Background to this inspection
Updated
8 November 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 23 August 2016 and was unannounced. The inspection team consisted of two inspectors, an interpreter and a specialist advisor. The specialist advisor was a nurse who had experience in the care of older people. Through the services of our interpreter we were able to seek the views of those people who spoke Punjabi and Urdu.
Before our inspection, we reviewed the information we held about the service. We reviewed statutory notifications the provider had sent to us since the last inspection. Providers are required to send us notifications to inform us of certain events and incidents, such as serious injuries sustained by people living at the service. We also contacted service commissioners to gather information they held about the service. We considered this information when we planned our inspection.
During the inspection, we spoke with ten people who used the service and three relatives. We also spoke with five care staff, the cook and the registered manager. Throughout the inspection we observed how staff interacted with the people who used the service.
We looked at seven people’s care records to see if these records were accurate, up to date and supported what we were told and saw during the inspection. We also looked at four staff records and records relating to the management of the service. These included complaints, accidents and incident records, medicines records and records relating to the management of the quality of the service.
Updated
8 November 2016
Our inspection took place on 23 August 2016 and was unannounced. At the last inspection in December 2015 the provider was rated requires improvement overall with a breach of regulation 11 in relation to the need for consent. During this inspection we looked to see if improvements had been made. We found the provider was meeting all requirements of the law. We did however identify further improvements were required.
During our last inspection the service did not have 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 and associated Regulations about how the service is run. We found the manager had recently made an application for registered manager’s status and had been interviewed by our registrations team who confirmed the manager was now awaiting the appropriate certification.
During the last inspection we found the provider was not appropriately displaying the inspection rating. At this inspection we found the provider was complying with this requirement.
Ruksar Nursing Home provides accommodation, personal and nursing care for up to 27 older people. At the time of our inspection there were 26 people living at the location.
People were not protected by robust recruitment practices that ensured care staff were suitable to work in care settings before they commenced work. Some members of staff had started work with recruitment checks incomplete. We found the provider was not meeting all the requirements of the law as they were not completing suitable employment checks to ensure staff were safe to work with people. You can see what action we told the provider to take at the back of the full version of the report.”
The risks to people had not been assessed and managed by the provider to ensure only suitable people were employed to work at the home.
People told us they felt safe. We looked at people’s care records and saw that people had detailed risk assessments and plans in place to manage risks in order to keep people safe. However, we found inconsistencies in the recording of care and support activities such as repositioning people where the care plan stated this was required to reduce risk. This meant that there was a risk that people were not receiving appropriate care.
People received their medicines safely and as prescribed and were supported to take medicines by staff who were suitably trained and deemed competent. People’s medicines were stored safely.
People received care and support from a suitably trained staff team. The registered manager had systems and processes in place to ensure that staff were kept up to date with their core training. We saw that there were some gaps in staff training, however the registered manager had plans in place to ensure this was delivered.
People were asked for their consent to care and support and the principles of the Mental Capacity Act 2005 were being followed. Staff had a basic understanding of the MCA.
People were supported to have sufficient to eat and drink, however people were not always offered choices of food. People’s specific dietary needs were catered for and specialist professional advice in relation to dietary requirements was being followed.
People were supported to access healthcare services when they needed to. People were supported by a staff team who were able to recognise changes in people’s health and well-being and knew how to report and respond to any changes.
People were supported by a staff team who mostly showed kindness and compassion. People were supported to make decisions about how their care and support was provided.
People were treated with dignity and respect and their privacy was maintained. People were encouraged to maintain their independence.
People had not always been involved in the planning and review of care, due to their capacity to make decisions. However relatives we spoke with felt they were asked for their opinions and input into their family members care plan. They felt they were kept updated with regards to any changes in relation to their family members care and support needs.
People did not always have access to activities they enjoyed. Planned activities did not always take place as staff did not have the time to facilitate them. Some people we spoke with told us they were able to visit a local park from time to time and people with religious and cultural needs were supported to attend places of worship and practice their religious or cultural beliefs.
People were supported by a staff team who knew people’s care and support needs well and had an understanding of people’s likes and dislikes.
People and their relatives told us they knew how to raise a concern or complaint and felt confident to speak to staff or the registered manager if they had any concerns about their care. The registered manager had a system for recording complaints and we saw that complaints were investigated appropriately.
People liked living at the home. The registered manager had recently introduced new systems to involve people and their relatives in the development of the service. Staff told us they felt involved in developing the service and felt the registered manager was approachable and acted on their concerns or suggestions.
The registered manager had developed systems and processes to monitor and analyse the quality of the service. We saw they were using information from some of the quality checks to drive improvement; however some systems were not effective in identifying issues or concerns.