We carried out a review of the data available to us about Jansondean Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Jansondean Care Home, you can give feedback on this service.
People’s experience of using this service and what we found
People told us they felt safe. There were safeguarding policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work and there were enough staff available to meet people’s care and support needs. Risks to people were assessed and staff were aware of the action to take to minimise risks where they had been identified. Medicines were managed safely. The service had procedures in place to reduce the risk of infections and COVID 19.
Assessments of people’s care and support needs were carried out before they started using the service. Staff received training and support relevant to people’s needs. People were supported to maintain a balanced diet. People had access to a range of healthcare services when needed. 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.
People had been consulted about their care and support needs. People had care plans that described their health care and support needs and included guidelines for staff on how to best support them. People knew how to make a complaint if they were unhappy with the service. There were procedures in place to make sure people had access to end of life care and support if it was required.
The provider took people’s views into account through satisfaction surveys and spot checks and feedback from these was used to improve the service. Staff said they received good support from the manager. The manager and staff worked with health and social care providers to drive improvement and to deliver an effective service.
Rating at last inspection and update
The last rating for this service was requires improvement (published 7 March 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
We undertook this focused inspection to check they had 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, effective, responsive 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 Jansondean 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.
Why we inspected
We undertook this targeted inspection to check on a specific concern we had about visiting arrangements at the home. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We found the following examples of good practice.
At the time of the inspection the home was following the current government guidance in relation to infection prevention and control. There were no relatives visiting people at the home. The provider ensured that people using the service could maintain links with family members and friends. They were able to communicate with their relatives using video calls and telephone calls. The manager had sent letters to relatives advising them visiting had temporarily ceased. The manager had also developed a new visiting procedure for relatives and residents to ensure that people were clear about the procedure for future visits to the home.
All visitors including health care professionals and essential staff were screened for symptoms of acute respiratory infection before being allowed to enter the home. They were supported to follow national guidance on wearing personal protective equipment (PPE) and social distancing. We saw the home was clean and hygienic throughout.
The provider had appropriate arrangements in place to help prevent the spread of Covid 19. They ensured all staff had received training on Covid 19, infection control and the use of PPE. We observed staff wearing appropriate PPE and socially distancing throughout our visit.
The provider had appropriate arrangements to test people and staff for Covid 19 and was following government guidance on testing. There were designated nursing staff that carried out all testing on people using the service and staff. This ensured that people and staff were tested for Covid 19 in a consistent way.
Black, Asian and Minority Ethnic Covid 19 risk assessments were carried out with people using the service and staff to ensure they could live and work safely at the home.
Further information is in the detailed findings below.
People’s experience of using this service and what we found
At our last inspection of the service we found breaches of regulations in relation to staffing, activities and people’s meal times experiences. At this inspection we found improvements had been made in relation to activities and peoples meal times experiences. However, we found that people were not supported by enough numbers of suitably qualified, skilled and experienced staff, risks to people were not always managed safely, people’s medicines were not always safely managed, and staff were not always up to date with training. We also found that the systems in place to monitor and improve the quality and safety of the services provided to people were not operating effectively.
The home had safeguarding procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work. The service had procedures in place to reduce the risk of infections.
People’s care and support needs were assessed when they moved into the home. 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 had access to health care professionals when they needed them. Improvement was required to meet people’s needs and promote their independence. We have made a recommendation about dementia friendly environments.
People and their relatives had been consulted about their care and support needs. The home had a complaints procedure in place and people and their relatives said their complaints were listened to and acted on. There were procedures in place to make sure people had access to end of life care and support when it was required.
The manager and staff worked in partnership with health and social care providers to plan and deliver the service. All of the staff we spoke with said they enjoyed working at the home. However, there were mixed views about the support they received from the registered manager. We have made a recommendation about motivating staff and team building.
Rating at last inspection and update: The last rating for this service was requires improvement (published 13 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but we found further breaches of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the second consecutive inspection.
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jansondean Nursing Home on our website at www.cqc.org.uk.
Enforcement
Please see the action we have told the provider to take at the end of this report.
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
Following the last inspection on 18 and 19 May 2016, we rated the service Good in the key questions, is the service effective, caring, responsive and well-led?. We rated the service requires improvement in the key question, is the service safe?. This was because the provider continued to fail to ensure staff member’s full employment history was documented. Staffing levels were not always sufficient to keep people safe and people were not always protected by robust infection control measures.
