Archived: Fore Dore Nursing Home

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence to support our summary please read the full report.

Is the service safe?

People were treated with dignity and respect. We spoke with six people living in in the home and they all told us they enjoyed living there and felt safe. Care plans were personalised to the individual and gave comprehensive information about how the person wanted their care and support to be provided.

People were cared for by staff who were properly trained, supervised and appraised.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff understood the signs of abuse and how to raise concerns with the right person when those signs were noticed.

Fore Dore had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). There was evidence the home considered the impact of any restrictions put in place for people that might need to be authorised under the Deprivation of Liberty Safeguards.

Is the service effective?

People's health and care needs were assessed and where possible they were involved in developing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with three visitors and they all confirmed they were able to visit the home whenever they wished and were able to see people in private. One visitor told us 'We are always made to feel welcome and usually see X in the main lounge. When we wanted to have a family meeting in private we asked to use the other lounge and the home arranged this for us'.

Is the service caring?

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. We saw staff provided support in accordance with people's wishes.

People we spoke with told us they were very happy living in the home and staff were caring and attentive to their needs. Visitors we spoke with told us 'my husband is looked after well' and 'We are always informed of any changes to my parent's condition and this assures me that they are well looked after'. We observed staff responding to people in a kind and caring manner.

Is the service responsive?

Since our last inspection the home had appointed an activity co-ordinator who worked 30 hours each week. We looked at activity records and saw people had taken part in a range of individual and group activities. One relative told us 'my parent is well entertained'.

Fore Dore gave clear information to people about how to complain. The home had not received any complaints in the last year. People living in the home and their visitors told us they knew how to complain and would be happy to raise any concerns if they had any.

Is the service well-led?

The home worked with external health professionals to ensure people's health needs were met. This included community nurses and GPs.

The registration of the provider of this regulated activity is subject to a registered manager condition and this location has not had a registered manager since 08 August 2013. The acting manager advised us they hoped to be able to submit a registered manager application for this location by the end of May 2014. We have asked the provider to keep us informed of the progress of this application.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive. The provider did not have a system in place to ask people who used the service for their views about their care and treatment.

As a result we were not assured that the quality of the service provided to people was continuingly improving. We have asked the provider to tell us what actions they intend to take to meet the requirements of the law in relation to quality assurance.

During our inspection we spoke with four people who used the service who all said they liked to live at Fore Dore Nursing Home and found the staff helpful to them.

We saw staff provided care to people as directed in their care plans and in response to requests from people who used the service. We found that some records did not demonstrate that people's care needs had been met appropriately.

We saw the home was clean and tidy. Infection control was promoted within the home and the risk of cross infection reduced by the systems in place.

Records showed a robust recruitment process had been followed when appointing new staff. This process protected people who used the service from receiving their care from unsuitable staff.

Staff were not consistently provided with adequate training and supervision to ensure they were competent to meet the care needs of people who used the service, but the acting manager was taking action to address this issue.

We spoke with staff who were on duty during our inspection. Staff were positive regarding the changes that had occurred in the home since our last visit. We were told more staff had been recruited, although one member of staff added that some existing staff members had left Fore Dore. Staff were complimentary about the acting manager and the positive effects they felt this person had made regarding the running of the home.

We found, from reviewing staff records and speaking with staff, that a robust recruitment procedure had not been consistently followed. This put people who lived at Fore Dore nursing home at risk from receiving a service from unsuitable staff members.

During our inspection we spoke with five people who used the service. We were told people liked to live at the home and that they liked the staff. Comments made included 'the staff are nice, they help me to be independent but will always help me if I ask' and 'the staff are kind'. We spoke with two visitors to the home who told us they were satisfied with the care their relative received.

We saw staff provided care to people as directed in their care plans and in response to requests from people who used the service. People were safeguarded against abuse.

People were not consistently protected from the risk of infection because appropriate guidance had not been followed.

People were not consistently cared for, or supported by, suitably qualified, skilled and experienced staff. This was because a robust recruitment procedure had not been followed and staff had not been provided with training and supervision. However, the manager was aware of the shortfalls regarding training and supervision and was in the process of developing an appropriate training and supervision programme.

People's confidential and person information was not stored securely.

We talked to three people who used the service and they told us the staff were kind and helpful to them and responded to their needs promptly. One person told us there were more trained staff and care workers in the home now.

We talked to staff who were on duty and they all confirmed there was planned trained nursing cover from trained nurses who knew the people who used the service and who knew the nurses. This provided continuity of nursing cover to people who used the service. Staff told us this was a big improvement since our last inspection. One member of staff told us 'it is better for the residents, as they know the nurses and the nurses understand them and their needs'. Another care worker said 'the nurses are good; they listen to us which means things are improved for the residents'.

There were enough qualified, skilled and experienced staff to meet people's needs.

The privacy and dignity of people who used the service was compromised in some areas. We saw one person's personal health information displayed in a communal area and people's bedroom doors, two toilets and one bathroom were not able to be locked. We noted there were unnamed personal toiletries left in bathrooms and showers, which did not ensure they were used by the owner only. Underwear was used for more than one person and was not named.

The home was warm and furnished in a domestic style. Some areas of the home required redecorating or refurbishment and some cleaning was required, for example the carpets.

We found people were at risk from moving and handling practices in the home and appropriate risk assessments had not been carried out regarding possible restrictive practices.

People were not fully protected against the risks associated with medicines.

People's personal and confidential information was not stored securely or safely.

Recruitment procedures were not followed appropriately to ensure people who used the service were protected.

People experienced care, treatment and support that met their needs and protected their rights.

We were told that improvements had, and were being made to the premises.

People we spoke with said they enjoyed the food they received. We were told the food was of a good standard, and we saw the food provided at lunch was hot, well presented and in sufficient quantities. We saw people were offered choices at meals.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that considerable improvement had been made in all the standards inspected. Work was ongoing and progress noted.