Archived: Jesmund Nursing Home

Jesmund Nursing Home provides accommodation, nursing and personal care for up to 25 older people. At the time of our inspection 21 people were using the service, most of whom were living with dementia.

A registered manager was 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 2008 and associated Regulations about how the service is run.

At this inspection we found significant improvements had been made, however, concerns remained in regards to the governance and management of the service. There were plans to improve the registered manager’s auditing and checking processes but these were not in place at the time of inspection. There was a lack of robust procedures to ensure appropriate action was planned and taken to address any concerns identified in a timely manner.

Staff treated people with dignity and respect. Staff were responsive to people’s requests for assistance and provided the help required to meet a person’s needs whilst still enabling them to have some independence. Staff interpreted people’s non-verbal communication and provided support in a kind and caring manner.

Risks to people’s safety had been identified, reviewed and management plans were in place to mitigate the risks. This included environmental risks and risks associated with people’s individual needs. Some risk management records did not include specific information about how risks were to be managed but there were plans to include this and staff were aware of how to support people safely. Incident reporting and recording had been improved to ensure all incidents and accidents were recorded and appropriate action was taken to support the individual, including liaising with the local authority safeguarding team when required.

There were sufficient staff to meet people’s needs and safe recruitment practices were undertaken to ensure appropriate staff were employed. Staff received regular training to ensure they had the knowledge and skills to undertake their duties and meet people’s needs.

Staff supported people with their nutritional and hydration needs. They liaised with healthcare professionals as required to ensure people’s health needs were met. People received their medicines as prescribed. Staff provided people with the level of support they required and additional information had been obtained to ensure staff were able to provide personalised care. Staff supported people in line with the Mental Capacity Act 2005 and adhered to any restrictions included in Deprivation of Liberty Safeguards authorisations.

The provider had arranged for an additional performer to visit the service and the activities on offer had been increased to ensure people had opportunities to be stimulated and engaged. The provider had liaised with the Alzheimer’s Society to obtain advice about how to adapt their environment to meet the needs of people living with dementia. An action plan was in place to make improvements to the environment but at the time of inspection these had not been undertaken.

The provider had worked with health and social care professionals from the local authority and the clinical commissioning group to help improve practices and had employed external consultants to further provide advice and guidance. Regular meetings were held with staff and people to obtain their views and opinions and these were taken on board when developing the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

However, we identified a continued beach of regulation relating to good governance. We will continue to monitor compliance with this regulation and liaise with the provider about the sustainability of continuous improvement.

Our last comprehensive inspection of this service took place on 9 August 2016. At that time we found the provider was in breach of six regulations relating to person centred-care, dignity and respect, need for consent, safe care and treatment, premises and good governance.

We issued warning notices for the breaches relating to safe care and treatment, premises and good governance. The provider was given until 19 September 2016 to make the necessary improvements. We undertook a focused inspection on 7 December 2016 to follow up the warning notices and found the provider remained in breach of the three regulations. We wrote to the provider requesting a plan outlining what action they would take to meet these breaches. We received weekly updates until the 3 February 2017 on the progress made. At that point the provider assured us they had made sufficient progress towards meeting the regulations.

We did not follow up the other three breaches relating to person centred-care, dignity and respect and need for consent at our focused inspection. After our comprehensive inspection on 9 August 2016 the provider submitted an action plan which stated they would take sufficient action to address the breaches by December 2016.

We reviewed the action taken to address all six breaches at this inspection.

After our comprehensive inspection on 9 August 2016 we rated the service as ‘requires improvement’ overall and in four key questions. The service was rated ‘inadequate’ for the key question ‘is the service safe?’ These ratings remained unchanged after our focused inspection on 7 December 2016.

A registered manager continued to be 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 2008 and associated Regulations about how the service is run.

At this inspection we found some of our previous concerns had not been sufficiently addressed and there was a risk of significant harm to the people using the service.

There were ineffective processes in place to assess the individual risks to people’s safety and ensure adequate management plans were in place to mitigate those risks. Risk assessments were not updated in response to incidents that occurred and staff did not provide people with the level of support they required to remain safe.

Processes to review the quality of the service still remained in need of improvement. There were not sufficient checks in place to monitor all areas of service delivery and the processes in place were ineffective in identifying and addressing the concerns we raised.

Our observations showed staff continued to not treat people with the dignity and respect they deserved and did not always provide people with kind, caring and compassionate support. We observed staff ignoring people’s requests for assistance, there were delays in providing people with the support they needed and often staff were focussed on the task they were performing rather than people’s wellbeing.

The environment was still in need of improvement to meet the needs of people living with dementia and our recommendation remains that the provider should consult guidance on providing a ‘dementia friendly’ environment.

There were limited opportunities for social stimulation for people at the home and in the community. We recommend the provider consults guidance on the social inclusion, engagement and stimulation of people in a care setting.

At this inspection we saw some improvements had been made. The registered manager and nursing staff had reviewed and updated people’s care records. This ensured additional information was provided to staff about how to meet people’s care needs. The registered manager had liaised with other health and social care professionals to review people’s mental capacity and organised for ‘best interests’ meetings to be held to ensure people received appropriate care. People had arrangements in place to deprive them of their liberty reviewed to ensure these arrangements remained in the person’s best interests.

