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Nynehead Court Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 5 June 2019

This unannounced inspection took place on 31 October 2018.

We last inspected Nynehead Court in December 2017, during that inspection we found people’s legal rights were not always understood and upheld because the service did not work in accordance with the Mental Capacity Act 2005. We also found medicines were not always managed safely and the governance systems were not fully effective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. During this inspection we found that improvements had been made in some areas, however we found some concerns which resulted in continued breaches in two of the regulations.

Nynehead Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service also provides care to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought, and is the occupant's own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people's personal care service.

Nynehead Court accommodates up to 44 people (in 38 bedrooms currently all used for single occupancy) in a three-storey historic building with a purpose-built wing for people who are living with dementia. At the time of the inspection there were 32 people using the service. There were two people in receipt of personal care who were living in the extra care housing.

There was a registered manager. 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.

Whilst we found some areas of medicines management had improved, there were still areas that required improvement. Risks to people were not always being identified and management plans put in place to mitigate any risks.

Care plans lacked some specific details to guide staff on how to meet people’s needs and they were not consistently person centred. Staff however knew people well and were able to describe how they supported people.

Some improvements were required to the processes in place where people lacked the capacity to make decisions for themselves. The systems in place to monitor the quality and safety of the service still required some improvement.

Staff knew how to recognise and report abuse and felt confident concerns would be acted upon. Staff told us they felt supported in their roles. There were enough staff on duty to meet people’s needs.

The provider had procedures in place to ensure that suitable staff were recruited. Staff received on-going training to ensure they were competent to carry out their roles

There were systems in place to protect people from the risk of infection. There were a range of checks in place to ensure the environment and equipment in the home was safe.

The provider had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm.

We received some mixed feedback regarding the choice of meals in the home. There were systems in place for people to give feedback regarding the food and we saw this was acted upon. The home sourced locally produced food and grew their own vegetables and fruits.

People were supported to

Inspection areas

Safe

Requires improvement

Updated 5 June 2019

Some aspects of the service were not safe.

Some aspects of people’s medicines management needed to be improved.

There were not always plans in place to reduce or mitigate risks to people.

There were sufficient staff to meet people's needs. Staff were recruited safely.

People were supported by staff who knew how to recognise and report abuse.

People were protected from the risk of infection.

Effective

Good

Updated 5 June 2019

The service was effective.

Where some decisions were made for people in their best interest, these were not always completed in line with the Mental Capacity Act 2005.

People saw appropriate health care professionals to meet their specific needs.

People were supported to have enough to eat and drink. Our observation of people’s mealtime experience was positive.

Staff received appropriate training and support to undertake their role and meet people’s needs.

Caring

Good

Updated 5 June 2019

The service was caring.

People and their relatives spoke highly of the staff supporting them.

People told us they were supported in a way that promoted their dignity and was respectful.

Staff working for the service knew people well.

Responsive

Requires improvement

Updated 5 June 2019

Some aspects of the service were not responsive.

People’s care plans were not consistently person centred and detailed.

People had access to a wide range of activities to meet their needs.

Where concerns were raised these were responded to and addressed.

Well-led

Requires improvement

Updated 5 June 2019

Some aspects of the service were not well led.

The governance systems to monitor and improve the quality and safety of the service people received were not fully effective.

People were supported by staff who felt able to approach their managers.

The service had good links with the local community.