This inspection took place on 24 November and 9 December 2014 and was unannounced.
Netherhayes Care Home is registered to provide accommodation for 28 people who require personal care, 21 people lived at the home when we visited. Most people who lived at the home were living with varying degrees of dementia. The provider is a partnership, a lead partner visits the home regularly and is involved in quality monitoring.
At the time of our visit, there was no registered manager. A new manager had been appointed and was due to start the following week. Since the inspection, this manager has registered with the Care Quality Commission. 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.
At our last inspection on 23 April 2014 we found a breach of the regulation on care and welfare related to choking risks and improvements had been made in this area. However, at this inspection, we identified new risks about people’s care and welfare, particularly related to managing people with behaviours that challenged the service.
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. There were no mental capacity assessments for people who lacked capacity. This meant staff did not have information to assist people to make decisions for themselves. Staff were seeking consent from relatives for people who lacked capacity. There was no records of ‘best interest’ decision making to show how people, relatives and other professionals were consulted and involved in decision making about people’s care and treatment.
People, relatives and visiting professionals gave us mixed feedback about the service provided. Most people were happy with the care and treatment they received and felt well supported by staff at the home. Some relatives expressed concerns about some aspects of people’s care and about their ability to influence day to day decisions and improvements for people living at the home.
People’s needs were assessed but improvements were needed to ensure all care plans provided staff with the detailed information they needed to deliver consistent and appropriate care. 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.
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. Improvements were required to ensure systems and processes were in place to protect people’s rights and to make care more personalised to people’s individual needs.
The provider had recently introduced a cook/chill meal provision at the home. Although people had a choice of menu , most people commented that they preferred the home cooked meals previously available at the home.
Staff working at the home knew people’s needs and preferences well and people and relatives said staff were caring and kind. There were friendly and respectful interactions between staff and people. People were supported by having enough staff on duty to meet their needs.
People were appropriately referred to a variety of health care professionals for specialist advice and treatment for their specific needs.
Staff were aware of signs of abuse and knew how to report concerns and were confident these would be investigated. A robust recruitment process was in place to make sure people were cared for by suitable staff.
People received most of their prescribed medicines on time and in a safe way. However, some improvements were needed in management of topical creams and ointments.
The provider had a range of improvements planned for the forthcoming year which included new care plan documentation, decoration , improvements to the environment of the home, and additional staff training.
We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.