Jansondean Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Jansondean is a large residential house set over two floors in the London Borough of Bromley. The service is registered to provide care and support to a maximum of 28 people. At the time of the inspection there were 28 people using the service.
The service had a registered manager in place. 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.
The provider continued to fail to obtain employees’ full service history in health and social care as required by law.
People did not always receive support from staff that had adequate rest between shifts. One staff member had been deployed to work excessive hours over a six-day period with only one day off.
The provider did not deploy sufficient numbers of staff during the lunch period to ensure people received effective care and support with their meals in a timely manner.
The service did not have robust cleaning schedules in place to ensure the service was free from dust and that the kitchen floor was adequately cleaned to minimise the risk of cross contamination.
People did not always receive activities that were stimulating and met their social needs. During the inspection we observed people were left without interaction which meant they were at risk of social isolation. We have made a recommendation in relation to the provision of activities.
Auditing systems in place did not always identify issues in a timely manner, to ensure issues were acted on appropriately.
People continued to be protected against the risk of harm and abuse as staff received on-going safeguarding training, knew how to identify, report and escalate suspected abuse. Risk management plans in place gave staff clear guidance to mitigate identified risks. Accidents and incidents were reviewed and audited to ensure patterns and trends were identified and action could be taken to minimise repeat occurrences. Staff continued to be provided with sufficient personal protective equipment to minimise the risk of infection.
People’s medicines were managed in line with good practice. Registered nursing staff ensured people received their medicines as intended by the prescribing pharmacist. Medicines were stored, administered, documented and disposed of safely.
People were supported to access healthcare professional services as and when needed; care plans were updated to ensure guidance given by healthcare professionals was included in the service delivery. People were supported to access sufficient amounts of food and drink that met their dietary needs and requirements. People with specific dietary needs were catered for.
Staff received on-going training to enhance their skills, and put these into the delivery of care. Staff confirmed training provided enabled them to improve their knowledge and they could request additional training if they felt this necessary. Staff were given the opportunity to reflect on their working practices and the registered manger was available to offer support and guidance.
People were treated with respect, kindness and empathy. Staff were aware of the importance of maintaining people’s confidentiality, treating them with dignity and embracing their diversity.
Care plans were person-centred and detailed people’s health, emotional and medical needs. Care plans were regularly updated to reflect people’s changing needs. People were aware of how to raise their concerns and action was taken to address these in a timely manner.
People spoke positively about the registered manager and care provided. The registered manager continued to seek people’s views through annual quality assurance questionnaires and issues identified were actioned where possible. The registered manager continued to work in partnership with other healthcare professionals to drive improvements.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.
Jansondean is currently registered to provide personal and nursing care for up to 28 people who may have dementia. At this inspection there were 26 people using the service. There was a registered manager in post who was appointed in April 2015 and had experience in nursing and as a previously registered manager. 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 this inspection on 18 and 19 May 2016 we found some improvement was needed to the fire risk and detection systems. Work was in progress to address issues that had been identified during a recent London Fire and Emergency Planning Authority inspection at the time of our inspection, but had yet to be completed. We will monitor the progress of the work and report on this at our next inspection.
We found improvements had been made to the quality monitoring system at the home and when issues were identified action was taken to address them. People and their relatives told us they knew the registered manager. They found her to be effective and told us she was visible in the home. At our previous inspections in November 2014 and February 2015 we had identified concerns about the monitoring of people’s needs and a lack of staff presence on the top floor of the service. The top floor had been out of use at our last inspection in May 2015. At this inspection we found there was an electronic system to monitor the care of people who were nursed in bed and we saw this was checked effectively. Additionally, we found noticeable improvements in staff communication and team work at the home.
People told us they felt safe and secure at the home. Staff knew how to raise any concerns about the people they cared for. Individualised risks to people were identified, assessed and monitored, and staff had guidance to reduce these risks. The premises and equipment were routinely checked for possible risks. Medicines were managed and administered safely. There was a high level of agency staff use but we found the manager tried to use the same agency and the same staff to ensure consistency wherever possible. The provider and registered manager also told us they had made efforts to recruit more permanent staff. People and their relatives told us they would like more permanent staff but there were enough staff to meet people’s needs.
Staff received training so that they could support people effectively. Staff told us they received regular supervision including a lot of informal supervision. The registered manager had identified supervision records were not up to date and had an action plan in place to address this by the end of the month. People told us they had enough to eat and drink and we observed this to be the case.
