1 December 2018
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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This comprehensive inspection took place on 17 and 18 September 2018. This visit was carried out by two adult social care inspectors.
Before the inspection we reviewed information available to us about this service. We looked at information we had from those who commissioned the services and the local authority. This was to help us in gaining a clear picture of the service provision. We also reviewed safeguarding information and notifications that had been sent to us. A notification is information about important events that the provider is required to send us by law.
The registered provider had completed a Provider Information Return (PIR). The PIR is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.
We spoke with a people about the service. This included seven people who lived at the home, five visiting relatives, the two registered managers, eight members of the nursing and care staff, a member of laundry staff and a member of domestic staff, the service’s occupational therapist, a community health professional and a medical practitioner. We spoke with the Director of Nursing on their return from annual leave. We also received comments from people who used our website to share their experiences of the service.
We looked at care records of seven people who lived at the home and at the risk assessments and daily notes relating to those plans. We also looked at records relating to the management of the service. These included audit records, policies and procedures and accident and incident reports. We looked at the recruitment records of seven members of staff recruited since the last inspection and the induction and training records of staff who worked in the service. We looked at the records of medicines and we checked on the quantity and storage of medicines in the home. We also checked the building to ensure it was clean, hygienic and a safe place for people to live.
We observed how staff supported people who used the service and used the Short Observational Framework for inspection (SOFI) on both units. SOFI is a way of observing care to help us understand the experience of people who could not easily talk with us.
We used a planning tool to collate all the information we held about the service prior to visiting the home.
1 December 2018
We carried out this inspection at inspected Risedale at Aldingham Nursing Home (Risedale at Aldingham) on 8 and 9 October 2018. The first day of the inspection was unannounced which meant the provider was not expecting us. We told the manager we would be returning to continue the inspection on the second day.
We last inspected Risedale at Aldingham in April 2016. At that inspection the service was rated Good. At this inspection we found the service remained good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Risedale at Aldingham is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Risedale at Aldingham Nursing Home provides accommodation for up to 74 people who need nursing or personal care due to physical or mental health needs.
The home is situated in the hamlet of Aldingham on the northern shore of Morecambe Bay and close to the market town of Ulverston. There are patio and conservatory areas and extensive gardens for people to use and staff and visitor car parking. The home has a passenger lift to allow access to the different floors in the home. The home has a range of equipment suitable to meet the needs of people living there.
The home is split into two separate units, Aldingham and St.Cuthberts. Aldingham is in a period building that has been adapted and extended for its present use. St Cuthberts is a purpose built unit designed to meet the needs of people who are living with dementia. Each separate unit has its own registered manager in post. 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 that Risedale at Aldingham was constantly working to improve their service for the people who lived there and to find ways to move the service forward. At this inspection we also found the service was continuing to improve and demonstrated some characteristics of 'outstanding'. For example, the service was particularly skilled at caring for and supporting people and their families at the end of life, responding to changing needs and working with other professionals.
The home had been accredited with the Gold Standard Framework (GSF) for end of life care in care homes and had an end of life strategy to underpin its continued development. This rigorously accredited programme focused upon systems for using and developing high levels of holistic care at the end of a person’s life. Relatives feedback was very positive and appreciative of this aspect of the service. Feedback we received made frequent reference to the professionalism, kindness and understanding of all the staff shown to people living in the home and their families.
People told us they felt safe living at Risedale at Aldingham and relatives expressed great confidence in the staff and management to keep their relatives safe and happy. The service was also very supportive of families and showed kindness and compassion as people dealt with difficult life events. We were contacted by relatives who wanted to tell us to tell us their experience of the service because they had been so impressed by the care their relative had received and they wanted to make sure we were aware of this.
The registered provider continued to improve the environment for the people who lived there. The building was well maintained and a clean and homely place for people to live. We saw that equipment in use was regularly cleaned and had been serviced and maintained safely. We observed people being moved by staff in a safe and dignified manner. Staff used the correct procedures.
People received their medicines in a safe manner. Medication audits were in place and staff had completed training on medicines administration and had competency assessments for this. Some as required medicines had not had stock balances carried forward for ease of monitoring and we made a recommendation that the service took advice and reviewed their procedure on this for more effective monitoring.
We found recruitment practices to be robust. In-depth induction programmes were provided for all new employees and a wide range of training modules were available for the staff team. Great emphasis was placed on supporting all levels of staff to develop their potential and to undertake training to advance their professional qualifications, knowledge and skills to provide a consistently high standard of care. Having such a skilled workforce that worked closely with local healthcare professional had a positive impact on people because we saw evidence this reduced unnecessary hospitalisation.
The home had a well-researched and evidence based system for the planning of people's meals to meet different nutritional requirements and diets such as pureed food. People who lived there, who could comment, made very positive comments about the standard of food as did relatives. One person described the meals as “gorgeous”.
The service had an effective safeguarding policy and staff had undertaken safeguarding training and could explain the process. The staff team were confident in reporting any concerns about a person's safety or wellbeing of anyone in the home. We observed the daily routines and practices within the home and found people were treated equally and their human rights were being promoted.
There were processes in place for reporting incidents and we saw that these were being followed. However, there were three incidents that we had not been notified about and this was explained to us by the management team as a genuine mistake. Immediate action was taken by the registered providers to review and amend their guidelines on notification of incidents and their protocols for managers to make sure that there were no areas of ambiguity that might lead to misinterpretation.
Staffing levels were consistent and flexible to meet changing needs. The staff team worked well together and had the skills, knowledge and experience required to support people with their care and social needs. Registered nurses were available to support people's day to day nursing needs.
The registered managers understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they worked within the law to support people who might lack capacity to make some of their own decisions. People who lived in the home were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice. Discussions had taken place to involve people, relevant others and medical professionals in decisions made in someone’s best interest but for one person it needed to be clearer who all the participants were. The registered managers corrected this straight away. .
People were supported to express their views and supported to access advocacy services, should they wish to do so. An advocate is an independent person, who will act on behalf of those needing support to make decisions. Quality assurance systems were in place to monitor the quality and running of service being delivered. People that lived in the home and relatives were asked for their views on the service formally as well through informal discussions with people and their relatives about their care and ideas for the home.
We saw there was a very positive and supportive culture within the service. The management team provided strong leadership and led by example. Relatives, staff and other agencies were very positive about the leadership of the service.
Further information is in the detailed findings below.