The provider had taken action to ensure a clean and safe environment was provided. They had improved their cleaning processes and there was closer checking and auditing of the cleanliness of the environment. The provider had also addressed the environmental risks and ensured a safe environment was provided.

Staff continued to provide people with the support they required with their health care needs, including their nutritional needs and ensuring people received their medicines as prescribed.

Staff received regular training and supervision, and there were regular staff meetings to obtain staff’s views about the service. There were enough staff employed to meet people’s needs and safe recruitment practices were followed.

Nevertheless, the provider remained in breach of regulations relating to safe care and treatment, dignity and respect and good governance. We have taken urgent action to restrict any new admissions to the service and requested weekly updates from the provider in regards to any incidents and accidents that occur and how these are managed. We are considering any further action that we may need to take to further protect people from harm and will report on this when it is complete. In addition, the provider was in breach of the CQC registration regulation relating to notification of other incidents. You can see what action we have asked the provider to take at the back of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook a focused inspection on the 7 December 2016 to check that they now met legal requirements relating to the three breaches where we issued warning notices. We will follow up the other breaches at future inspections. This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive inspection, by selecting the 'all reports' link for ‘Jesmund Nursing Home’ on our website at www.cqc.org.uk.

Jesmund Nursing Home provides accommodation, personal and nursing care to up to 25 older people. At the time of our inspection 22 people were using the service. Most of the people using the service had a cognitive impairment and some were living with dementia.

A registered manager was 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 2008 and associated Regulations about how the service is run. The provider worked closely with the registered manager to provide the day-to-day management of the service.

At this inspection we found the provider had not taken sufficient action to address the requirements of the warning notices issued. The environment continued to be dirty and unpleasant and there were no cleaning schedules in place. Carpets were heavily stained and there were stains on the walls. Furniture in people’s rooms were ripped and covered in food debris. Some of the bathrooms had cracked floors and broken bath panels meaning they could not be adequately cleaned.

The provider had still not addressed all of the environmental risks to people’s safety. They had not undertaken a full health and safety risk assessment and there were not always plans in place as to how risks to people’s safety were being mitigated. The provider had begun work on covering radiators and installing window restrictors but this had not been completed and there were no clear plans as to when the work would be completed or how the risks were being managed in the meantime. Some broken equipment continued to be held together with electrical tape.

The provider did not have proper quality assurance systems and clear improvement plans about how they were addressing the concerns identified at this and our previous inspections. There were no processes or systems in place to monitor and review the safety of the environment. Checks on the cleanliness of the service were ineffective and did not address each person’s bedroom.

The provider remained in breach of the regulations relating to safe care and treatment, premises and good governance. Following our inspection and as part of our decision making process for enforcement action against the provider, we wrote to them requesting a plan outlining what actions they had taken since our inspection and what further action they planned to take in order to meet the breaches of regulations summarised above. We received an action plan within the timescale requested. This showed that the provider had addressed or was in the process of addressing our most urgent concerns. We have requested weekly updates from the provider on the action they are taking and will continue to monitor the provider’s action plan. On this occasion we are not taking further enforcement action but we will consider taking further enforcement action if when we inspect again, we find that adequate improvements have not been made to the service.

Jesmund nursing home provides accommodation, personal and nursing care to up to 22 older people. At the time of our inspection 20 people were using the service. Most of the people using the service had a cognitive impairment and some were living with dementia.

A registered manager was in post. This was a new registered manager, and they were not in post during our previous inspection. Previously the provider had also acted as the 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.

The provider had not ensured people’s safety was being adequately maintained. A clean and safe environment was not provided. We observed that many people’s rooms and en-suite bathrooms were dirty, as well as much of the furniture in their room, and there were stains on walls, carpets and furniture.

The provider had not considered the risks to people’s safety posed by the environment. Windows were not restricted by appropriate and effective devices meaning there was a risk of people falling from height. Fire exits and fire escape routes were blocked meaning people would not be able to safely exit the building in the event of a fire. People were at risk falling and injury due to hazards at the service, including loose wiring, access to razors and uncovered radiators.

There were insufficient processes in place to monitor the quality of service provision. Whilst auditing processes had improved since our last inspection, there were no processes in place to monitor the environment and mitigate risks to people’s safety. Care planning audits had not identified the improvements required to ensure accurate and detailed care records were maintained, and held securely. There were a lack of processes to learn from incidents, and feedback received about the service.

Care planning processes identified behaviour and symptoms people needed support with, but did not sufficiently address how staff were to manage these behaviours and provide the support required. There was a risk that people did not receive the support they required with their individual needs, particularly in regards to personal care and managing behaviour that challenged staff.

Staff had not consistently adhered to the Mental Capacity Act (MCA) 2005. Staff informed us that people using the service did not have the capacity to make most decisions about their care, however, there was no evidence that staff carried out MCA assessments to confirm this. The provider had not undertaken the necessary arrangements to identify whether people were being deprived of their liberty and if it was within their best interests.

