Myford House Nursing & Residential Home

We found the following examples of good practice.

• People were supported within a self-contained designated unit that had a separate key coded entrance.

• People were supported by a staff cohort who worked only on the unit and were not permitted to work elsewhere. Staff who had received their Covid-19 vaccination were allocated to work on the designated unit to minimise risk of transmission of Covid-19 to staff.

• People who had tested positive for Covid-19 were required to self isolate in line with current guidance. Where people were non-compliant with self isolation due to their cognitive needs, capacity assessments were completed and best interests’ decisions were made regarding the use of assistive technology to mitigate the risk of transmission of Covid-19. This included the use of floor sensor mats and door alarms to alert staff when people walked with purpose in the least restrictive way.

• Cleaning schedules were in place and cleaning was undertaken in line with current guidance. Daily checks were undertaken by the registered manager to ensure compliance.

• People were supported by staff who wore Personal Protective Equipment (PPE) in line with current guidance.

• People had been supported to engage in activities to aid their understanding and reduce their anxieties regarding staff wearing PPE. Quotes from people living at the home about how using PPE may impact on them were shared with staff on a creative visual tool which was shared with staff to reiterate the importance of wearing PPE appropriately.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Myford House Nursing and Residential Home is a nursing home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 57 people.

Myford House provides accommodation across two floors. The home is divided in to various units and at the time of inspection they were only using two of the units. On each floor people had access to communal areas where they could socialise with others living in the home.

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

Governance systems were in place and being used effectively, these included monitoring visits from the provider.

Risks to people’s safety had been assessed and people were protected from the risk of harm.

People received their medicine as prescribed and were supported by sufficient numbers of staff, who had been trained to provide safe care and support.

The provider could demonstrate they learnt and shared lessons when things went wrong. They had prepared the home to manage the risks associated with the current pandemic. Infection, prevention and control measures were in place.

The service worked in partnership with other agencies to improve outcomes for people. The atmosphere in the home was positive and people were engaged.

The provider understood their duty of candour.

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 requires improvement (published 21 April 2020) there were multiple breaches of regulation. Following the last inspection, we issued a warning notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 outlining the improvements we needed to see.

Why we inspected

We carried out an unannounced focussed inspection of this service on 11 February 2020. Breaches of legal requirements were found. The provider was issued with a warning notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection the provider produced an action plan outlining how they would improve.

We undertook this focused inspection to check they had met the warning notice, followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Myford House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Myford House is a care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 57 people.

Myford House delivers care across two floors, with bedrooms and communal spaces on each floor. People have access to en-suite toilets and adapted bathrooms. There is a hairdressing salon and access to outside space.

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

Risks to people’s safety were not always considered. We observed a few incidents which had the potential to cause harm. The provider took immediate action to ensure people were safe.

Staff were not always deployed in the most effective way. On the first day of inspection there was a lack of co-ordination around staff’s knowledge of the people they were allocated to support. Staff did not always have enough time to spend with people and there were a high number of people being cared for in bed.

The provider was not able to demonstrate effective governance of the service. Some audits had not been completed and the provider was not aware of external reports written about the service.

The provider had not completed a recent infection control audit and we found areas of the building needed a deep clean.

People received their medicine on time. However, we did find missing signatures on some of the documentation. People had personal evacuation plans in case of an emergency.

Lessons learnt exercises were completed however the new management team were not aware of all previously reported concerns. We ensured they received this information in order to complete the required investigations.

The provider was open and honest about the issues in the service and the new management team had plans to address each issue. Staff told us they were feeling confident about the changes being made.

The provider applied their duty of candour following an incident although one relative told us they would have liked additional information.

The management team were increasing their level of engagement with people, their families and the staff team. Daily meetings ensured there was improved communication across the service.

The service worked in partnership with others and was actively engaging external agencies.

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 13 March 2019).

Why we inspected

We received concerns in relation to the management of people’s safety. As a result, we undertook a focused inspection to review the Key Questions of Safe 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 have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

The provider was aware of the improvements needed and acted to mitigate the risk of harm.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Myford House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the safe care and treatment of people, the staffing and the overall governance of the service at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

The inspection took place on 11 December 2018. The inspection was unannounced.

At our previous inspection on 26 and 27 October 2017, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safe handling of medicines and good governance. At this inspection we found the provider was no longer in breach of regulations and that improvements had been made.

People were getting their medicine at the correct time and safe administering procedures were being followed. We observed staff were recording temperatures of the medicine room and fridge. However, there were inaccuracies with the results which had the potential to put people at risk. We also found that clearer instructions were needed for staff in relation to the administration of medicine via a gastric tube.

People were supported by sufficient staff who understood how to recognise and report safeguarding concerns. Staff felt well trained and supported.

Accident and incidents were investigated and records completed appropriately. Actions were put in place when required to reduce the likelihood of reoccurrence.

People had up to date care plans and all staff had access to the information via newly introduced technology.

People's nutritional needs were met and they had access to home cooked meals, drinks and snacks throughout the day.

People were supported to consent to their care. Applications to deprive people of their liberty had been made to the correct authorities.

People were treated with compassion and given time to discuss their concerns.

