Archived: Nethercrest Residential Home

Updated 6 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 26 and 27 April 2018 and was unannounced. The inspection was carried out by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

We looked at our own systems to see if we had received any concerns about the home. We analysed information on statutory notifications we had received from the provider. A statutory notification is information about important events which the provider is required to send us by law. We also spoke with representatives from the local authority prior to the inspection who commissioned services from the home. We considered all this information when planning our inspection of the home.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with six people living at the home and three relatives. We spoke with the manager, two representatives from the management team, eight members of care staff, the cook, the maintenance man and a visiting healthcare professional.

We looked at eight care records, and six medication records. We also looked at records kept on accidents and incidents, safeguarding concerns, complaints as well as staff training records and audits completed to assess the quality of the service provided.

Updated 6 July 2018

The inspection took place on 26 and 27 April 2018 and was unannounced. At our last inspection in October 2017, the following concerns were raised:

The provider had failed to ensure that staff had the qualifications, competence, skills and experience to keep people safe and ensure people were protected from harm. This resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to ensure there were sufficient numbers of suitably qualified, competent and skilled staff to meet people's care and welfare needs. This resulted in a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to ensure that all people using the service have given consent before any care or treatment is provided. This resulted in a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to ensure people using the service were treated with dignity and respect at all times. This resulted in a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to ensure there were effective systems of governance, including assurance and auditing systems or process to assess, monitor and drive improvement of the quality of service provided. This resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to notify the Commission of authorisations with regard to DoLS, as is required by law. This resulted in a breach of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations 2009 (Part4) Notifications.

Following the last inspection, we met with the provider to discuss our concerns and asked them to complete an action plan to show what actions they would take and by when, in order to improve the ratings of the key questions of Safe, Effective, Caring, Responsive and Well Led. We also imposed conditions on their registration which required them to provide us with information, on a monthly basis, outlining actions taken and improvements made. At this inspection, we found improvements were being made, but there still remained work to be done in a number of areas.

Nethercrest Residential 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.

At the time of the inspection there was a manager in post who had recently been recruited and was in the process of submitting an application to become 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.

People felt safe and were supported by staff who were aware of the risks to them and how to manage those risks. Staff were aware of their responsibilities to raise any safeguarding concerns. A dependency tool was in place to ensure staffing levels were based on people’s individual needs. Health and safety checks were in place to ensure equipment was safe to use. People received their medicines as prescribed but administration of medication was not consistently recorded. Accidents and incidents were reported, recorded and acted upon but information was not routinely analysed to ensure lessons were learnt.

Systems were in place to observe staff practice and training had been sought to ensure staff were provided with the skills to meet people’s needs effectively. Where people were deprived of their liberty, the appropriate applications had been made, and staff routinely obtained people’s consent prior to supporting them. Staff were not fully aware of who was being deprived of their liberty and further work was required regarding the recording of this information.

People’s dietary needs and preferences were catered for and people were supported to make choices at mealtimes. Drinks were readily available to ensure people remained adequately hydrated throughout the day.

Staff were aware of people’s particular healthcare needs and how to support them to maintain good health. People were supported to access a variety of healthcare services.

Improvements had been made to the environment and this had created a more homely atmosphere. There was a programme of works in place and this was ongoing. Where maintenance work was required, systems were in place to ensure this was completed in a timely manner.

People described staff as kind and caring and were treated with dignity and respect. Staff supported people to make choices regarding their daily living and where possible, encouraged people to retain some form of independence.

Care records continued to be reviewed in order to provide staff with more information and guidance to meet people’s needs. Systems were being developed in order to involve people in the development of their care records. People were supported to take part in activities but there was recognition that this was an area for improvement and an action plan was in place to address this.

There was a complaints process in place and where complaints had been received, they had been responded to appropriately.

There was an improvement in the management oversight of the service. People were complimentary of the manager and the improvements that had taken place since the last inspection. Staff felt supported and listened to and were provided with the training and support to meet people’s needs. Audits were in place to assess the quality of the service but there was a lack of analysis of information in some areas which would help drive improvement. People’s opinion of the service was sought and action taken in response to concerns and suggestions made.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.