Archived: Dunollie Residential and Nursing Home

Dunollie Residential and Nursing Home is registered to provide residential and nursing care for up to 50 older people who may be living with a physical disability or dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided in an extended building across three floors and a smaller detached property on the same site. At the time of our inspection, there were 45 people using the service. Thirty-three people had nursing needs and 12 people were receiving residential care.

The service had a registered manager. They had been the registered manager since March 2016. A registered manager is a person who has registered with the 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.

At the last inspection in May 2017, we identified breaches of regulation relating to the premises and equipment and the governance of the service. This was because areas of the service were unclean and infection prevention and control practices needed to improve. Audits had been ineffective in monitoring and maintaining standards of hygiene and promoting good infection prevention and control practices.

At this inspection improvements had been made and the provider was now compliant with these regulations. The service was clean and free from malodour. Systems were in place to make sure areas of the service were regularly cleaned. The registered manager acted on feedback about the storage of some equipment and developing cleaning schedules and checks of air-mattresses and cushions.

Records relating to medicines in stock and those administered were not always accurate. This placed people at increased risk of harm. We made a recommendation regarding managing and auditing medicines.

Staff were safely recruited. We received mixed feedback about staffing levels. Some people told us staff were busy at times and not always available to provide support. The provider used a dependency tool to monitor staffing levels and we observed sufficient staff were deployed to safely meet people’s needs.

People told us they felt safe living at Dunollie Residential and Nursing Home. Staff were trained to recognise and respond to safeguarding concerns. Risk assessments contained appropriate information to guide staff on how to safely meet people’s needs.

Maintenance checks helped make sure the home environment and equipment were safe. The provider had systems in place to minimise the risks associated with a fire occurring.

Action had been taken to create a ‘dementia friendly’ environment. We made a recommendation about changes that could be made to further develop this.

Staff received regular training; they told us they preferred face to face practical training to some of the online 'eLearning' courses on offer.

New staff provided positive feedback about the support and guidance provided during their induction. Staff received regular supervision and an annual appraisal of their performance to support their wellbeing and continued professional development.

Nurses completed additional training and were supported with their revalidation requirements.

We received positive feedback about the food. Staff supported people to eat and drink enough and worked effectively with healthcare professionals to make sure people’s needs were met.

People had choice and control over their daily routines. Staff supported people to make decisions and respected people’s choices. Mental capacity assessments and best interest decisions had been documented when necessary. The registered manager appropriately applied to deprive people of their liberty when necessary.

Staff were kind and caring in the way they supported people. People told us staff supported them to maintain their privacy and dignity.

Care plans contained appropriate information and detail to support staff to provide person-centred care. Staff showed a good understanding of people’s needs and the support they required. The registered manager had introduced changes to how care plans were reviewed to make they consistently contained more person-centred information about how people’s needs were met.

Staff worked closely with professionals to meet people’s complex nursing needs. This included working with the local hospice to meet people’s needs at the end of their life.

There were a range of activities on offer and people were happy with the opportunities available to them. Staff supported people to spend their time how they chose and to pursue their own hobbies and interests.

People told us they felt able to raise and issues or concerns. The provider had a formal system in place to manage and respond to any complaints.

People told us the service was well-led and gave consistently positive feedback about the registered manager.

The registered manager and provider completed regular audits to monitor the service provided. Records were organised and there were clear systems and processes in place to oversee and coordinate the effective management of the service.

At the time of our inspection, there were 45 people using the service; 34 people had nursing needs and 11 people were receiving residential care.

At the last inspection in February 2016, we identified breaches of regulation around safe care and treatment and around the governance of the service. This unannounced inspection took place on 25 May 2017. During the inspection, the provider demonstrated that some improvements had been made and they were compliant with the regulation relating to safe care and treatment. However, we found infection prevention and control practices were not effective. We found mattresses, wheelchairs and pressure relieving equipment which were malodorous, contaminated or showing evidence of ingrained dirt. The service did not have a named infection prevention lead. We found the provider was not compliant with Criterion 1 and 2 of The Health and Social Care Act 2008 - Code of Practice on the prevention and control of infections and related guidance. This was a breach of regulation relating to the premises and equipment.

We were concerned that staff had not identified and addressed these concerns and audits had been ineffective in monitoring and maintaining standards of hygiene and promoting good infection prevention and control practices. This was the fourth consecutive inspection where we had identified that improvements were required to the safety of the service. This demonstrated that the provider’s oversight and governance was not always effective in monitoring and improving the quality of the service and in maintaining compliance with the fundamental standards of quality and safety. This was a breach of regulation relating to the governance of the service.

You can see what action we told the provider to take in relation to these breaches of regulation at the back of the full version of this report.

Staff received training, supervision and annual appraisals to support them in their role. We received mixed feedback regarding staffing levels. We observed that sufficient staff were deployed on the day of our inspection and people’s needs were met in a timely way. The provider assessed staffing levels and these were maintained at the level identified as necessary to meet people’s needs. Although we found staffing levels were safe, feedback we received showed us staff deployment did at times impact on the quality of people’s experience of living at the service.

People’s needs were assessed and risk assessments put in place to support staff to provide safe care and support. Risk assessments were generally detailed and comprehensive. We identified some examples where nutritional risk assessments had not been updated when people’s needs had changed. We found that people were weighed, but weights were not always accurately recorded. The manager showed us work they were doing to introduce a 'resident of the day' scheme to more closely monitor the care and support provided to people who used the service. They told us this would ensure people’s weights were more effectively recorded and monitored. We will review this system at our next inspection of the service.

