Archived: Ruksar Nursing Home

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.

Where people had not been able to consent to certain aspects or decisions about their care records of decisions had not been completed. The provider could not show how people gave their consent to care and treatment or how they made decisions in the person’s best interests.

We received concerns in relation to safe care and management at the home in November and December 2015. As a result we undertook a comprehensive inspection to look into those concerns and check that the provider had followed their plan and that they now met legal requirements.

The home is registered to provide accommodation and personal care for adults who require nursing care and who may have a dementia related illness. A maximum of 27 people can live at the home. There were 23 people living at home on the day of the inspection. There was no 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.

In response to three serious incidents in October and November 2015 the provider was working with external agencies to make changes to reduce the risk to people’s safety. Whilst changes had been made these will need to be reviewed by the provider to ensure they improve the risks to people’s safe care and treatment.

People told us that they felt safe in the home and felt the staff helped to keep them safe. People were not concerned about the risk of potential abuse and staff told us about how they kept people safe. During our inspection staff were available for people and were able to support them by offering guidance or care that reduced people’s risks. People told us they received their medicines as prescribed and at the correct time. They also felt that if they needed extra pain relief or other medicines these were provided. People told us there were enough staff to support people at the home and they did not have to wait for care to be provided.

People told us staff knew how to look after them. Staff felt their training reflected the needs of people who lived at the home. Nursing staff had recently began their clinical supervision which they felt supported and help them in providing care to people who lived at the home.

People were supported to eat and drink enough to keep them healthy. We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us and we saw that their privacy and dignity were respected and staff were kind to them. People received supported to have their choices and decisions respected and staff were considerate of promoting their privacy and dignity.

People had not always been involved in the planning of their care due to their capacity to make decisions. However, relatives felt they were involved in the care of their family member and were asked for their opinions and input. The provider will need to consider how to involve and include people in reviews of their care plans and show their involvement.

People told us they had limited abilities and chose not to maintain their hobbies and interests. However, staff offered encouragement and supported people to read or attend places of worship.

Relatives we spoke with told us they were not aware of the provider’s complaints policy, but were confident to approach the manager if they were not happy with their care. The provider had reviewed and responded to all concerns raised.

The provider had appointed a manager for the day to day running of the home, who was on leave on the day of the inspection. In their absence additional nurse cover had been provided. The provider was also in the process of recruiting a deputy manager who would also lead on the clinical aspects of people’s care and support.

Regular checks had been completed to monitor the quality of the care that people received and look at where improvements may be needed. Management and staff had implemented recent improvements and these would need to be regularly reviewed to ensure people’s care and support needs continued to be met. The management team were approachable and visible within the home which people and relatives liked.

You can see what action we told the provider to take at the back of the full version of this report.

We used the services of an interpreter to assist us in gaining the views of people for who English is not a first language.

Is the service safe?

People we spoke with told us they felt safe and comfortable living at the service. One person who used the service told us, "I like the home, the food is good the staff are good and I am quite happy'.

We were concerned about the level of cleanliness and hygiene at the service. The dedicated domestic hours for a large house had not been sufficient to ensure effective cleaning. Correct infection control procedures to protect people who used the service had not been followed. We found people's bedrooms, bedding, pillows and equipment personal to them was stained and marked. Bedroom walls and furniture were stained and there was a strong odour in some bedrooms. We found a lack of appropriate attention to infection control impacted on people's care and could place them at risk of infection through contamination.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found that proper policies and procedures were in place and the manager knew how and when to make an application. No applications had been submitted. We found that not all staff practiced in a way that ensured people's freedom of movement was not unnecessarily restricted.

Is the service effective?

We saw that people's care needs and the risks they faced to their health had been assessed. We saw the service cooperated with others such as the continuing health care team to promote people's wellbeing. This is a service where people who have had a hospital stay have their medical needs assessed with a view to recovery and possible return home with the right support. This meant that staff took into consideration external professional advice in order to promote people's health and wellbeing.

