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Archived: Netherton Green Care Home Requires improvement

The provider of this service changed - see new profile


Inspection carried out on 14 January 2016

During a routine inspection

Our inspection was unannounced and took place on 14 and 15 January 2016.

Netherton Green Residential and Nursing Home is registered to provide accommodation and support for 120 people. The home is a purpose built building and consists of four separate single storey buildings each accommodating up to 30 older people. The four units are called Saltwell, Darby House, Windmill House and Primrose. On Windmill House, nursing care was provided to people who lived with dementia and 28 people were in occupancy. Primrose provided care for people who lived with dementia and 29 people were in occupancy. On Darby House palliative nursing care was provided and 25 people were in occupancy. Saltwell provided intermediate/rehabilitation nursing care and 30 people were in occupancy. This is a step down support unit for people discharged from hospital who were not ready to return to their own homes.

At our last inspection of July 2014 the provider was not meeting two regulations that we assessed relating infection control standards and staffing levels within Primrose unit. Improvements were also required regarding the caring approach towards people and the level of interaction from staff with people who lived with dementia, on Primrose. Following our inspection the provider sent us an action plan which highlighted the action they would take to improve. Our inspection findings confirmed that improvements had been made. However we found other areas of practice that required improvement at this inspection.

There was a registered manager in post at the home. 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 were kept safe from harm or potential abuse by staff who had been trained and knew how to recognise and report concerns. Information about the risks to people’s safety were communicated and equipment was in place to meet their needs safely.

There were enough staff across the different units but staff were not always effectively deployed to consistently meet people's needs.

People were cared for by staff who had been recruited safely and who had received induction and training. Additional training was needed and had been planned to ensure they met people's needs

and kept them safe. Staff felt that they were well supported.

People's rights were met under the Mental Capacity Act 2005 (MCA), and the Deprivation of

Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority. Assessments of people’s capacity and advanced decisions made by them were known.

Most people enjoyed the meals offered. Some people were not proactively given a choice because information about meals was not provided in a way they could understand. Some people did not receive the support they needed to eat and drink sufficient amounts.

People were complimentary about the staff and described them as kind and patient. However some people’s support was not sufficiently personalised to meet their needs and preferences. People’s dignity was at times compromised because staff did not always promote choice or anticipate the needs of people whose communication was limited.

People told us that they felt that activities at the service were limited. We saw the provider was taking action to improve this.

People were given information on how to make a complaint and systems were in place to manage complaints. People felt the home was well led. There was a new management structure in place. We saw quality assurance systems had improved and had picked up a number of shortfalls which the registered manager had plans to address. However we found additional

Inspection carried out on 16 and 17 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the home.

The visit was unannounced, which meant the provider and staff did not know we were coming. We last inspected the home on 28 January 2014 and the home met the regulations we inspected.

Netherton Green Residential and Nursing Home is registered to provide accommodation and support for 120 people. The home is purpose built and consists of four separate single storey buildings, each accommodating up to 30 older people. The four units are called Saltwell, Darby House, Windmill House and Primrose.

There was a registered manager in post at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home and has the legal responsibility for meeting the requirements of the law; as does the provider.

Most people we spoke with were complimentary about the home and its staff, describing them as kind and caring. We saw examples of positive interactions between staff and people living at the home. Staff checked with people to see whether they were comfortable or needed anything. Visitors to the home told us they were made to feel welcome and staff were considerate towards them. However, some relatives and staff said that staff had less time to be able to interact positively with people on Primrose unit and our observations confirmed this. Most concerns that we found related to Primrose unit.

The home offered a number of activities both within the home and during days out. Most people told us they were kept busy and stimulated by the activities on offer, although this was not so evident in Primrose unit, where people living with more advanced dementia lived. People said staff respected their choices around what they wanted to do.

People, their relative and representatives felt that their opinions were listened to concerning the provision of care. People told us staff and the manager were approachable.

People’s health and well-being was supported by staff arranging appointments with external healthcare professionals when required, such as a G.P. Staff cooperated with, and followed the advice of, external healthcare professionals when supporting people’s health needs.

People felt confident in raising issues or complaints with staff. One visitor described how staff had told them about how to raise a complaint when their relative first arrived at the home. However, we found that not all matters of complaint were recorded in accordance with the provider’s policy on complaints.