People were supported to take prescribed medicines. Accidents and incidents were reported, recorded and analysed to identify any patterns or trends. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. We received positive feedback from people who used the service about the food provided at the service.

People told us staff were generally kind, caring and attentive to their needs. We observed that staff were respectful. However, people were not always treated with care and dignity. We found some people had malodorous rooms and were being supported to use equipment or sleep in beds that were dirty or contaminated. This was not dignified or caring.

The provider is required to have a registered manager as a condition of their registration for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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. At the time of our inspection, the service did have a registered manager. We received positive feedback about the manager who was described as approachable and responsive to feedback.

Dunollie Nursing Home is a 58 bedded nursing home. The service is located in the South Cliff area of Scarborough. It provides nursing care for up to 50 older people who may have a dementia or physical disability in an adapted and extended building and personal care and support for another eight people in a separate detached building. On the day of our inspection there were 47 people using the service.

We found that the service was not always safe. Prior to this inspection we had received information from the local authority about a person receiving a serious injury accidentally. We had attended meetings with the local authority relating to this person. We were also made aware of a second person receiving a similar injury accidentally. However, it was apparent that following the first accident the provider had not ensured that the risks of scalds was assessed and no measures put in place to prevent further injuries. We made an announced visit on 2 February 2016 to begin looking at the circumstances of the second incident to decide whether or not it could have been prevented or whether we need to take further action before continuing our unannounced inspection on 25 February 2016..

People had not worked within their competency or had the skills required to deal with the incidents of scalds. The manager had since made sure that staff received up to date first aid training.

This was a breach of Regulation 12 Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had only put systems in place to mitigate the risks to people following the second incident of scalding which meant they had not monitored the risk following the first incident. They had not put measures in place to prevent any further incidents The provider had not provided transitional support during the manager’s probationary period to assess and monitor the risks to people’s health and safety.

One incident had not been notified to the local authority immediately and CQC were not notified about the first incident for four months. This was a breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the second day of inspection on 25 February 2016 we found that staff were recruited safely and staffing levels were sufficient to meet people’s needs. When we looked at rotas we saw that staffing had remained at the same levels over time. We observed and staff confirmed that they were not rushed.

Medicines were managed safely. They had been audited by the service and a pharmacy check had been carried out. Actions identified by the pharmacist were completed.

Staff were supported by the manager and senior staff in supervision and through staff meetings. When they started work at the service they had an induction and training was carried out in a variety of ways.

There was a choice of food which was served in dining rooms or on trays in people’s rooms. Food looked appetising and people told us they enjoyed their meals. We saw that where people were at risk of malnutrition they were referred to a dietician.

We observed many positive interactions between staff and people who used the service. Staff spoke to people with respect and treated people in a dignified manner. People were encouraged to maintain their relationships outside of the service. The staff were working within the principles of the Mental Capacity Act 2005. We saw staff sought consent from people throughout the day and saw that the registered manager had made applications for authorisation to deprive some people of their liberty lawfully.

There were audits in place for aspects of the service and peoples care. Notifications had been made by the manager to CQC. There was a complaints policy and procedure which people were aware of.

There was a business continuity plan in place for the service in case of unforeseen emergencies such as fire.

People were able to tell us they had received their medication and/or their creams had been applied but this was not always reflected accurately in their records.

We found the records were not accurate and would not inform staff accurately as to what had or had not been prescribed. We have issued a compliance action in relation to record keeping.

People we spoke with told us they were satisfied with their care and treatment. We looked at their care records and found they accurately outlined the support people needed.

We spoke with staff and found they were knowledgeable about the people they were supporting. We observed interactions and saw that people were treated with dignity on all occasions.

People we spoke with told us they felt safe at the service. One person said 'The girls are very busy and usually help me when I ring for assistance'. Another person told us 'They look after me okay but I have to wait sometimes because they are so busy'.

We found that medicines were not managed in line with the prescribers instructions or in a way that promoted peoples health and well being.

We found that records, other than medication records were accurate and fit for purpose.

Although people we spoke with told us they were satisfied with their care and treatment we found inconsistencies between some people's care plans and the care and support they received.

People we spoke with told us they felt safe at the service. One person told us 'They are so kind and patient with me'

We spoke with one person about their medicines. They were happy that care staff looked after their tablets and said that they got their medicines 'at the right time.' However when we asked this person, who was prescribed one inhaler 'when required' they were unsure how often they could use it. Antiepileptic medicine for one person was not available for two days. For another person medication for a heart condition was not available for four days. Medicines for four other people were not available in the home for two days and could not be given. Overall we found medicines were not always safely handled and improvements were needed.

Staff we spoke with told us they felt supported. We were shown a new e-learning system that was being introduced at the time of our visit. The transitional arrangements made it difficult to evidence accurate training levels.

We saw that systems were in place to monitor the quality of service provision though actions plans were not always immediately implemented.

We found that records were not always accurate and fit for purpose.

People who used the service told us that they were generally satisfied with their care and treatment. One person told us 'Staff care for me kindly' and another person told us 'There are good carers'.

Relatives we spoke with during our visit told us they were happy with the care and that the staff were helpful. One person told us that they attended relative and service user meetings where they felt there was an atmosphere of inclusion and could air their views. Relatives and people who used the service told us that the manager listened and put things right.

Staff told us that they had confidence in the acting manager and that she had listened to their concerns regarding care and acted upon them.

However we found that satisfactory management systems were not in place to ensure people's welfare and safety was promoted.