Through the services of our interpreter we were able to seek the views of those people who spoke Punjabi and Urdu. One person told us, 'The food is good we have a choice of Indian, halal or English meals, we are always asked'. We found that the service was effective in considering the religious and cultural needs of people. We saw information had been gathered about people's preferred language and staff could speak to people for who English was not their preferred language. We saw that people's religious requirements about clothing or objects of religious significance had been considered and that staff knew what to observe and respect people's beliefs. For example we saw for one person that a white head cap had religious significance and staff we spoke with understood this.

We saw that care plans provided staff with guidance to meet people's including people's personal choices or routines. Some people had been assessed at high risk of falls and were sleeping on a mattress on the floor. We found their bedrooms lacked any evidence that their needs for a personalised bedroom, furnishings of comfort or an alternative to a mattress on the floor had been considered. Their care plans did not show what furnishings had been considered or tried, to improve their comfort.

Is the service caring?

We observed staff interacting with people and saw that these interactions were positive and caring. People were complementary about the staff. One person told us, 'The staff are friendly and always ask us if we need help, I think they are very good'. A visiting professional told us, 'The staff are calm, patient and always responsive'.

One relative told us that they were happy with the care and that staff were responsive to their relatives' needs and had changed the care plan to suit these.

Is the service responsive?

People told us that there was enough stimulating activity to keep them interested. One person told us, 'We do have activities, quizzes, crafts, music and we go out for walks or to the church'. A record of activities and who engaged in them was helping staff monitor who engaged in activities and who needed assistance.

There were sufficient numbers of staff on duty. People we spoke with said they were not kept waiting for assistance but we saw there were occasions when staff were not immediately responsive to people's needs. This was because there were occasions when the lounge was unsupervised. The training records were not fully up to date and some gaps in essential staff training were evident. We saw the provider was planning to act on these gaps.

Although no recent complaints were recorded people told us they would feel confident to speak the manager if they did have a concern. We saw that appropriate steps had been taken to resolve the complaint of a relative.

We saw records for the reporting of accidents, incidents or safeguarding concerns demonstrated the manager had systems in place for the reporting and sharing of information. Although there had been minimal falls we saw the manager was monitoring the frequency of falls and ensuring people had the right support to minimise these. This should mean that any lessons to be learnt or risks to people are identified and minimised.

Is the service well-led?

The manager had registered with us, CQC. Compliance actions had been issued at our previous two inspections to this service. At this inspection we saw that some improvements had been made in relation to the systems for seeking the views of people who used the service, and improving the activities available to people.

There were systems in place to monitor the quality of the service but we found these were ineffective in relation to fire safety standards. The provider was working with the fire service in order to make the required improvements.

We carried out this inspection to ensure that improvements were made following our previous inspection on 16 April 2013. We spoke with two people, two relatives and three staff members. We spoke with the registered manager on the telephone.

We found that improvements had been made so staff had access to training which would enable them to ensure people were protected from harm. However, further improvements were required to improve staff understanding.

Systems to monitor the quality of the service continued to be inadequate, although some aspects had been improved. One relative said, "We have no problems here."

Records had improved and people's care plans were more detailed. However, further improvements were required to ensure records related to the management of the home were obtained.

We found that there had been an improvement in the way that people and their relatives were involved in their care delivery.

People received care that that met their needs. One person said, 'I am perfectly happy here, I cannot grumble.' We found that people had regular access to other healthcare professionals.

Arrangements were not in place to ensure that people were protected from harm.

Improvements had been made in the way that medicine was handled. One person said, 'That is always on time.'

Improvements had been made to ensure that the premises and equipment were suitable. People we spoke with were satisfied with the building and equipment. One person said, 'I have no complaints there.'

Employment checks were carried out prior to staff working at the home. Improvements had been made in the way this was managed.

Staff received appropriate support to carry out their role. People we spoke with were happy with the care and treatment provided by staff.

Systems were not always in place to ensure the effective identification and management of actions required to improved the service. Comments were not always taken seriously and acted upon to make improvements.

Records were not always available to show compliance and some records were not fit for purpose.