Service to the Aged

Updated 3 September 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors and two professional advisors who were a nurse and a speech and language therapist. The inspection was also supported by an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience contacted people’s relatives by telephone to request their feedback.

Service and service type

Service to the Aged (Sage) is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed notifications of accidents and incidents, deaths, safeguarding alerts and feedback from relatives and professionals received since the last inspection. We used all of this information to plan our inspection.

During the inspection

We spoke with fourteen staff including the deputy manager, three nurses, senior care assistants, care assistants, the activity coordinator and the chef. We spoke with ten people living in the home and one visitor. We carried out observations of staff interacting with people in all three units and the communal lounge. We also observed a mealtime in the dining room, in the units and people eating in their rooms.

We looked around all three units and checked a sample of equipment such as pressure relieving mattresses.

We reviewed a range of records. This included medicines records in two of the three units and medicines management in general. We looked at the care records for eleven people. We looked at three staff files in relation to recruitment records. A variety of records relating to the management of the service, including quality assurance audits, infection prevention and control, training records and health and safety were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found and we looked at more records. We spoke with the registered manager by video call. We spoke with one person living in the home and seven relatives of people living in the home by telephone. We also received feedback from four relatives by email. We received feedback from one professional who had regular contact with the home.

Updated 3 September 2021

About the service

Service to the Aged (known as Sage) is a residential care home providing nursing and personal care to older people of the Jewish faith. The home is registered to accommodate 60 people. At the time of the inspection there were 39 people living in the home.

The home is purpose built consisting of three separate floors with their own lounges, kitchenettes and bathrooms. In addition the home has a number of communal rooms on the ground floor for dining, activities and visitors. One floor specialises in caring for people who live with dementia and two floors accommodate people with nursing needs. There is always a nurse in charge of each of the three floors.

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

Risks to people’s safety and wellbeing had been assessed and action taken to help keep people safe from harm, however we found some risks relating to catheter care and dysphagia. Medicines were managed and administered safely. People experienced good care and treatment.

The home followed appropriate procedures for reporting any accidents or safeguarding concerns. Incidents and accidents were reflected on to see if any improvements were needed.

There were enough staff deployed to meet people's needs and ensure their safety. The home’s recruitment procedure was not always followed properly in checking applicants’ conduct in previous employment. We made a recommendation to improve recruitment practice.

People living in the home and their relatives told us they enjoyed living at this home and felt their religious and cultural needs as Jewish people were met well. The food, activities and daily and weekly routines met their requirements. They told us they were happy with the care and support they received. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff received training for their roles. Staff were caring and kind in their interactions with people and asked their consent during daily tasks. Staff knew people’s needs well. Staff supported people to meet their health and nutritional needs.

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 good (published 23 November 2019) . At this inspection the rating has deteriorated to requires improvement.

Why we inspected

The inspection was prompted in part by notifications of three specific incidents. Two of the incidents had been investigated by the local authority and one was being investigated at the time of the inspection. As a result, this inspection did not examine the circumstances of the incidents.

The information CQC received about the incidents indicated concerns about the management of catheters, dysphagia and communication between staff employed at the home and externally employed care workers. This inspection examined those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make some improvements.

Enforcement

We found a breach of regulations relating to safe care and treatment (managing risks). You can see what action we have asked the provider to take at the end of this full report.

The provider acted immediately to try to mitigate the risks to ensure people would receive safe care and treatment.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.