Staff asked people’s consent before they delivered care and there were arrangements to comply with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were referred to health professionals when this was needed and professionals’ advice was used to form part of people’s care plans.
People told us staff were kind and considerate. People told us they were involved in their care and were treated with respect and dignity. People’s care plans reflected their current needs and wishes and were regularly reviewed. They knew how to make a complaint if they needed to and told us they felt sure it would be looked into.
This focused inspection took place on 29 September 2015 and was unannounced. At the previous comprehensive inspection on 21 and 22 May 2015 we had found breaches of legal requirements in the arrangements to obtain and record people’s consent when they lacked capacity for some decisions and in the quality assurance system. The provider sent us an action plan to tell us how they would meet the requirements of the regulations. We carried out this inspection on 29 September 2015 to check action had been taken to address the breaches of legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for (Jansondean) on our website at www.cqc.org.uk
Jansondean is currently registered to provide personal and nursing care for up to 28 people who may have dementia. At this inspection there were 23 people using the service.
There was a registered manager in post at this inspection. They had been appointed in April 2015 and their application for registration as a manager had recently been confirmed. 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 this inspection on 29 September 2015 we found that arrangements to obtain and record people’s consent to care and support where they did not always have capacity to make decisions complied with the law. People’s capacity to make decisions was assessed for each specific decision. Where people needed to have their liberty restricted for their own safety relevant authorisations from the local authority were applied for in line with the relevant legislation and code of practice. A visiting social care professional confirmed that the applications made by the service were appropriate. Processes were in place to ensure the authorisations were complied with. In view of the changes made and the fact there were no other breaches or concerns in this key question at our last inspection, we have revised the rating for this key question, improving the rating to ‘Good’.
There were new arrangements to monitor the quality of the service; these were now more detailed and covered all aspects of people’s care. They included a system for checks on the premises and equipment, and accidents and incidents were monitored and analysed. However some improvement was required as some checks on the quality of the service were not always consistently completed. It was not always clear that action taken had successful resolved the problem. The rating for this key question remains ‘Requires Improvement’ and the overall rating remains unchanged from the comprehensive inspection.
This inspection took place on 21 and 22 May 2015 and was unannounced. At the last inspection on 3, 4 and 6 February 2015 we had found breaches of legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2010 in respect of people’s care and welfare, medicines management, staffing, recruitment, quality assurance and record keeping. CQC is considering the most appropriate regulatory response to resolve the problems we found.
There were also breaches of regulations for training and processes to seek and record people’s consent from a previous inspection of November 2014 which we had not been able to follow up at the February 2015 inspection because the provider had submitted an action plan they were working through at this time.
We carried out this inspection of 21 and 22 May 2015 to check action had been taken to address all the previous concerns found and to provide a fresh rating for the service.
Jansondean is currently registered to provide personal and nursing care for up to 28 people who may have dementia. At this inspection there were 18 people using the service.
There was no registered manager in post at this inspection. The previous registered manager left in January 2015. The current manager was appointed in April 2015 and had experience in nursing and as a registered manager. 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. The new manager and a representative of the provider told us the new manager would be applying to register later in the month.
At this inspection we found improvements had been made in most areas where we had previous concerns. Despite this we found breaches of the regulations in respect of the need for consent where people lack capacity and in relation to good governance of the service. There were no specific decision based mental capacity assessments for people who may lack capacity and there was not an effective system in place to manage and monitor some risks to people in relation to aspects of the premises. You can see the action we have asked the provider to take at the back of the full version of this report.
People told us they felt safe at the service. Staff were aware of how to raise any safeguarding issues. Identified risks to people such as falls or from skin integrity breakdown were now effectively monitored and plans were in place to reduce risk. Records of people’s care such as fluid charts and wound charts were being completed and checked so that people’s welfare was effectively monitored. There were plans in place to manage a range of emergencies. There were safe recruitment procedures in place and there were enough staff to meet people’s needs. Medicines were safely managed and there were adequate systems to reduce the risk of infection.
People said they had enough to eat and drink and we saw nutritional risk was monitored and plans were in place to reduce risk. Staff told us they had received suitable training and support to carry out their work. People had access to a suitable range of health care professionals and staff made appropriate referrals when needed to meet people’s needs.
People told us they were well looked after and we observed staff to be attentive and caring. Staff knew people‘s preferences and respected people’s dignity. People’s care plans provided an accurate record of their care and support needs however people or their relatives had not been involved in planning care and treatment. People’s needs for socialisation were met through a range of suitable activities. There was a complaints system readily available and relatives and residents meetings were held to capture people’s experiences of care and views about the service.
