16 and 17 June 2015
During a routine inspection
The inspection took place on 16 and 17 June 2015 and was unannounced.
Summer Lane Nursing Home is a care home providing accommodation for up to 90 people who require nursing and personal care. There are two units within the home that are each split into two areas. Balmoral provides residential and nursing care to older people and Waverly provides care to older people who are living with dementia. The home is purpose built and all bedrooms are for single occupancy. During our inspection there were 37 people in Balmoral and 30 people living in Waverly
At the last inspection on 20 October 2014 we identified concerns with some aspects of the service and care provided to people. The service was found to be in breach of seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) stating how and when improvements would be made. They told us they would make the necessary improvements by February 2015. At this inspection we found that some action had been taken to improve the service and meet the compliance actions set at the previous inspection. We found continued and further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
There was a manager but they were not registered with the Care Quality Commission. The manager had been in post since April 2015 and they told us they would be starting the process of registering with us. 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 and associated Regulations about how the service is run. There had not been a registered manager since December 2014.
People and their relatives raised concerns over the staffing levels. There had been times when the staffing levels had dropped below minimum levels. The manager told us they had recently recruited new staff to fill their vacant post and they had a plan in place with an agency to cover staff sickness. There was a lack of staff visibility during our inspection however we found people’s physical needs were being met.
Medicines were not always looked after in line with the homes medicines policy and national guidance.
Two people told us they did not feel safe at Summer Lane due to other people who use the service entering their bedrooms. One person raised concerns with us during our visit over a person entering their room and allegedly assaulting them. We discussed this with the manager and a safeguarding referral was made. Staff were aware of how to identify signs of abuse and how to report them, they felt confident the manager would deal with concerns appropriately.
A recruitment procedure was in place and staff received the appropriate pre-employment checks before starting work with the service. Staff were following appropriate guidance in relation to infection control.
Plans were in place to manage risk relating to peoples care. However, information in the care plans was not always reviewed and updated. People were at increased risk of not receiving appropriate treatment as accurate monitoring records were not always kept by staff. People were supported to see healthcare professionals where required.
We found people’s rights were not fully protected as the manager had not followed correct procedures where people lacked capacity to make decisions for themselves. We observed where decisions were made for people the principles of the Mental Capacity Act 2005 were not always followed.
People felt there was enough available to eat and drink, however not all the people we spoke with were happy with the food provided. The manager had received feedback relating to the food and had arranged to meet with the catering company to address the comments received.
We received mixed feedback on how caring the staff were at Summer Lane. Most of the comments were positive, however some people felt the staff were not caring. People told us staff treated them with dignity and respect.
People told us they were happy with the activities provided, however with only one activity coordinator in post there were not enough staff to engage all people in meangful activities, the manager had employed another activity coordinator and had plans to employ a third member of staff.
People told us they were involved in their care planning. Care plans lacked information relating to people’s likes, dislikes and personal history. The manager had plans in place to update all of the care plans into a new format which would incorporate people’s needs and preferences.
Staff told us they had not received recent up to date training, the manager had an action plan in place to address this. New members of staff received an induction which included shadowing experienced staff before working independently.
The provider had a complaints procedure in place, people felt confident to raise concerns with the manager. Relatives were not always aware of how to make complaints. Where complaints had been made these were responded to and investigated in line with the provider’s procedure.
The manager and senior management had systems in place to monitor the quality of the service provided. Audits covered a number of different areas such the environment, infection control and medicines.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.