We found that the provider carried out a number of audits to identify areas for improvement in the delivery of care and the environment. Some audits were focussed on particular areas of care, such as people’s nutritional needs. However, we found that issues we had identified had not been picked up by the audits carried out, such as the need for repairs to one person’s bedroom. We saw that the provider had a system in place to learn from accidents and incidents to reduce the risk of them reoccurring.

We found that the environment on Primrose unit was, in some areas, not adapted to people living with advanced dementia. For example, signage was not accessible and items used to assist people to find their bedrooms was not consistently used. We also found poor areas of cleanliness on the unit, including carpets, walls and chairs being stained and an offensive odour being detectable in the entrance hall and one corridor area.

We found that one person’s room was not properly maintained and that repairs to damaged areas in the room had not been undertaken.

We found that people’s privacy and dignity were not always supported on Primrose unit because locks on some toilet doors were not working. We saw that one person was not dressed in a way which supported their dignity. Relatives of another person living on the unit told us they were not always dressed appropriately.

Not all staff were aware of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which help to support the rights of people who lack the capacity to make their own decisions or whose activities have been restricted in some way in order to keep them safe. We found that some people’s records contained documents which showed that, where they lacked capacity, decisions in their ‘best interests’ had been taken by the appropriate people. Other records lacked the correct documentation and demonstration of the legislation being properly used.

Staff demonstrated awareness of what could constitute abuse and that matters of abuse should be reported in order to keep people safe. However, some staff were not clear about which external agencies they could report abuse to.

Staffing on most of the units was at an adequate level to ensure people received the support they required. However, this was not the case on Primrose unit where we found examples of people’s quality of care being affected by inadequate staffing levels.

We found two breaches 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 this report.

Inspection carried out on 28 January 2014

During a routine inspection

We carried out this inspection to check on the care, treatment and support of people. On the day of the inspection there were 118 people living in the home. We spoke to 13 people, two relatives, seven members of staff and the manager.

Records showed that people's consent was not being recorded consistently, but people told us their verbal consent was sought before any care or treatment. One person said, "Staff do ask for my consent".

We found that the provider had a system in place to ensure people needs were identified and staff knew what people's needs were and how to support them. One relative said, "I am very happy with this home, staff and management. My relative has all the care that is needed".

The provider had system in place to ensure the home was clean and tidy, and that cross infection was managed appropriately.

The provider had a quality assurance system in place to ensure the quality of the service people received.

Inspection carried out on 7 March 2013

During a routine inspection

People told us they were happy with the quality of care they or their relative received. Comments included, �Top notch, this is an excellent home. People are well looked after here� and, �I like it here, the staff are very kind�.

People told us the staff were respectful and caring towards them. People told us their privacy and dignity was maintained. Staff shared positive examples of how they provided people with choice and promoted their independence.

People said their needs were assessed and regularly reviewed with them. People told us they felt safe in the presence of the staff. One person commented, �I feel safe with them, they are very good�. Staff had received training on protecting vulnerable adults. They were able to describe abuse and knew how to respond to ensure people were protected from the risk of harm.

People were complimentary about the staff. Staff told us they enjoyed their work and said they were, �very� well supported. They said they had received training to keep people safe and to meet their individual needs.

People and their representatives were made aware of the complaints process. People said they felt confident in raising concerns and considered that they would be listened to.

Complaints made had been appropriately addressed.

Inspection carried out on 19 October 2011

During a routine inspection

People told us that they were happy with the care they received and that they felt safe. People we spoke to told us,"I can't fault the care here". �Everything is okay here".Quite happy, good food, plenty of drinks".

One relative told us:

"My mom was here for several years and when dad was no longer able to look after himself there was only one place where we wanted him to be looked after".

All the people we spoke to told us, "staff are kind and very caring". They told us that staff assisted them when they needed it.

We found that the home is a comfortable and pleasant place to live and has recently been refurbished. All bedrooms are single occupancy, although toilet and bathroom facilities are shared. People are able to personalise their bedrooms as they choose to reflect their individual taste and interest.

People told us how they spend their day. They said that they get up and go to bed when they choose. They are able to have their meals in the main lounge/ dining room or their bedrooms if they preferred, or were unwell. They told that they enjoy the activities that take place. They told us that their friends and relatives are able to visit them when they want.

Reports under our old system of regulation (including those from before CQC was created)