People and staff commented positively about the new manager at the service and said they had confidence in their ability to lead. We found that improvements had been made in a short space of time. The manager had introduced a range of quality checks to monitor the quality of the service although these had not been implemented at the time of inspection. It was therefore not possible to judge their effectiveness.
We carried out an unannounced comprehensive inspection of this service on 11 and 12 November 2014. A number of breaches of legal requirements were found. As a result we undertook a focused inspection on 03, 04 and 05 February to follow up on whether action had been taken to deal with the breaches in regulations.
You can read a summary of our findings from both inspections below.
Comprehensive Inspection of 11 and 12 November 2014
This inspection took place on 11 and 12 November 2014 and was unannounced.
We had previously carried out an unannounced responsive inspection of this service on 5 August 2014, following concerning information we received. We found breaches of the Health and Social Care Act 2008 in relation to people’s care and welfare, respecting and involving people, safeguarding people, staffing and failure to notify CQC of events as required. We took enforcement action in respect of people’s care and welfare and respecting and involving them in their care. Following this inspection in September 2014 the local authority imposed a suspension of new placements at the service which remained in place at the time of the inspection.
There were breaches of the Health and Social Care Act 2008 from a previous inspection on 22 and 23 January 2014 in relation to the management of medicines, monitoring the quality of the service, maintenance and storage of records. For both the inspections of 22 and 23 January and 5 August 2014 the provider was asked for an action plan to tell us how they were going to improve. These were sent to us following both inspections. We carried out this comprehensive inspection to check if the provider had completed their action plans and was now meeting the regulations as well as to provide a rating for the service.
There was a registered manager in post who was registered as manager in June 2014. 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 this inspection we found that although improvements had been made in some important areas there were some continued breaches of legal requirements of the Health and Social Care Act 2008. These included medicines, staffing, monitoring the quality of the service and keeping accurate records. Where we have identified continued breaches of the regulation in these areas we will make sure action is taken. We took enforcement action and served warning notices in respect of these continued breaches.
We also found breaches in respect of arrangements for people’s capacity to make decisions and some areas of staff training. You can see what action we told the provider to take at the back of the full version of the report.
There were improvements to the way the service involved people and consulted them about their care. People and their relatives told us they felt safe, staff were kind and caring and that they were consulted more. There were increased opportunities for people to socialise, a programme of activities and the lounge area had been redecorated. There were also improvements to the care provided. People’s care plans had been updated and they had been asked about their preferences, although these were not always accurately recorded. Staff felt the manager had made considerable changes to the culture of the service together with the support of a manager from another service. They told us they had received a lot of training which they felt had improved their skills and knowledge and that care was more person centred than it had been before.
Focused inspection of 03, 04 and 06 February 2015
At our inspection of 11 and12 November 2014 we had found continued breaches in respect of four regulations and took enforcement action. We took enforcement action in relation to how the provider managed medicines, had enough suitable staff, record keeping at the service and how they monitored the quality of the service. We asked the provider to comply fully with these regulations by 31 December 2014.
The provider was also asked for an action plan in respect of two other breaches of regulations for staff training and arrangements for consent and decision making where people lack capacity to do so. We will follow up and report on these at a later date.
We were notified by the provider that the registered manager had been dismissed in January 2015. There was no registered manager in post at the inspection. There was an acting manager in post who had been working at the service since December 2014. The provider also told us that they had appointed a regional quality advisor to help monitor and improve quality across their homes.
At this inspection on 03, 04 and 06 February 2015 we followed up on the breaches of legal requirements, concerning the management of medicines, staffing, records and monitoring the quality of the service which had resulted in enforcement action. We found that although improvements had been made in respect of some aspects of these legal requirements there was evidence of continued breaches of the legal requirements, in medicines, staffing, records and monitoring the quality of the service. We also found breaches of regulations for recruitment and care and welfare. Where we have identified continued breaches of the legal requirements in these areas we will make sure action is taken. We will report on this when this is complete.
There had been some improvements with regard to medicines storage and recording but they were still not managed safely. Systems for the safe management of medicines were not always followed. Checks on staff competency to administer medicines were not in place. A bogus nurse had been able to administer medicines on one occasion and two errors had been made. This had been reported to the relevant authorities although not until the following day. There had also been a delay in seeking of medical advice for people affected by the medicines errors.
