Saxondale Nursing Home

We found the following examples of good practice.

The home was clean and well ventilated.

Staff wore personal protective equipment (PPE) appropriately. Staff had completed training in infection control, COVID-19 and putting on and taking off PPE.

The provider was supporting people who used the service and staff to access regular testing, this included lateral flow device (LFD) testing for staff.

The home had been closed to non-essential visitors because of a COVID-19 outbreak. However, the home was now open to visitors. Visitors to the home were required to follow infection control procedures, complete a LFD test and wear PPE.

Social distancing was observed as far as it was practicable to do so.

The home was clean and there were no malodours. Staff had access to cleaning products and cleaning schedules included high touch areas such as door handles and handrails, which were cleaned regularly.

Saxondale Nursing Home is a care home providing personal and nursing care to people aged 65 and over at the time of the inspection. The service can support up to 36 people. At the time of this inspection, 22 people were living at the home.

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

Inconsistencies in leadership and systems of governance had led to shortfalls at the service. Audit processes historically had been sporadic or non-existent, which meant management oversight of the service was sometimes poor. The provider had employed a new manager in August 2021, and from this point onwards we found visible improvements to the service and audit processes had been made. Staff and external professionals recognised the service was improving, but felt further action was needed to raise the standard of care. One visiting professional told us, “Now [new manager’s name] is in, I see they are getting a handle of things and the service has improved.”

People received safe care. However, whilst we were satisfied people received a safe service, certain practices placed people at an increased risk of receiving unsafe or poor care. Records of reviews of people’s care and weight monitoring checks were not always kept. Low staffing was a recurring feedback theme and systems to calculate minimum staffing levels were not always robust. We asked the manager to review staffing arrangements after the inspection. Saxondale Nursing Home is a converted Victorian home; although aspects of the service looked homely, work was needed in the environment to prevent the building from falling into a state of disrepair. During the inspection we observed mostly good practice in relation to medicines management and infection control.

The manager assured CQC during and after the inspection they were committed to improving Saxondale Nursing Home. They were working towards a comprehensive action plan, with regular support and input from the provider.

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

Rating at last inspection

The last rating for this service was good (published 10 July 2018).

Why we inspected

We received concerns in relation to the environment, staffing and systems of governance at the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to record keeping and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The registered provider sent an action plan detailing how they were going to make improvements. This inspection took place to check if improvements had been made. We found that the registered had made sufficient improvements to meet the requirement of this Regulation.

Saxondale Nursing Home 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.

Saxondale Nursing Home is registered to provide accommodation for up to 36 older people. Accommodation is provided over two floors, accessed by a passenger lift. Communal lounges and dining areas are provided. On the day of the inspection there were 30 people living in the home.

The service had 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.

People told us they felt safe at Saxondale Nursing Home and staff told us they would report any concerns to the registered manager. Systems and processes were in place to ensure that people were protected from abuse and improper treatment.

Visitors said they were made to feel welcome at any time and were very positive about the care their relatives received.

Staff were knowledgeable about people living at the home and understood how to meet their diverse needs.

We observed warmth and affection between staff and people who used the service. People were treated with dignity and respect.

We found the home was clean and odour free. Bedrooms had been personalised and communal areas were comfortably furnished. The home was adequately maintained, and equipment had been serviced to make sure it was safe to use.

Staff recruitment procedures were robust and ensured people’s safety was promoted.

Sufficient numbers of staff were provided to meet people’s needs.

Staff were provided with relevant training, supervision and appraisal so they had the skills they needed to undertake their role.

Staff told us they felt supported by the registered manager.

People told us they and their relatives had been involved in their plan of care and had participated in regular reviews.

We found systems were in place to make sure people received their medicines safely, so their health was looked after.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences, so people’s health was promoted, and choices could be respected.

People were supported to take part in a variety of activities.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies in the service support this practice Wherever possible, people were involved in decisions about their care and were offered choices.

People and staff were happy with the service and praised the manager. There was a positive and open culture within the service. Staff said they felt able to raise concerns and were confident they would be responded to.

There was a complaints procedure in place and we saw where concerns had been raised these had been dealt with appropriately.

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified, action was taken to address these shortfalls.

People using the service were asked for their views and were able to influence the way the service was managed.

Accidents and incidents were investigated, recorded and monitored and action was taken to help control risk and prevent further accidents and incidents from happening.

The registered provider has made progress since our last inspection to improve the service for people living at Saxondale Care Home. These changes are very recent and need to be sustained.

Saxondale nursing home is registered to provide care for up to 34 older people with a diagnosis of dementia or mental health needs. There were 27 people living there at the time of our inspection.

There was no registered manager at the time of the inspection; however there was a manager in post who was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 to run the service. When a service does not have a registered manager we place a limiter on the well- led domain of the report, which cannot be rated as good.

At the last inspection on November 17 2016, we asked the provider to take action to make improvements to the safe management of medicines, staff training and appraisal and the recruitment and selection of staff .The provider sent us an action plan explaining how they would address this and sent regular updates showing the progress they were making. We continued to liaise with the local authority and monitored intelligence we received about the home. At our inspection of 4 April 2017, we saw that a new management team was in place and improvements had been made.

The provider had a safe recruitment procedure in place that involved pre-employment checks being made prior to the person commencing employment. However we found there were still gaps and inconsistencies in staff personnel files.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role.

