Netherhayes Care Home

People’s experience of using this service:

People were supported by staff that were caring, compassionate and treated them with the utmost dignity and respect. People received person centred care and support based on their individual needs and preferences. Staff were aware of people's life history, and their communication needs. They used this information to develop positive, meaningful relationships with people.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. People’s health had improved because staff worked with a range of healthcare professionals and followed their advice.

People received personalised care from staff who knew what mattered to them. They were encouraged to socialise and pursue their interests and hobbies.

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.

People and relatives said the service was safe. Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. The environment was safe and people had access to appropriate mobility and moving and handling equipment needed. There was enough staff on duty at the right time to enable people to receive care in a timely way.

People's care plans were detailed and up to date about their individual needs and preferences.

People's concerns and complaints were listened and responded to. The registered manager used complaints as an opportunity to learn and improve the service.

People, relatives, staff and professionals gave us positive feedback about the quality of people’s care. Quality monitoring systems included audits, observation of staff practice and regular checks of the environment with examples of continuous improvements made in response to findings. People, their relatives and staff told us the registered manager was approachable, organised, listened and responded to them and acted on feedback.

Rating at last inspection: Good. (last report published 29 July 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, the service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We last inspected this service on the 24 November and 9 December 2014 and we found the service was not meeting the requirements of the regulations we inspected at that time. We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Where people did not have the capacity to consent or make decisions, the provider had not acted in accordance the Mental Capacity Act (2005) and Deprivation of Liberty safeguards. Risks to people and staff from people with behaviours that challenged the service were not always identified or well managed. Improvements in staff training were needed to ensure staff were supported to acquire and maintain skills and knowledge to meet people’s needs effectively and safely. Improvements were needed in management of topical creams and ointments. Quality assurance and audit processes were in place to help monitor the quality of the service provided. However, improvements were needed as some of the shortfalls we identified had not been recognised or dealt with. The overall rating for the service was ‘requires improvement’.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to ensure that the areas that required improvement had been met. We found significant improvements had been made.

Since the last inspection a manager had registered with the Care Quality Commission (CQC). 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 using the service, relatives and professionals said the service was well managed by the registered manager. Relatives and visiting professionals provided positive feedback about the service and improvements achieved since the last inspection. Staff said the registered manager was very supportive and good improvements had been made since their arrival.

People said the staff were kind, friendly and respectful towards them. People said they felt safe at the service. Comments included, “I am very happy here. Staff are kind and gentle”; “I speak my mind. It is very good here…here I get all the help I need” and “I am confident with staff. I know they are well trained.” Staff had developed positive and caring relationships with the people at the service and clearly knew them well.

There were systems in place to protect people from harm and abuse. The staff team understood their responsibilities under safeguarding. The registered manager responded appropriately to any concerns. Medicines were safely managed and staff were trained and competent to deal with medicines. There were suitable plans in place to deal with any emergency situations. Risk assessments were in place to ensure the care and support provided was safe. Accidents and incidents were monitored for trends and themes.

Recruitment practices were followed to ensure that all staff were suitably qualified and experienced to work at the service. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people's individual needs.

Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and demonstrated a very good understanding of how this impacted on their practice.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs and preferences.

People knew how to complain about the service if necessary and there was information displayed about how to make a complaint. People said they would be happy to speak with the registered manager about any concerns. They were confident their concerns would be listened to and acted upon.

People were involved in the planning and delivery of their care and support. All confirmed that routines were flexible. People were offered various activities and they were supported with their social interests.

The registered manager had provided consistent leadership and was a good role model for all staff. A positive and open culture had been developed by the registered manager. There was an appropriate system in place to monitor the quality of the service and respond to people’s suggestions for improvements.

We spoke with the registered manager, deputy director and seven staff who worked at the home and looked at three staff records. We spoke with three professionals, a GP, community nurse and a hairdresser who regularly visited the home and obtained feedback from them. People we spoke with confirmed they were very satisfied with the care provided. One person said 'They are very kind' and another said, 'Staff take care of us, they always keep an eye on us'. Relatives we spoke with were also very satisfied with the care provided at the home. One relative said, 'I have always been very happy with the care, I don't think they could do any more for X'.