Staffing levels were not safe. There was still no system in place to decide on safe staffing levels that took into account the needs of people at the service. Staffing levels did not always comply with the provider’s own staffing levels. There were not always enough suitably qualified and experienced staff available. There was no induction record for nurses to evidence they had the necessary skills to carry out the work. There was also no one suitably trained to oversee aspects of clinical care such as the pressure areas on a daily basis.
Risks to people such as pressure ulcer risks or risk of dehydration or falls were not always accurately monitored or recorded. Records in respect of pressure area care were sometimes missing, muddled or hard to follow and not always accurate. Care plan records did not always accurately reflect people’s needs. There were no recorded checks for those people who were unable to use a call bell and, for one floor with people with high levels of need, no system in place to record checks on their welfare. These were introduced as a result of the feedback at the inspection.
The quality of the service was not monitored effectively. Some areas identified at the inspection on 11 and 12 November in respect of monitoring the quality of the service had been addressed, such as the leak in the roof and the removal of the rubbish in the garden. However there was no clear system in place to regular monitor the quality of the service and the acting manager told us this was being developed. Audits that had been carried out were not fully comprehensive. Where they had identified some issues these had not always been acted on.
People’s fluid and dietary needs were not always identified, or monitored and people’s care plans still did not always reflect their nutritional needs accurately. We found that the provider’s policies had not included verifying the suitability of agency staff before they started work. We were told by the acting manager that the bogus nurse had not had references or police checks completed by the agency. Safe recruitment practices were not always followed.
People’s records and records related to the management of the service such as staff rotas were disorganised and inaccurate making them difficult to follow.
This inspection took place on 11 and 12 November 2014 and was unannounced.
We had previously carried out an unannounced responsive inspection of this service on 5 August 2014, following concerning information we received. We found breaches of the Health and Social Care Act 2008 in relation to people’s care and welfare, respecting and involving people, safeguarding people, staffing and failure to notify CQC of events as required. We took enforcement action in respect of people’s care and welfare and respecting and involving them in their care. Following this inspection in September 2014 the local authority imposed a suspension of new placements at the service which remained in place at the time of the inspection.
There were breaches of the Health and Social Care Act 2008 from a previous inspection on 22 and 23 January 2014 in relation to the management of medicines, monitoring the quality of the service, maintenance and storage of records. For both the inspections of 22 and 23 January and 5 August 2014 the provider was asked for an action plan to tell us how they were going to improve. These were sent to us following both inspections. We carried out this comprehensive inspection to check if the provider had completed their action plans and was now meeting the regulations as well as to provide a rating for the service.
There was a registered manager in post who was registered as manager in June 2014. 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 this inspection we found that although improvements had been made in some important areas there were some continued breaches of legal requirements of the Health and Social Care Act 2008. These included medicines, staffing, monitoring the quality of the service and keeping accurate records. Where we have identified continued breaches of the regulation in these areas we will make sure action is taken. We took enforcement action and served warning notices in respect of these continued breaches.
We also found breaches in respect of arrangements for people’s capacity to make decisions and some areas of staff training. You can see what action we told the provider to take at the back of the full version of the report.
There were improvements to the way the service involved people and consulted them about their care. People and their relatives told us they felt safe, staff were kind and caring and that they were consulted more. There were increased opportunities for people to socialise, a programme of activities and the lounge area had been redecorated. There were also improvements to the care provided. People’s care plans had been updated and they had been asked about their preferences, although these were not always accurately recorded. Staff felt the manager had made considerable changes to the culture of the service together with the support of a manager from another service. They told us they had received a lot of training which they felt had improved their skills and knowledge and that care was more person centred than it had been before.
We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them, and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
At the inspection on 22nd and 23rd January 2014 we found a breach of regulation 9 of the Health and Social Care Act 2008. There were inadequate arrangements for emergencies. At this inspection we found that there was a business contingency plan. This had contact details and guidance to cover a range of possible emergencies; although we noted it did not always refer to the correct location. There were personal emergency evacuation plans in place.
Most people told us they felt safe at the service. Staff knew how to recognise abuse and how to raise a safeguarding alert. They were also familiar with whistleblowing procedures. There were risk assessments in place where risks to an individual had been identified although these were not all up to date. There were not always enough staff on duty to meet the service required staffing levels.
We found that people may have been deprived of their liberty unlawfully as we observed circumstances where an application for authorisation under the Deprivation of Liberty Safeguards (DoLS) should have been considered and it had not been made.
We also found that some people did not have access to call bells to alert staff if they needed help.
