Archived: The Harriet Nanscawen Nursing Home

At our last inspection we rated the service good. We did rate one key area-safe as requires improvement. This was because the service did not have enough slings to help prevent infection control and people did not have personal evacuation plans. The registered manager assured us these matters would be dealt with swiftly and she provided information to show they had resolved these areas. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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Why the service is rated as good.

People said they enjoyed living at the service and felt safe and well cared for. Comments included

“This place has a very good reputation - one of the best smaller ones” and “They are very good here with the care

People were supported to maintain their independence and live fulfilling lives doing the things they enjoyed and being encouraged to try new things. Some people did comment there were no outing organised.

The home had a registered manager. A registered manager is a person who has registered with the CQC 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 registered manager had returned to work at the service in the summer of 2017 to retake up the role of manager. They had reapplied to CQC and had been re-registered as the registered manager in February 2018.

Staff were caring and knowledgeable about people’s needs, wishes and preferred routines. This helped them to plan personalised care. People, their families and visiting healthcare professionals were positive about the care and support people received. This considered their changing needs and healthcare needs.

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. People told us they could choose what time they got up and where they wished to spend their day.

Care and support was person centred and well planned. Staff had good training and support to do their job safely and effectively, although training records did not reflect all the training which had been completed.

Risk assessments were in place for each person. These identified the correct action to take to reduce the risk as much as possible in the least restrictive way. People received their medicines safely and on time. Accidents and incidents were carefully monitored, analysed and reported upon.

There were effective staff recruitment and selection processes in place. Staff understood about how to keep people protected and who to report abuse to.

Quality assurance processes and audits helped to ensure that the quality of care and support as well as the environment was closely monitored. This included seeking the views of people and their relatives.

We have made recommendations in relation to some records being more robustly maintained and kept up to date.

Further information is in the detailed findings below

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found the service was safe because people who received support from the service told us the staff looked after them and treated them well. One person told us "The girls here are all very kind ". Another person told us "I'm happy here. It's very good and very clean here. The activities they do are good." People told us they could speak with the staff or their manager if they had any concerns.

Staff told us they received training in a range of health and safety areas such as moving and handling, medication awareness, and safeguarding. This meant staff were enabled to deliver care and support safely.

On the day of our inspection we met seven people who were supported by the service and they looked happy and relaxed. They told us the support they received made them feel safe and reassured. A relative we spoke with said the support their relative received gave them the confidence they were being very well supported. They told us 'I'm happy that when I'm not here things are the same as when I am, as they should be.'

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw comprehensive assessments of need were done before a person received support. We saw the manager did regular supervision with staff to ensure that care and support were being delivered safely.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Although it was found that the home was not currently assessing the risk of this, the manager told us that following new rulings from the Supreme Court they would seek guidance from the DoLS assessment team urgently.

Is the service effective?

This service was found to be effective because people told us the service supported them in a way that suited their personal needs and maintained their quality of life. All of the people we spoke to were very happy with the care and support provided. A relative told us 'I'm confident that if anything was wrong they would get it sorted very quickly.' Another told us 'They're wonderful. My relative is very happy here.'

Staff told us the provider arranged relevant training and support to help them meet the needs of the people they supported. Training records showed that specialist training such as hydration, pressure damage care, and diabetes had been delivered. People told us they felt the support they received helped them to maintain some independence. We heard staff suggesting that people try things on their own first and then ask for help if needed.

Relatives told us 'No where's perfect compared to home, but this is as near perfect as you will get.' Another relative told us 'The home has a very good reputation locally; it's a fantastic place'. People and their relatives told us that the manager and staff were very approachable, and always had time to listen to them. This showed people's views were listened to and the service was effective at dealing with any concerns or issues.

Is the service caring?

We found the service was caring. For example, we observed staff treated each person as an individual with dignity and respect. They spoke to people in a calm, re-assuring and friendly manner. People told us that all of the support staff were nice and attentive. A relative told us the staff always went out of their way just to offer 'that little bit extra' and this made them feel their relative was very well cared for.

We found the home was very clean and pleasant. People we spoke to, their relatives, and some of the staff also commented on how clean and fresh they found the home, and how this was appreciated. We saw staff made activities and mealtimes accessible to all of the people who lived at the home. We saw visiting times for friends and relatives was open and one relative told us that whenever they visited the home all of the people who lived there seemed very happy.

Is the service responsive?

We found the service was responsive because people's needs were thoroughly assessed by the service before they received support. The registered manager told us some people would trial the service initially through respite stays. This meant that people had the opportunity to see if they were satisfied with the service and their needs and preferences were fully understood before moving in permanently.

We saw people's care was planned and delivered in line with their individual needs and preferences. Each person's care plan was reviewed every month and changes made to the support needed if necessary. The manager told us people were also re-assessed if a significant change in their needs was noticed or following a prolonged hospital admission.

We saw that keyworkers had regular discussions with people about their support, and if appropriate relatives and carers could also contribute. Notes of reviews were recorded in people's care plans. This ensured care and support remained appropriate to each person's individual needs.

People told us they were able to make choices regarding what time they received their support. The staff we saw demonstrated a good understanding of each person's support needs and preferences and how they should be met. This meant that people were able to retain control over their daily activities.

Is the service well led?

We found the service was well led. The registered manager has been in post for a number of years and is currently registered with CQC. We saw that the whole staff team worked together very effectively to ensure people's needs were met.

There was a clear staffing structure in place with clear lines of reporting and accountability. Staff said they felt well supported by colleagues and the registered manager. They told us they could report any issues or concerns to the registered manager in the first instance, and also used more senior colleagues for advice and support. The quality of the service was monitored through regular personal contact with people and their representatives, internal and external audits, staff supervision, and annual service user surveys.

We saw the provider had a comprehensive range of policies and procedures for staff to follow. Staff confirmed that the induction process was thorough and included training and development around key policies and procedures.

We reviewed a number of management documents and saw examples of clear monitoring of staff training and supervision, to ensure this was received on a regular basis.

We saw care and support was being well planned and delivered by a staff group who were trained and supported to do their job well. Staff understood safeguarding processes. This helped to keep people safe and protected.

Systems were in place to review the quality of care, including seeking the views of people living at the service. Records were accurate and demonstrated care and support was being delivered in line with assessed needs.

We carried out a desk top review to follow up the improvements made. The provider sent written information that we reviewed. We did not speak to anyone using this service. We concluded from the information sent that the provider has now demonstrated compliance with record keeping.