Is the service safe?

We found comprehensive assessments were made about people's needs and risks factors. The provider used a range of well- known tools to assess risks, for example in relation to risks of falling, developing pressure ulcers and malnutrition and dehydration. Care plans were detailed about the care and support each person needed and included information about how to reduce risks as much as possible. However, we found the care plan for one person about their nutritional needs in relation to their poor swallowing reflex was not accurate about the foods the person could safely eat. This meant that staff were offering the person some foods that increased their choking risks. Since then, the provider has confirmed the person has been reassessed, and their care plan has been reviewed and updated and now accurately reflects their needs and risks.

The environment was adequately maintained and regular health and safety checks and quality monitoring checks were carried out. Accident and incidents were recorded and monitored and we found evidence that learning from incidents took place and of actions taken to reduce risks.

Is the service effective?

People told us they were very satisfied with the care provided. People expressed their views and were involved in making decisions about their care and treatment. Care plans we looked at were personalised for each individual, were regularly updated and reviewed and gave detailed information about how to support the person effectively, with one exception related to a person's swallowing risks.

We found care plans included information about what people could do for themselves and about the help and support each person needed to be as independent as possible. Health professionals we spoke with confirmed staff at the home contacted them appropriately about people's health care needs and carried out their instructions. We found staff were supported to provide appropriate care and treatment to people through regular training and supervision.The provider had a range of effective quality monitoring systems in place to identify, assess and manage risks relating to people's health, welfare and safety.

Is the service caring?

People and relatives we spoke with confirmed people were treated with dignity and respect. Staff were kind, caring and compassionate towards people and we found improvements had been made to meet people's emotional and mental wellbeing needs. We found each person who lived at the home was treated as an individual and staff accommodated their needs and wishes, and respected people's right to make their own choices. People were involved and consulted in all decisions made about them. Where people did not have capacity, the provider involved relatives and members of the multi professional team in making decisions in the person's best interest.

Is the service responsive to people's needs?

The atmosphere in the home was happy and relaxed. Staff at the home knew about the people who lived there, and about their care and support needs. They noticed when a person needed their attention and responded quickly. Staff had undertaken training on how to support the needs of people with dementia. We saw there were enough staff on duty, staff chatted with people and took time to listen to them. They made eye contact with people before speaking with them and gave each person time to understand and formulate a response to any questions. We found people's care, health and welfare needs were being met most of the time.

Is the service well led?

The home had an experienced registered manager in day to day charge of running the home. The provider employed a deputy director who visited the home several times each week and other managers within the partnership were also involved in the home. For example, related to health and safety systems and about the work of the activity co-ordinators. The provider may wish to note these arrangements meant information and evidence, such as related to health and safety was difficult to access at the home. We found a number of managers made decisions about different aspects of the home. This meant, at times, the rationale for those decisions was not always clear or understood by staff who worked there and accountabilities for different aspects of the home seemed somewhat confused.

People told us that staff were nice to them but all said that staff did not have time to spend or talk with them. One person said 'The staff are lovely, you can't complain about this lot' but added that generally they sat in their chair or watched the television as there was 'little to do'. Staff were not very visible as we observed care delivery around the home as they were busy. People who had been identified as needing time to talk or support to go out did not have these needs met. Comments from people included 'I didn't get to this age to be in a prison' and staff told us 'no, we don't have time to spend with people, time is tight'.

We found that people's health needs were met and they looked well cared for. People told us that the food was 'lovely, we are very lucky'. However, the records showed care and care planning was not personalised for individuals meaning that care was delivered in a task focussed way.

We saw there was a robust complaints and recruitment system. These ensured that people would be able to voice any concerns and that they would be listened to and that people were protected from unsuitable staff.

People expressed their views and were involved in making decisions about their care and treatment. People told us that they could do what they wanted at the home and we saw people being treated with dignity and respect. One person said, 'I wouldn't change a thing. The staff are lovely and we like to chat with them.'

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Appropriate arrangements were in place in relation to the recording of medicine and before staff began work. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.