Is the service effective?
People's consent to care and treatment was not routinely or regularly sought. Mental capacity assessments were not carried out to establish if people had the capacity to make a decision about their care and treatment. Staff told us they had training on the Mental Capacity Act 2005 but we did not see evidence that this was put into practice. Some people's Do Not Attempt Cardiopulmonary Resuscitation (DNAR) forms had not been completed correctly in accordance with the law.
People using the service had access to health and social care professionals when required.
Is the service caring?
At this inspection we found there were aspects of the service that were not caring. Most people and their relatives we spoke with were happy with the care provided and told us they thought the staff were kind.
However we found people were not always involved in decisions about their care or treatment. We found people were expected to be in their rooms from approximately 5pm onwards, rather than choosing where they wished to be. Some people were also routinely put to bed at this time without consultation. We found that most meals were taken in people's bedrooms. People were not involved or consulted about their care plans. We observed that people were not always treated with respect and dignity. Staff did not always knock on people's doors before they entered and did not always explain or ask consent before carrying out personal care.
Is the service responsive?
We carried out this inspection in response to concerning information given to us regarding people's care. At the inspection on 22nd and 23rd January 2014 we found that there was a breach of regulation 9 of the Health and Social Care Act 2008 in respect of the planning and delivery of people's care. At this inspection while we saw some improvement in the care planning; people's care and treatment did not always meet their needs. Some care plans did not always provide information and guidance to staff about how people's health needs, individual needs and preferences should be met. People's fluid food and turning charts were not always kept up to date.
Is the service well led?
At our inspection on 22nd and 23rd January 2014 we identified areas of this domain where the provider was not meeting the essential standards of quality and safety. They sent us an action plan to tell us how it would become compliant with the regulations.
At this inspection we found the registered person was failing to notify the Care Quality Commission of incidents that arose while carrying out the regulated activity as it was required to do under the regulations.
Otherwise we did not inspect the service for its compliance with essential standards in this area at this inspection but will consider this question at a later inspection.
You can see the action we have taken in respect of our findings in the full report.
This inspection was a follow up to enforcement action taken against the provider and to ensure that suitable improvements had been implemented in relation to: cleanliness and infection control and the safety, and suitability of premises. The provider had suitable systems in place to protect people against the risks of acquiring an infection; this included arrangements related to the safe handling and disposal of waste, cleaning within the home and relevant training for staff. We found concerns related to the flooding and dampness within the premise had been addressed. However, we were not able to assess if the provider was meeting the requirements of Regulatory Reform (Fire Safety) Order 2005 as this assessment would need to be undertaken by the London Fire and Emergency Planning Authority.
Most people using the service we spoke with told us they were happy with the care they received, although some people felt improvements were required in the delivery of personal care. One person told us '[staff] help me with washing and dressing, they never refuse. It's not like home but it's nice'. Another person told us 'we have activities and the food is good. I have to put things right sometimes like putting the pillow in right position'.
People's needs were not adequately assessed, and care and treatment was not always delivered in line with an individual's care plan. We found the provider had failed to ensure that people were protected against: risks of acquiring a health care associated infection; the unsafe use and management of medicines; and unsafe premises following recent flooding and breach of fire safety regulations. The provider's arrangements for assessing and monitoring the quality of service people received were unsuitable. Records relating to people's care and the management of the service were not fit for purpose, and placed people at risk of receiving unsafe care. An all residents safeguarding referral was made to the local authority on 24 January 2014.
We found that people were happy at the home and that they felt supported by staff to maintain their independence where possible. However, we also found that care was not always carried out in the way that had been planned and that care plans were not always accurate or reflected the needs of the person living at the home. Staff we spoke with showed a good understanding of the safeguarding of vulnerable adults but had not been supported with recent training. Medication was stored securely and administered correctly according to the prescription.
Some people told us that staff were 'brilliant', 'very friendly' and 'polite.'
People said that staff were responsive to their needs although they appeared to be very busy at times.
Some people told us that they had been involved in the needs assessment process and development of care plans.
Family and friends told us that they could turn up at anytime and that 'care seems reasonably good'. Staff were observed by people using the service to be 'friendly and kind'.
The home's 2010 resident customer survey shows that overall people thought the quality of service provided was at a minimum 'quite good'. An action plan had been put in place to address areas identified as needing improvement. From resident meeting minutes, people who used the service acknowledged the improvements that the nursing home had made in relation to areas requiring attention from the survey.