Archived: Nunthorpe Oaks Residential Care Home

Nunthorpe Oaks is a care home which provides residential care for up to 56 older people. Some people supported by the service were living with dementia. At the time of inspection 39 people were using the service. Nunthorpe Oaks is a purpose built building set out over two floors.

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

At the time of inspection the service was being monitored closely by the local authority due to a range of concerns raised about the quality and safety of the service. At this inspection we found the provider had acknowledged the concerns raised and was taking action to support staff and make improvements. The improvements identified by the management team had not been fully completed and quality assurance systems had not identified some of the shortfalls we found. People and relatives told us they felt the service was now on the right track but there was further work to do.

We found medicines were not always managed safely. Risks to people were not always assessed and managed effectively. People’s individual care needs had not always been assessed and reviewed regularly. We found the home required refurbishment and was not always free of malodours.

Staff knew how to safeguard people from abuse. Recruitment processes reduced the risk of unsuitable people being employed. Staff told us there were usually enough care staff on duty to meet people’s needs. Staff were supported through a system of induction, training and supervision. However, the provider recognised that there had been some shortfalls in these areas. The provider was working to address this issue.

A range of activities were provided for people. We have made a recommendation about outings and activities for people who do not want to join in group sessions.

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.

The service had recently been working closely with a range other professionals and agencies to improve the service on offer to people. A complaints system was in place. Lessons were learnt from adverse incidents.

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 outstanding (published 2 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches of regulation in relation to the safety and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Nunthorpe Oaks provides care and accommodation for up to 56 older people some of whom were living with dementia. The service is purpose built with accommodation provided over two floors and this includes communal lounge and dining areas. There are garden areas surrounding the building. At the time of the inspection there were total of 54 people who used the service.

The home 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 received a consistently high standard of care because staff were led by an experienced and proactive registered manager. The staff team were highly motivated and enthusiastic, and committed to ensuring each person had a good quality of life. There was a clear management structure in place and oversight from the registered provider. There were systems in place to monitor the safety and drive the continuous improvement of the quality of the service provided. A comprehensive programme of audits and checks were in place to monitor all aspects of the service, including care delivery, accidents and incidents, health and safety, infection prevention and control and medicines. Audits resulted in clear action plans to address shortfalls or areas of improvement.

The registered manager displayed exceptional leadership qualities, drive and enthusiasm. They empowered staff to provide outstanding care that was tailored to individual’s needs. Without exception people, their relatives and professionals told us they experienced and we observed compassionate care from staff who strove for excellence. This ensured the service was run in the best interest of people who used the service.

People received care and support in an exceptionally personalised way. Staff knew people well, understood their needs and the way they communicated if they were living with dementia. Care was focused on people's wishes and preferences. This meant people were able to maintain their independence and achieve a good sense of self-worth and wellbeing. The impact this had on people was outstanding and had resulted in them being settled, content and helped them to lead as full and active lives as they wanted to.

Staff developed exceptionally positive and caring relationships with people and their families. Staff were very motivated and demonstrated a commitment to providing the best quality care to individuals in a compassionate way. People's privacy and dignity was maintained at all times during the inspection. Health professionals told us people received end of life care that was exemplary, and that staff worked closely with the community nursing team to ensure people and their family were treated with dignity and respect, and that their individual preferences were considered at all times.

People’s independence was actively encouraged. The registered manager and staff displayed clear resolve to make a positive difference to people's lives. Activities were invigorating, outings and events were well thought through, varied and in plentiful supply. Staff encouraged and supported people to access activities within the community. There were meaningful activities for people living with dementia.

Assessments were undertaken to identify people’s care, health and support needs. There was a strong emphasis on person centred care. People and their families were at the centre of decision making whilst working alongside professionals to get the best outcome possible. Care plans were developed with people who used the service and relatives to identify how they wanted to be supported.

People were protected by the services approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People told us staff treated them well and they were happy with the care and service received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

There were sufficient staff on duty to meet the needs of people who used the service. Staff were available to provide support with visits out in the community. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff started work.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as health, falls, moving and handling and the use of equipment. This enabled staff to have the guidance they needed to help people to remain safe.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, which meant they were working within the law to support people who may lack capacity to make their own decisions.

People were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

Where able, people could make their own day to day decisions and lifestyle choices. They could choose to participate in activities or spend time in their rooms. We saw people could maintain contact with their friends and family.

We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing. People's views were taken into account in the assessment and care planning process.

People who used the service were protected from the risk of abuse and told us they felt comfortable and safe with staff.

Staff received appropriate training and had regular supervision and appraisals.

The quality of the service was monitored and reviewed on a regular basis.

We spoke with one person about their medicines and the care they received. This person said " I'm happy to take my medicines in the living room, the staff are good, and I get all my medicines on time.'

We saw that some people managed their own medicines and appropriate risk assessments had been completed and ongoing support was provided to do this safely.

One of the relatives we spoke with told us they were happy with the staff who looked after their mum and the staff were very good. Another relative told us 'Staff on the whole do their best.'

People told us they were able to make their own day to day decisions and lifestyle choices. They confirmed they had menu choices, could choose to participate in activities or spend time in their rooms. We saw people could maintain contact with their friends and family.

We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing. People's views were taken into account in the assessment and care planning process.

We found processes for the administration and management of medicines were not always been followed.