People were not always treated with dignity and respect. We observed that the language used by staff during our inspection and in people’s care records at times was disrespectful to the person involved. People felt that at times staff were task focussed and they did not always feel involved in their care and how they spent their time.

Many of the people using the service had cognitive impairment or were living with dementia. The environment had not been adapted to support the people living there, and we recommend that the service refer to national guidance about developing a dementia friendly environment.

There were sufficient staff on duty to meet people’s needs, and we saw that staff were supported through regular supervision and attendance at training courses. However, some staff felt these could be more frequently. Staff felt listened to and able to express their views and opinions. They felt able to approach their management team, and told us they were accessible when they needed advice and support.

Staff liaised with other health and social care professionals for support on how to meet people’s needs. This included in regards to their behaviour and their physical health. There was a regular visiting GP and we saw that people were visited by other healthcare professionals. Safe medicines management processes were in place and people received their medicines as prescribed. Staff monitored that people ate and drank sufficient amounts.

The provider was in breach of the legal requirements relating to safe care and treatment, person centred-care, treating people with dignity and respect, consent to care, safety and suitability of premises and good governance. You can see what action we have asked the provider to take to address the breaches of regulation in relation to person centred-care, treating people with dignity and respect and consent to care at the back of this report. We are taking further action against the provider in relation to safe care and treatment, safety and suitability of premises and good governance. Full information about CQC’s regulatory response to these concerns is added to the back of the report after any representations and appeals have been concluded.

Below is a summary of what we found. The summary is based on our observations during the inspection and from looking at records. We met and spoke with people using the service but many people were unable to share their views and experiences with us due to their complex communication needs. We spoke with three relatives of people using the service after the inspection. During the inspection we spoke with the provider who is the registered manager, three members of staff and the activities co-ordinator.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Relatives told us that people were safe. One person said, 'I think she's very safe there. We've never had a problem.' Another person told us, 'Yes, I think it's safe and they take a lot of precautions especially when moving my relative around the home.'

Any potential risks to people's health, safety and welfare within the home were assessed by senior staff. There was appropriate guidance for staff on how to take action to minimise these risks to keep people safe from harm or injury in the home. This information was checked regularly by staff which meant they had up to date information about how to keep people safe.

People were cared for in an environment that was kept mostly clean and hygienic. Some areas of the home were not as clean as others and hand sanitisers and soap dispensers were not all properly maintained. The provider did not have full assurance that all risks were effectively managed to prevent the spread of infection in the home. However, staff knew how to maintain good standards of cleanliness and hygiene within the home to reduce the risk of cross infection, as they had received appropriate training to do so.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and in how to submit one. This meant that people would be safeguarded as required.

Is the service effective?

People's views and preferences had been taken into account when staff planned their care and support. People's records showed their care and support needs were reviewed regularly by staff. There was information and guidance for staff on how to provide care and support that met people's needs. However some records did not always reflect and evaluate, where there were changes in people's general health or wellbeing, how this impacted on the care and support provided.

Staff we spoke with demonstrated a good understanding and awareness of the people they cared for and in particular, what was important to them. They received regular training and supervision meetings to support them in their roles, so people could be assured their needs were being met by appropriately skilled and trained staff.

Is the service caring?

People we spoke with had positive experiences of staff that worked in the home. Comments we received included; 'I think the staff are very caring.' and, 'Nothing seems like too much trouble. They are treating my relative so well and have done a good job with her.'

During our inspection we observed friendly, patient and kind interaction between staff and people using the service. Staff spoke with people respectfully and took time to listen and chat with them. People that needed extra help and support moving around the home or with eating and drinking were not rush or hurried by staff and could do so at their own pace.

Is the service responsive?

There were mechanisms in place to monitor people's general health and wellbeing. We saw regular checks were made and documented and staff used this information to highlight and take appropriate action about underlying issues or concerns they had about an individual's health or wellbeing. This information was shared so that all staff had the most up to date information about people's current care and support needs.

Information and concerns about people's health and wellbeing were shared with other healthcare professionals such as the General Practitioner (GP) and the behavioural support team at the local council. This meant people received the additional help and support they needed, promptly.

People's relatives told us the service shared information about their loved ones promptly. One person said, 'They're very good at letting the family know if anything happens and they always keep us up to date.' Another person told us when their relative had arrived at the home they were very underweight. They said the home had kept them regularly informed of their relative's progress and the actions taken by staff to care for and support them and as such they had seen significant improvement in their overall health and wellbeing since they arrived.

Is the service well-led?

The views and experiences of people using the service and their relatives were sought by the service. Changes and improvements to the service were made when people wanted or needed these.

Although the provider understood the importance of quality assurance and carried out some checks to assess and monitor the quality of service, they did not regularly check some aspects of the service provided which meant they missed opportunities to make improvements or changes that were needed.

We used SOFI as a method to help us understand the experiences of people using the service. We observed that people's experience of the service was overall positive.

Peoples care plans were comprehensive and staff had very good knowledge of individual needs and the ways that people like being supported.

We found improvements had been made since our last inspection in the way the home provided choice of food and drink to people.

It was evident from the practices we saw during our visit that the people using the service were well supported by the staff that worked there and treated with respect.