People’s privacy and dignity was preserved.

People had access to a range of activities which their family members could join in if they wanted.

People's complaints were investigated and responded to in a timely manner.

People were supported by a manager who is registered with the Care Quality Commission.

The registered manager had governance systems in place which ensured issues were identified and acted upon. However, the issues around medicine storage had not been picked up although temperatures were being recorded.

The provider worked well with other agencies to support the practice in the home.

The inspection took place on 26 and 27 October 2017. Day one of the inspection was unannounced, and day two of the inspection was announced.

There was no registered manager at this service, and there had been no registered manager in post since May 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 our previous inspection on 14 and 15 August 2017, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing; person-centred care; safe care and treatment; dignity and respect; and good governance. The service was placed into special measures, which meant that significant improvements were required. At this inspection, we found the provider remained in breach two Regulations. These were in regard to the proper and safe use of medicines (safe care and treatment), and good governance. However, we found the provider was no longer in breach of the Regulations regarding person-centred care; staffing and dignity and respect.

Medicines were not always stored or administered safely. Not everyone had received their medicines at the correct time, which placed them at risk of harm.

Not all staff had received the necessary training relevant to their roles. The provider and manager had audits in place to monitor and improve the quality of care provided. Whilst the provider and manager had taken immediate action when health professionals the CQC had brought issues to their attention, their audits had not always been effective in identifying these concerns themselves.

People were sometimes placed in undignified situations and treated in a disrespectful manner.

There were sufficient staff on duty to safely meet people's needs, and staffing levels were kept under review. Safe staff recruitment procedures were in place to ensure people were only supported by people who were suitable to work in care.

People's weight, food and fluid intakes were monitored and action taken to maintain people's health. People had access to a range of healthcare professionals, and their changing health and wellbeing needs were responded to.

Staff were positive and enthusiastic about the improvements made at Myford House. and the on-going improvements in place. Staff knew people well and there was a natural rapport and ease between staff and the people they care for.

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The inspection took place on 14 and 15 August 2017. Day one of the inspection was unannounced, and day two was announced.

There was no registered manager at this service. A home manager had been in post for three months and had started the registration process with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 our previous inspection in January 2017, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to good governance. At this inspection, we found the provider was still in breach of this regulation, as well as identifying four other breaches of Regulations. These were in relation to person-centred care; dignity and respect; safe care and treatment; and staffing.

People did not receive their medicines safely. Medicines were administered without being signed for, and without making the staff team aware they had been given. 'As required' medicines were given without a clear rationale for doing so, and without authorisation from the lead nurse. The nursing staff did not know how to safely administer one particular medicine.

People's risk assessments were not followed, which placed people at risk of harm and neglect. Staff were not always vigilant to changes in people's health, as per the risk assessments relating to their individual health conditions.

Where agency staff were used, they were not always inducted and supervised by experienced and senior staff members. Agency nurses were not supervised by the lead nurse, and the lead nurse had no oversight of clinical decisions made.

People did not always see health professionals when required. Their medical and health needs were not consistently reviewed. Changes in people's health and wellbeing were not responded to.

People's dignity was not upheld, including in relation to their personal care, appearance and hygiene.

The recording system used was unclear and unsafe. Important information about people's medication were not documented or shared. Care records contained inconsistent information, making it difficult to ascertain what their needs were and how they had presented that day.

Staff did not feel able to approach management with any concerns, including safeguarding concerns and whistle-blowing. They felt fearful in their roles, and morale was low.

The manager and the provider had been unaware of some of the concerns we brought to their attention during our inspection, and these had not been identified as part of their internal quality assurance measures.

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; if we have not taken immediate action to propose to cancel the provider’s registration of the service, it 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.

Myford House Nursing and Residential Home provides accommodation and personal care for up to 57 older people and for people living with dementia. On the days of our inspection there were 38 people living there.

The home had a registered manager who was present for the inspection. 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 our last inspection in September 2016, we found people were not supported to manage their behaviours. At this inspection, staff had learnt new skills and received support from other healthcare services to enable them to safely help people to manage their behaviours. People may not always receive care and support in a timely manner because there were not always enough staff on duty. Care practices did not always protect people from the risk of harm. However, they were supported by staff to take their prescribed medicines. People felt safe living in the home and staff were aware of their responsibility of protecting them from the risk of potential abuse.

At our previous inspection it was highlighted that staff and managers did not have sufficient understanding about the Mental Capacity Act [MCA]. We also found there was a lack of understanding about when a Deprivation of Liberty Safeguards [DoLS] application should be submitted to the local authority to lawfully deprive a person of their liberty. At this inspection staff had a better understanding of MCA and DoLS and people confirmed their consent was always obtained.

People were supported by staff who may not have received up to date training or an induction into their new role. People had a choice of meals but were not adequately supported by staff to eat and drink. People were assisted by staff to access relevant healthcare services when needed.

People were not cared for in a manner that promoted their right to dignity at all times. Care practices varied where some staff were more attentive to people’s needs than others. People were involved in planning their care to ensure their specific needs were catered for.

