Risedale at Aldingham Nursing Home

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.

Risedale at Aldingham Nursing Home provides accommodation for up to 31 people who need nursing or personal care due to physical or mental health needs.

The home is a large period building, which has been extended and modernised to suit its present use. Accommodation is provided over three floors and there are two passenger lifts to help people to access the upper floors. The home has a range of equipment suitable to meet the needs of people living there.

All of the bedrooms had a private ensuite toilet and there were shared toilets and bathrooms suitable to meet people’s needs. There were 29 bedrooms for single occupancy and one double room that two people could choose to share.

There was a registered manager employed 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 who lived in the home and the visitors we spoke with told us that this was a good home and said that they would recommend it to other people.

Staff were patient, kind and caring. They knew people well and gave people the time they needed to express their wishes.

People were supported to maintain their independence and their privacy and dignity were protected.

There were enough staff, with the appropriate skills and knowledge, to provide the support people required.

People were safe. They were protected from abuse and risks to their safety had been identified and managed.

People were provided with meals and activities they enjoyed. Visitors were made welcome and people could see their friends and families as they wanted.

The registered manager set high standards. She asked people for their views and used these to develop the service. People knew the registered manager and how they could speak with her if they needed.

People’s rights were protected. The registered manager was knowledgeable about her responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body and was required to maintain their safety and welfare.

The registered provider and registered manager had good systems in place to monitor and improve the quality of the service.

We spoke with people who lived in the home in their rooms and in the communal areas of the building. We also spoke in private with visitors to the home and the staff who were on duty. Some of the people who lived in the home were not easily able to tell us their views about the home and the support they received. We used the Short Observation Framework for Inspection to assess how well the service met their needs.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

People who lived at Risedale at Aldingham Nursing Home were protected from the risk of abuse. People told us they felt safe living in the home. All the staff we spoke with showed that they had a good understanding of their responsibility to protect people. They said they had received training in safeguarding people from abuse. They told us they would not tolerate abuse in any form but would report this immediately. All the staff showed they knew how they could report concerns.

The staff in the home knew the actions to take to protect people. We saw that risk assessments had been carried out to identify hazards to individuals' safety and to reduce and manage risks. Where people had complex care needs additional risk assessments had been completed including around moving and handling, pressure area care and nutrition.

People were provided with nutritious meals and snacks which they told us they enjoyed. This ensured they were protected against the risk of malnutrition and dehydration.

The home had appropriate policies and procedures regarding The Mental Capacity Act 2005 deprivation of liberty safeguards. The manager of the home was knowledgeable about the Mental Capacity Act 2005 and the Mental Capacity Act Codes of Practice. This meant people could be confident that their rights would be protected.

Is the service effective?

People we spoke with told us the staff knew the support they required and provided this when they needed it. From our observations we saw that there were enough staff, with the appropriate skills, to meet people's needs and to provide a high standard of care. The staff told us they had completed a range of training to give them the skills to meet people's needs.

The home employed a range of ancillary staff including an activities coordinator, domestic staff, kitchen staff and a maintenance person. This ensured people were provided with activities and meals which they enjoyed and a clean and well maintained environment to live in.

Throughout our inspection we found the home was clean and free from odour. The domestic staff we spoke with showed that they understood this was important in maintaining the dignity of people who lived in the home. A visitor to the home told us, 'This is one of the cleanest homes I've been in, there's never any smell, that was important to us'.

Is the service caring?

Everyone we spoke with told us that people were well cared for in this home. One person said, 'The staff know what support I need and are very caring'. A visitor to the service said, 'The staff are all lovely, they really do care about people'.

All the staff on duty during our inspection took the time to speak to people. We saw many positive interactions which supported individuals' wellbeing. The staff were patient and considerate when supporting people. We saw that people were comfortable and confident with the staff who were on duty.

Is the service responsive?

People told us they were happy living at Risedale at Aldingham Nursing Home. One person told us, 'I like it here' and another person said, 'It's grand'. We saw that people were treated with respect and given choices about their daily lives.

We looked at a sample of the records the home held about people. We saw that people and their families had been asked about their preferences about their lives and care. The staff on duty were knowledgeable about individuals' preferences and ensured people received support as they wanted it.

People were provided with a range of activities which took account of their preferences and needs. Visitors to the home told us they were made welcome and could visit at any time, as they chose. People were supported to maintain relationships with their families and other people who were important to them.

Is the service well-led?

People who lived in the home, their families and health professionals who supported people all said the manager was 'very visible' and 'approachable'. Visitors to the home told us they 'felt comfortable' with the manager and said they would be confident speaking to them if they had any concerns.

Staff we spoke with told us the home was well managed. One person told us, 'This is the best the home has ever been'. The staff told us they felt supported by the manager and knew they had high expectations of the service.

The home provided accommodation to people who required personal and nursing care and the registered manager of the home was a qualified nurse.

The registered provider for the service had good management support systems which ensured senior managers had a good oversight of the quality of the services it provided.

People told us,

'The staff are all very nice',

'We're well looked after'

And said, 'I have no complaints, but I would tell someone if I did.'

Some of the people who lived in the home were not easily able to express their views about the service they received. We observed people in communal areas to assess how they were supported by staff in the home. We saw that the staff on duty were knowledgeable about the care people needed and their preferences about how they wanted to be supported. People were treated with respect and given choices in a way they could understand. We saw the staff respected the decisions people made.