirements in each of the outcome areas we looked at.

Nesfield Lodge is a purpose built home providing care for up to 44 people specialising in dementia care. The home is on two levels, the first floor being serviced by stairs and lift. All rooms have en-suite facilities and both floors provide communal lounge and dining areas. On the day of our inspection there were 42 people living at the service.

There was a registered manager in post at the time of our 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.

People told us they felt safe at the service. Staff were knowledgeable about how to keep people safe and prevent them from avoidable harm. However, we noted one person was prevented from accessing the outside space due to concerns about their safety. The registered manager told us they would look at risk assessments to support the person to take managed risks.

Staff were employed in sufficient numbers to care for people safely though at busy times this meant they did not have time to engage with people other than when delivering care interventions.

Medicines were managed safely. People received their medicines as prescribed. We found the medicines storage room to be too hot on the day of our visit. Records of temperatures showed this had been the case during hot weather. The provider had agreed to install an air conditioning unit to ensure medicines were stored at safe temperatures at all times.

The Care Quality Commission is required by law to monitor and report on providers’ adherence to the requirements of The Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS). Where one person’s freedom had been restricted in order to keep them and others safe a DoLS authorisation had been sought and was in place. However, another person was being prevented from accessing the garden but this had not been considered as a DoL.

Some best interest decisions had been recorded where people were involved in safeguarding protection plans but other people who lacked capacity to make decisions did not have best interest decisions recorded. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Staff told us training had improved at the service following the appointment of the registered manager. The registered manager explained they had used a training matrix to identify those staff requiring refresher training and had made arrangements for them to attend relevant training.

People appeared to enjoy the food provided at the service and were supported to maintain a balanced diet. Where people required additional support to maintain a healthy dietary intake this information was shared across the whole staff team to ensure arrangements were in place to help them access an enriched diet.

Where people needed additional support from health professionals to maintain their physical and mental health referrals were made in a timely way.

People we spoke with and their relatives told us they were satisfied with the care they received. Staff were clear about the need for people to receive a high standard of care and told us they would challenge if this was not the case.

Where life histories were obtained this helped staff better understand people, their values, interests and personal preferences. In some cases, where the person was not able to inform staff about their lives, relatives were involved in preparing life histories. However, we found some people did not have life stories recorded.

People were treated with dignity and respect. We noted two occasions where people did not receive consistent support. We raised this with the registered manager who told us they would ensure staff were clear about the need to provide consistent responses when people were becoming anxious or distressed.

Although the registered manager was working to improve the activities available to people these were limited at the time of our visit. Some people told us the activities on offer were not appropriate for them.

Relatives told us they were confident they could raise any concerns and these would be addressed. People were invited to attend ‘residents meetings’ in order to provide feedback about their experience at the service.

Everybody we spoke with provided positive feedback about the registered manager and the impact they had on the service since commencing in post.

Staff were clear about what was expected of them and told us communication and morale was good.

Audits were effective. Where necessary action plans had been drawn up to address shortfalls in the service.

People appeared very comfortable and all were well dressed and clean. One person told us "they help me with washing and dressing and are very kind".

Care plans that we read contained assessments of need and outlined how needs would be met. The assessments were regularly reviewed to ensure that they reflected people's up-to-date needs.

Most areas of the home that we saw were clean and fresh. Two people who lived at the home commented on the high standards of cleanliness. One person said "they keep everywhere beautifully clean." Another person said "the cleaners do a good job of keeping the place clean". However we did note some backlog maintenance which impacted upon service users' comfort and wellbeing.

We looked at medication charts and reviewed records for the receipt, administration and disposal of medicines and conducted a sample audit of medicines to account for them. We found that records were complete and that people had received the medication they had been prescribed.

Staff spoken with said that during the day they always had enough staff to support the people who lived at the home but during the night this may not be so. We also discovered that supervision and appraisals had not been undertaken in accordance with the provider's policy.

The provider had a complaints policy for ensuring complaints were recorded and fully investigated but our inspection revealed that the policy was not universally followed.

At the time of our visit there were 39 people living in Nesfield Lodge. Because people living in the home were unable to tell us their views on how they were cared for, we used a formal way to observe their experiences.

Throughout the observation staff treated people with dignity and respect. We observed examples of good communication skills such as a positive, friendly and warm approach. There was good interaction, humour and banter between staff and people who lived in the home. This helped to create a relaxed and friendly atmosphere.

We spoke with two relatives who spoke positively about Nesfield Lodge. One relative told us; 'Relatives are given the opportunity to influence what happens in the service through relative's meetings as well as being able to talk to the staff or manager at any time' Another relative explained; 'The staff know when they can leave [my relative] to be independent and when they need to step in to help.'

We reviewed a sample of five staff files and found appropriate checks had been undertaken before staff began work. All the staff files reviewed contained copies of application forms, interview notes, references and proof of identity. We saw Criminal Record Bureau clearance checks had been carried out for all care staff.

During our visit we saw the service had effective systems in place to regularly assess and monitor the quality of service that people received. We saw regular audits were undertaken by the manager.

All the people we spoke to said the staff looked after them well. Comments included, 'They are very caring' and 'They do a good job'. Our observations showed us that people were responded to promptly when they needed staff assistance and that there was good supervision of people in the communal areas of the home.

People who use the service said they had enough to do at the home. One person said, 'You can do what you like'. It was clear from other people's responses that they were happy to be involved in activity that was provided.

People who were able to told us they felt safe at the home. We saw that people were happy and comfortable with staff in their interaction with them. There was positive interaction, good eye contact; people were clearly getting on well with the staff, laughing and joking with them, asking for things, approaching them, not afraid to speak their mind.

All the staff we spoke to said they had enough staff to meet people's needs properly. One said, 'We always have enough staff and sickness is covered properly now with overtime, agency or bank staff'.

Relatives of people who use the service said they felt people were treated with dignity and respect and were given choices about the way in which care was given. Relatives said they were kept fully informed and involved on people's care needs and any changes. They also said,

'They respect Mum's privacy, treat her with great respect'

'No problems in that area'.

People's relatives told us they were happy with the care and support provided at the home. They also said there was plenty of activity for people to get involved in. Their comments included:

'Always looks well cared for and clean, her hair is always nice'

'They keep her clean and tidy, see to her well'.

Health professionals were very positive about the service. Their comments included:

'The environment is very stimulating for people, it looks great'

'They ask for advice, listen and act on it well'.

People who use the service said they enjoyed the food in the home. They said:

'Very nice'

'Enjoyed that'.

People who use the service were not able to tell us if they felt safe or protected from abuse. However, through our observations, we saw that people seemed confident in their surroundings and in their interactions with staff. They approached staff when they needed to and made good eye contact with them.

One relative we spoke to said there always seems to be enough staff to meet people's needs. However, other relatives did not think there were enough staff and said they had concerns that people were not always properly supervised. One said, 'Only concern is staffing levels, don't think they have enough, three care staff on each floor just doesn't seem to be enough to supervise people properly. Mum has had people wandering in to her room and she doesn't like it'.

A health professional also said, 'Would be in my top ten homes in the city for people with dementia, if the staffing levels were increased'.

Relatives of people who use the service and health professionals said staff seemed well trained to carry out their job.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Nesfield Lodge

All Inspections

23 November 2015

During an inspection looking at part of the service

6 October 2014

During a routine inspection

18 November 2013

During a routine inspection

21 February 2013

During a routine inspection

1 September 2011

During an inspection looking at part of the service

4 April 2011

During a routine inspection

Reports under our old system of regulation