Archived: New Milton Nursing Home

New Milton Nursing Home is a nursing care home providing personal and nursing care to up to 24 people. The service provides support to older people and people who have dementia. At the time of our inspection there were 20 people using the service. People were supported in 1 adapted building and had access to communal areas consisting of a lounge and dining area as well as a conservatory and some outside space.

People’s experience of using this service and what we found

Medicines were not managed consistently. Risks had not always been properly assessed. Lessons were not always being learned when things had gone wrong. Environmental and building checks were being completed regularly. Staff were being safely recruited. Staff used PPE appropriately which supported the infection control for everyone in the care home.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People had care plans although these lacked details and contained discrepancies. People received suitable balanced diets appropriate to their needs. Staff worked with a variety of organisations to ensure people accessed and received appropriate support when needed. The care home had been adapted and was undergoing redecoration.

Systems were not always robust or effective in driving improvements. The registered manager had not been notifying CQC of certain events and changes in line with regulations. New systems were being put in place to monitor and support management oversight, which included an electronic recording system. Management was approachable and promoted communication with people, relatives and staff. People and relatives were involved in their care and staff worked in partnership with other professionals and agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 June 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

The provider plans on applying to CQC to change their legal entity. This application will be reviewed when it is received.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about medicines management, training, staffing and care planning. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New Milton Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s safe care and treatment, consent and the overall governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service: Environmental risks had not always been identified and assessed. The premises were not always safe for people living at the service. Infection control procedures were not always followed by staff.

There was a governance framework in place, designed to assess the quality and safety of care, which was not always effective. The management team completed audits of the service and created action plans to improve quality and safety. However, these did not include actions to remove or reduce the risks we found or fully assess the service.

Care records detailed how people liked to be supported and their current health needs, but these were not always person-centred.

There were regular reviews of people’s needs to make sure they received the support they required. People had regular input other health care professionals and external agencies, for example GPs. People received care which promoted positive outcomes to their wellbeing and independence.

Medicines were managed safely, and support was provided in line with best practice. Individual risks to people had been fully assessed and mitigated to help keep people safe.

People’s privacy and dignity were respected by staff at all times. People were supported to attend and engage in activities within the service which were of interest or benefit to them. The service worked in partnership with other health and social care agencies to support people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were safely recruited and received regular training. New staff were provided with a comprehensive induction which provided them with the relevant knowledge and skills needed to support people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published October 2016).

Why we inspected: This was a planned inspection based on the rating at the previous inspection.

Enforcement: We have identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the safety and governance of the service. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will continue to monitor the service through information we receive from the service, the public and partnership agencies. As part of our process we will be requesting an action plan to be completed to address the issues identified. We will re-visit the service in-line with our inspection programme. If we receive any concerning information we may inspect sooner.

There was a 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. The registered manager was also the provider of the service and was supported by a deputy manager.

The service provides accommodation with nursing and personal care for up to 24 older people, some of whom are living with dementia. Twenty-four people were living at the home on the day of our inspection, although one person was in hospital.

People felt safe living at New Milton Nursing Home and with the staff who looked after them. Staff understood their responsibilities to challenge poor practice and to raise any concerns about people’s health and wellbeing with the managers. The suitability of staff to deliver personal care was checked during the recruitment process.

There were enough suitably qualified and experienced nurses and care staff to meet the needs of people living in the home. Staff worked well together to make sure people received the care and support they needed and the atmosphere was calm and relaxed.

The provider used a range of assessment tools to identify possible risks associated with people’s health and well-being and included clear guidance for staff on how to mitigate the identified risks. The provider had procedures and policies to ensure the safety of the environment and equipment in the home. People’s medicines were managed, stored and administered safely.

People were confident in the ability of staff to care for them. Staff received appropriate training and support so they could meet people’s needs effectively. Staff were encouraged to develop within their roles and study for nationally recognised care qualifications. New staff shadowed experienced staff until they knew people well and understood how to support them.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They had identified people whose care plans contained some restrictions to their liberty and had submitted the appropriate applications to the authorising authority. Staff worked within the principles of the MCA. They offered people choices and supported them to make their own decisions where possible.

Risks around people’s nutritional intake had been identified and people were offered food and drink that was suitable for their individual dietary needs. External health professionals were contacted when people's needs changed and further health involvement was needed to maintain their health. People and their relatives were confident their healthcare needs were met. Appropriate arrangements were made to support people until the end of their life.

Staff had developed positive, caring relationships with people and demonstrated an easy rapport in their communications and interactions. Staff were patient and understanding and sensitive to people’s needs. People were spoken with politely and courteously and told us staff treated them with respect. People’s relatives and friends were able to visit when they wanted to and played an important role within the home.

Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed. However, care plans were not always consistently followed. Relatives were kept well informed about their family members’ support needs and where appropriate, actively involved in decisions about their relatives care. People told us that staff were responsive to their requests for assistance.

There was no activities co-ordinator working at the home. Social activities were led by the deputy manager and carried out when staff had finished providing personal care. Following a recent quality assurance questionnaire, the provider had identified that responding to peoples’ social needs was an area that required improvement.

People and their relatives were happy with the service provided within the home. People openly complimented staff and spoke well of the home and the care received. The management team were known and visible to people, relatives and staff and had an in-depth understanding of people’s medical and emotional needs.

The provider’s quality monitoring system included consulting with people, their relatives and reviewing practice within the home to ensure planned improvements were focussed on people’s experience.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with and their relatives told us they were treated with respect and dignity. One person said: "I have been fine since I have been here, I wouldn't stay if I wasn't treated properly". A relative told us: "I have been impressed about the care provided and the efforts made to find out a bit more about my mum's condition".

Staff we spoke with told us: "I have completed safeguarding training and we covered whistleblowing procedures. I know what I should do if I have concerns and how to report them". The deputy manager confirmed that staff had received training in the safeguarding of vulnerable adults.

Medication management arrangements were in place to ensure medication was administered, stored and managed safely.

Is the service effective?

People's health and care needs were assessed with them and their relatives. A relative confirmed this, they told us: "I have been able to discuss my relatives needs and have seen the care assessment and plans they have produced. Staff talk to me and make me aware of any concern". We saw that specialist dietary, mobility and equipment needs had been identified in care plans where required. People who were at risk of falls had plans in place intended to reduce the assessed risk.

Relatives we spoke with confirmed that they were able to see people who used the service in private and that visiting times were flexible. All relatives we spoke with told us they could visit at any time. One relative said: "I can't always get here at the same time each day so it's good they don't mind when you turn up".

Is the service caring?

We observed that people who used the service were supported by kind and attentive staff. We saw that care staff showed patience, gave encouragement when supporting people and were knowledgeable of their needs. One person we spoke with commented: 'I can always rely on the 'girls'. I like to do most things for myself, but they are always there if I need them". A relative said: 'I visit regularly. The staff are lovely always welcoming and friendly, that is one of the reasons we chose the home" another told us: "The staff are really lovely to my relative and I've seen them treat other people in the home really well'.

People using the service and their relatives were invited to attend meetings to discuss the service provided and surveys to seek their individual views were circulated. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People we spoke told us they knew how to make a complaint if they wanted to. One person said told us: "I wouldn't hesitate to tell someone if I was unhappy, but I'm not". A relative said: "We had some papers telling us what we needed to do if we had a complaint". We looked at how complaints had been dealt with, records showed very few complaints had been received. The acting manager told us: "We have a complaint at the moment that I'm dealing with. It's never very nice to receive one but the important thing is how you deal with it and learn from it".

Is the service well-led?

The service has a quality monitoring system in place, the deputy manager told us: "I have been carrying out audits and making changes where they have been needed" and: "I've also started to update policies and risk assessments". Records seen by us showed that updates and amendments had been made to ensure information and risk assessments were up to date. The deputy manager was aware of the need to use the information to continually improve the service.

During our inspection, there were a number of people being cared for in bed and at high risk of pressure sores. Appropriate risk assessments had been completed and care plans put in place to reduce the risk of pressure sores happening.

At our previous inspection, we identified that the provider was not meeting the expected standards in some of the outcome areas. We set compliance actions, requiring the provider to make the improvements required to ensure the quality and safety of care. There were still no specific care plans in place to provide clear instructions for staff to follow to ensure in case of need medicines were given at the right time. The quality and accuracy of records about people's care still needed to improve.

There were effective recruitment and selection processes in place to ensure that the right staff were working in the home. The manager and care staff had a good understanding of when concerns with people's safety and welfare needed to be reported. Staff also had a good understanding of what it meant to act in people's best interests and the process to follow.

People living at the nursing home told us that they were happy with life there. One person told us, 'There is always a choice in what I do, what I eat, where I go'. People living at the home told us that they felt respected but we found that suitable arrangements were not in place to fully promote people's choice and dignity at all times.

Another person told us, 'I love it here. I came on respite care and did not want to leave'. We observed that all people had care plans in place but these were not always updated to reflect the changing needs of people. There were systems in place to safeguard people living at the home but some staff required further training to ensure proper procedures were followed.

We reviewed staffing and recruitment systems. All staff files and the care plans for people were filed securely and there were recruitment processes in place. We observed that some of the records that we reviewed had gaps in the recruitment process but safeguarding checks on staff were always completed to ensure appropriate staff were working in the home to care for the people.