The Nuffield Care Centre is a nursing home that provides accommodation and support for up to 35 people with a range of conditions and disabilities. Accommodation is arranged over 2 floors with a lift that provides access to the first floor. The home is owned by Saffronland Homes.
The home had a registered manager in post on the day of our 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 and associated Regulations about how the service is run.
People had mixed views about living in the home. Some people told us they were treated well by staff who were kind and caring. Other people said staff were not always caring or friendly.
There were not always enough staff working in the home to meet people’s needs. People said the staff were very good but always rushed and they sometimes had to wait a long time for assistance. We saw several examples of staff not responding to call bells in a timely way throughout the day.
Although risk assessments were in place where people had an identified risk, these were not always updated following reviews with the latest information and goals for staff to follow. For example to address nutritional needs and pressure ulcers.
Care plans were not person cantered and not easy to follow. Information was kept in various folders making it confusing. For example information was kept electronically, some in paper files and some in people’s rooms.
People did not always receive their medicines safely. The lunch time medicine round on the first floor was an hour late which meant people did not always receive medicine as prescribed. We also noted some medicine was not stored safely in accordance with procedures.
People’s health care needs were not being met. We noted records relating to repositioning people with pressure ulcers were not well maintained and incorrect dressings were used. Pressure ulcers were not being managed effectively.
People were registered with a local GP who visited the home weekly. Visits from other health care professionals for example care managers, dentist and optician also took place.
People’s nutritional needs were not always managed appropriately. When people had their fluid intake and output monitored their fluid balance charts were not being recorded correctly to provide accurate information. We saw when people’s weight loss was recorded this information was not managed safely to prevent people from becoming malnourished. We observed lunch being served in the dining room and we saw staff supported people who required help to eat. People who ate their meals in their rooms had less support as there were not enough staff deployed to assist them.
The was no activity coordinator employed and people did not have access to appropriate activities to ensure they did not become bored or socially isolated when they chose to spend their time in their rooms.
People told us they felt safe. Staff had undertaken training regarding safeguarding adults and were aware of what procedures to follow if they suspected abuse was taking place. There was a copy of Surrey County Council’s multi-agency safeguarding procedures available in the home for information and staff told us this was located in the office for reference.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DolS) which applies to care homes. The manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and Dolls and what they needed to do should someone lack capacity or needed to be kept safe. People who required a DolS authorisation had an application in place.
Staff recruitment procedures were safe and the employment files contained all the relevant documentation and safety checks to help ensure only the appropriate people were employed to work in the home.
People had been provided with a complaints procedure and knew how to make a complaint. They told us they knew who to talk to if they had any issues or concerns.
There were quality assurance systems in place to monitor the service being provided, for example reviews of care plans, risk assessments, and health and safety audits. However these were not always effective as they failed to identify shortfalls in staffing levels, care plans, risk assessments and the quality of care being provided.
The registered manager was doing her best to manage the home. However she did not have the support and resources she required to undertake her role effectively. People, relatives and staff said they found the registered manager approachable and available. Staff told us they felt valued and feedback from people about the quality of the service was positive.
The Nuffield Care Centre is a nursing home that provides accommodation and support for up to 35 people with a range of conditions and disabilities. Accommodation is arranged over 2 floors with a lift that provides access to the first floor. The home is owned by Saffronland Homes.
The home had a registered manager in post on the day of our 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 and associated Regulations about how the service is run.
People had mixed views about living in the home. Some people told us they were treated well by staff who were kind and caring. Other people said staff were not always caring or friendly.
There were not always enough staff working in the home to meet people’s needs. People said the staff were very good but always rushed and they sometimes had to wait a long time for assistance. We saw several examples of staff not responding to call bells in a timely way throughout the day.
Although risk assessments were in place where people had an identified risk, these were not always updated following reviews with the latest information and goals for staff to follow. For example to address nutritional needs and pressure ulcers.
Care plans were not person cantered and not easy to follow. Information was kept in various folders making it confusing. For example information was kept electronically, some in paper files and some in people’s rooms.
People did not always receive their medicines safely. The lunch time medicine round on the first floor was two hours late which meant people did not always receive medicine as prescribed. We also noted some medicine was not stored safely in accordance with procedures.
People’s health care needs were not being met. We noted records relating to repositioning people with pressure ulcers were not well maintained and incorrect dressings were used. Pressure ulcers were not being managed effectively.
People were registered with a local GP who visited the home weekly. Visits from other health care professionals for example care managers, dentist and optician also took place.
People’s nutritional needs were not always managed appropriately. When people had their fluid intake and output monitored their fluid balance charts were not being recorded correctly to provide accurate information. We saw when people’s weight loss was recorded this information was not managed safely to prevent people from becoming malnourished. We observed lunch being served in the dining room and we saw staff supported people who required help to eat. People who ate their meals in their rooms had less support as there were not enough staff deployed to assist them.
The was no activity coordinator employed and people did not have access to appropriate activities to ensure they did not become bored or socially isolated when they chose to spend their time in their rooms.
People told us they felt safe. Staff had undertaken training regarding safeguarding adults and were aware of what procedures to follow if they suspected abuse was taking place. There was a copy of Surrey County Council’s multi-agency safeguarding procedures available in the home for information and staff told us this was located in the office for reference.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (Dolls) which applies to care homes. The manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and Dolls and what they needed to do should someone lack capacity or needed to be kept safe. People who required a Dolls authorisation had an application in place.
Staff had an understanding of the Mental Capacity Act 2005 and had undertaken training in this. We saw mental capacity assessments had been completed and included in people’s care plans.
Staff recruitment procedures were safe and the employment files contained all the relevant documentation and safety checks to help ensure only the appropriate people were employed to work in the home.
People had been provided with a complaints procedure and knew how to make a complaint. They told us they knew who to talk to if they had any issues or concerns.
There were quality assurance systems in place to monitor the service being provided, for example reviews of care plans, risk assessments, and health and safety audits. However these were not always effective as they failed to identify shortfalls in staffing levels, care plans, risk assessments and the quality of care being provided.
The registered manager was doing her best to manage the home. However she did not have the support and resources she required to undertake her role effectively. People, relatives and staff said they found the registered manager approachable and available. Staff told us they felt valued and feedback from people about the quality of the service was positive.
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.
During our inspection we found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what we told the provider to do at the back of this report.