People were involved in their care assessment but they were not always supported to pursue their interests, hobbies or promote their independence. People could be confident their concerns would be listened to and action would be taken to attempt to resolve them.

People were at risk of inadequate care and support because the provider’s governance had not assessed, monitored or improved the service enough since the last inspection to promote quality standards. People were aware of who was running the home and were able to have a say about how the home should be run.

You can see what action we told the provider to take at the back of the full version of the report.

Myford House is a nursing home that provides personal care and accommodation for up to 57 older people, most of whom are living with dementia. At the time of the inspection there were 34 people living at the service. The provider is also registered to carry out diagnostic and screening procedures at this location. At the time of the inspection, the provider was not carrying out this regulated activity therefore it was not inspected. 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.

People were supported by a staff team who could describe the signs of abuse. We did however, identify that concerns about people were not always reported to the registered manager and the local safeguarding authority when required. Risk management processes were in place which did protect people against harm in some aspects of their care. However, they did not effectively reduce the risks to people through behaviour by some that may challenge.

People were supported by sufficient staff numbers to meet their needs. Staff members had been recruited to their roles safely and pre-employment checks were completed. People were happy with the support they received with their medicines, however, recording issues meant we could not confirm if some medicines were given as prescribed.

People told us permanent staff had the skills required to support them effectively. However, not all people felt agency staff were able to meet their needs. We did identify areas in which staff did not have the required training and skills. People who lacked capacity to consent to their care did not always have their rights upheld by the use of the Mental Capacity Act 2005. People were supported to maintain their day to day health needs and their nutritional needs were met.

People were supported by a staff team who were kind and caring in their approach. People’s privacy and dignity was protected and promoted. People were supported to maintain relationships that were important to them. Relatives were encouraged to visit without restriction and were part of the ‘community’ within the service.

People mostly received care that met their needs and preferences. People’s care plans did not always reflect their needs or the care they received. People were beginning to become involved in reviewing their care needs and developing their care plans. Staff were engaging people in day to day activities within the home although improvements were needed to the leisure opportunities made available to people. People felt able to make a complaint and complaints made were fully investigated by the provider.

People were not protected by quality assurance systems that always identified the improvements needed in the service or care being delivered to them. People were cared for by a staff team who felt well supported by management and were motivated and committed to their roles. People felt the registered manager had made significant improvements in the service.

We found the provider was breaching the regulations regarding safe care and treatment, the need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection completed in February 2016, we rated the provider as ‘inadequate’ and the service was placed into special measures. The overall rating for the provider following the most recent inspection is ‘requires improvement’. However, as the provider remains to be rated as ‘inadequate’ for one of the key questions they will remain in special measures.

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 and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. If not enough improvement is made within this timeframe and there is still a rating of inadequate for any key question or overall, we may take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe living in the service. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received training in safeguarding adults and could identify signs of abuse.

Risks to people had been identified, assessed and kept under review.

People were protected from unsafe or unsuitable equipment. The provider employed a staff member who was responsible for ensuring that equipment was properly maintained. Staff spoken with told us that they felt their safety was maintained and that they worked in a safe environment.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. People told us that they felt the service met their needs. Staff had a good understanding of the people's care and support needs.

Staff told us they received effective support from their managers and said they found them approachable. This meant that staff felt able to raise any concerns with their manager.

Is the service caring?

Interactions between people and staff were positive and supportive. People appeared relaxed in the company of staff and were treated with respect. Staff promoted their independence, choice and dignity. People told us that they felt staff treated them well and on the whole respected their privacy and dignity. One person told us, 'The majority of staff are very kind, they are so nice, friendly and helpful'.

Is the service responsive?

People told us they felt able to raise concerns. One person told us, 'I have not had a reason to make a complaint, but I would have no problem in telling someone if I was not happy'. Another person told us, 'The service is very good, staff are very kind, I have nothing to grumble about'.

We found that the service responded to people's changing needs. People had access to support and advice from the multidisciplinary team.

Is the service well led?

The service is managed by an experienced registered manager, who was well-supported by a senior manager. This meant that people benefited from receiving a service that was well led.

The quality of service provided by the home was regularly assessed and monitored. Regular audits were undertaken which included audits for health and safety, medication, care planning and infection control. This meant that people's needs were regularly reviewed and risks to their health and wellbeing were assessed and identified promptly.

Staff told us that they felt part of a good team and that they were well supported by the management team. We were told that the management team were responsive to staff requests and could be easily approached with any concerns. Staff commented that they felt they provided a very good service which met people's needs.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke to one person who used the service during the inspection and they told us that they were happy with the way the service looked after their medicines for them.

People who lived in the home and their relatives told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'The staff are very good' and another said, 'The staff are lovely'.

The provider had developed a system whereby they can monitor how well the home was meeting the needs of the people who live there.

We watched the staff looking after people as they arrived for breakfast. We saw that the staff always asked them how they would like things to be done, were always mindful of their privacy and treated them with respect.

We saw staff going from bedroom to bedroom to provide support to people and we saw the system they used to record this.

People who needed to have occasional medications were given so when needed and in accordance with agreed protocols.

We saw that staff were always available when people needed help. We saw that the staff were friendly and always acted professionally.