The staff we spoke with were very knowledgeable on safeguarding and whistle blowing policies and procedures.

We looked at people's records and found they identified risks associated with people's care and treatment.

People were supported to take sufficient food and drink to maintain a balanced diet and snacks were available in-between. People we spoke with who used the service told us they liked the food and were given choice.

We found there was enough staff with the right skills, knowledge and experience to meet people's needs. However, staff told us at certain times they could do with more staff to ensure people's needs were met in a timely way.

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

We have made a recommendation about refreshing training for staff on the Deprivation of Liberty Safeguards.

We looked at care records and found they contained a care plan entitled, 'This is my Life’ this gave staff an understanding of peoples life stories, choices and preferences and what was important to the person.

We observed staff working with people and found they were kind and caring in their nature. Staff we spoke with were knowledgeable about respecting privacy and dignity and gave examples of how they would do this.

We checked people's care records that were using the service at the time of the inspection. They told staff how to support and care for people to ensure that they received care in the way they had been assessed.

The service had an activity co-ordinator who arranged social events in the home. So people accommodated at the home had access to suitable activities.

The home had a complaints procedure and people we spoke with knew how to raise concerns if they needed to. We saw the manager had taken appropriate action when complaints had been received and had resolved them in a timely and effective manner.

We recognised that the new manager had implemented many changes which had impacted on the home in a positive way. People who used the service, their relatives and staff gave positive feedback about the manager. However, systems in place to ensure the service was of good quality required embedding in to practice.

People who used the service and their relatives were listened to and there were opportunities where they could raise issues and be part of the service development.

Saxondale nursing home is registered to provide care for up to 36 older people with a diagnosis of dementia or mental health needs. There were 36 people living there at the time of our inspection.

It is a condition of registration with the Care Quality Commission that the service has a registered manager in place. 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 had left the service and the provider had put interim management arrangements in place to support the operations and on-going improvement of the service. How?

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People were not always being protected from the risks associated with medicines. We found there were shortfalls in the ordering, administration and disposal of people’s medicines that could result in mishandling or error. We found some people’s medicines were not managed safely, so they were not protected against the risks associated with the unsafe use and management of medicines.

People told us they felt safe living in the home and relatives we spoke with told us they thought their family members were safe.

People were not being protected by the home’s recruitment processes. The registered person had not ensured a robust recruitment process had been followed or recorded for all staff.

There were sufficient staff, however a significant number of staff needed to update their training to ensure they had the appropriate experience, training and skills to meet people’s needs.

People on each unit received a balanced and nutritious diet, including those people on the general nursing care unit who needed their meals pureed or softened. However, people’s dietary and fluid intake was not being monitored effectively. This left people at risk of poor nutrition or hydration.

People were not always being protected from poor quality care through the processes for audits and quality assurance. Some of the concerns we identified on this inspection had been identified in quality assessments undertaken by the provider, but actions had not been completed to rectify them. Others had not been identified. Some audit systems had been used effectively to improve people’s care, for example in reducing the risk of falls.

People told us the covering manager was accessible and approachable. Efforts were being made to increase opportunities for people to give their feedback about the home and the quality of their experience.

We found infection control was not being managed appropriately. This meant people were at increased risk of contracting an infection.

The systems for staff supervision and appraisal were not being used consistently or effectively to support staff development and to improve their skills.

People’s dietary and fluid intake was not being monitored effectively. This left people at risk of poor

nutrition or hydration.

The physical environment throughout the home did not always reflect best practice in dementia care.

The communal areas were tired and in need of decoration and throughout the inspection there was an unpleasant malodour in the communal areas.

We found care plans and risk assessments were not properly completed. People were not always supported to maintain a healthy diet. However, people identified as high risk of malnutrition were not weighed and checked at regular intervals.

On the second day of our inspection the acting manager was actively addressing the issues we found however it was too early to see if these improvements would be sustained.

The number of shortfalls we found indicated quality assurance and auditing processes had been ineffective. There was evidence of limited monitoring and support from the registered provider to ensure the covering manager was achieving the required standards in the day to day running of the home. Checks on systems and practices had been completed by the acting manager but there were a number of matters that needed immediate attention. This meant the registered provider had not identified risks to make sure the service ran smoothly.

We visited the service on 30 May 2013 as part of our scheduled inspection programme and also to check that improvements had been made regarding suitability of premises.

People said about the home, 'They (staff) respect your privacy in here.' One person said about mealtimes 'We have a set menu but if you don't like it they will sort something else out for you.'

People experienced care, treatment and support that met their needs and protected their rights. One person told us "It's nice in here, it's a nice home.'

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People experienced care, treatment and support that met their needs and protected their rights. We spoke with a relative of someone using the service. A relative we spoke with said, 'Staff are fantastic. (My relative's) well looked after. She gets a bath or a shower and is clean. Staff know what they're doing.'

Adequate maintenance of the premise, in respect of furnishings and fittings had not been maintained. We saw floor coverings that were stained and there were some areas where the surface of the floor underneath the floor coverings were uneven. In some people's rooms there was no lids on toilet seats and wallpaper had not been replaced where it had been ripped from the wall. There was also an unpleasant odour that permeated the majority of the ground floor area and did not make the lounges pleasant places for people, staff and visitors to spend their time.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People's personal records were accurate, fit for purpose and held securely. Other records to protect people's safety and wellbeing were being maintained.