We carried out a review of the data available to us about Naseby 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 Naseby Care Home, you can give feedback on this service.
People, staff and visitors to Naseby were protected from risks of infection as policies and staff practices reflected best practice guidance. Visiting was by appointment and safeguards included a rapid Covid-19 test being completed on arrival to ensure visitors had a negative test result. Safe indoor visiting areas included screening between people and their visitors and utilising an external door avoiding non-essential visitor footfall in the building.
The premises and equipment were visibly clean. Cleaning materials had been changed to meet government guidance. Flooring in communal areas had been replaced to enable more effective cleaning to take place.
People and their families had been kept up to date with government guidance including visiting, testing and vaccines. People were involved in decisions and had their consent obtained for testing and vaccination in line with legal requirements.
Risks to people’s mental well-being were understood and included part of the pre-admission assessment ensuring a person would be able to cope safely with an initial period of self isolation. Social activities took place each day both in the communal lounge and in people’s rooms. Technology had been used to aid contact with families and friends including video calls.
PPE was available throughout the home and in good supply. Regular testing of people and the staff team were being completed in line with government guidance. Staff were up to date with infection, prevention and control training including how to put on and take off PPE safely.
We have also signposted the provider to resources to develop their approach.
Further information is in the detailed findings below.
At the last inspection the service was rated ‘Good’. We found at this inspection the service had maintained a rating of ‘Good’.
People were receiving safe care provided by a staff team that understood how to recognise signs of abuse and the actions needed if abuse was suspected. People’s risks had been assessed and staff were able to explain their role in minimising people’s risk of avoidable harm. Risks had been managed whilst respecting people’s rights and choices. Improvements had been made in assessing and managing environmental risks.
Staff had been recruited safely with checks ensuring they were safe to work with vulnerable adults. Staff had completed an induction, ongoing training and had the support which enabled them to carry out their roles effectively. A dependency tool had been used to ensure staffing levels met the assessed needs of people.
Improvements had been made in medicine administration including a more robust medicine auditing system. People were having their medicines ordered, stored, administered and recorded safely. Staff had completed infection control training and followed procedures that ensured people were protected from avoidable infection. Positive, responsive relationships with health and social care professionals had enabled effective care outcomes for people.
Prior to admission assessments had been carried out to establish people’s care needs and choices. The information gathered had been used to create person centred care plans that recognised people’s diversity. Activities were an integral part of each day and included group social gatherings, entertainers, visiting animals and for some people one to one time in their rooms. Limited information had been gathered about people’s past interests and hobbies but Naseby Care Home had begun completing life histories for people with help from families.
People and their families described the staff as caring. We observed staff demonstrating kindness and patience and providing emotional support. 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. A complaints procedure was in place that people and their families were aware of and felt able to use if necessary.
The signage and building layout didn’t always provide opportunities for some people living with a dementia to orientate themselves around the property and gardens independently. Plans were in place to landscape the gardens enabling direct access from the building. The registered manager told us they would look at improved signage around the home. Audits had highlighted areas that required redecoration and a maintenance schedule was in place for works to be carried out.
The registered manager provided visible support to the staff team and worked alongside staff providing leadership. Staff described the management culture as open and supportive which had enabled them to speak honestly about concerns and also share ideas. Quality assurance processes were in place and effective in capturing areas that required improvement. We saw that actions identified had been completed but actions and outcomes had not been recorded. The registered manager told us they would include this in future audits.
Further information is in the detailed findings below.
The inspection took place on the 6 and 7 January 2016. The inspection was unannounced on the first day and announced on the second. The inspection was carried out by two inspectors. At the last inspection in August 2014 the service was not meeting the regulatory requirements for care and welfare of people and records. We found during this inspection that improvements had been made and the service was now meeting these requirements.
Naseby Care Home is registered to provide accommodation and personal care for up to 21 people. At the time of our inspection there were 18 older people living at the service, some of whom were living with a dementia. Accommodation is provided over the ground and first floor. The managers’ office is located on the second floor. The first floor is accessed by a lift and stairs, the stairs continue up to the second floor. All of the bedrooms are single occupancy. Two rooms have an en-suite wash basin and toilet. Three rooms on the first floor are not accessible from the lift or suitable for a hoist. There are three shower rooms, two on the ground floor and one on the first floor. There is one bathroom. On the ground floor there is a lounge area which leads into a conservatory that is used as a dining room. There is a well equipped kitchen, laundry and sluice room. The service has a secure well maintained garden at the rear of the building which is accessed across a gravel parking area.
The service has 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.
We found that the service was not always safe. We found that medicines were not always administered safely. We found that on the morning of the 16 December staff had signed to say that five separate medicines had been given to one person. We checked the medicine supply and found they were still in the pack and had not been given. We found three opened bottles of eye drops. Each stated that they expired 28 days after opening. None had a recorded date for when the bottles were opened. All three had prescription dates over 28 days old. We looked at records for one person who had a prescription for medicines that needed to be given as required. We checked the medicine and amounts given corresponded with the medicines remaining. A medicine administration record sheet is kept in bedrooms for creams with a body map that showed the areas any creams needed to be applied. We checked the charts for the week for one person and they had been completed correctly.
We found that the service did not review the amount of care workers needed to support people when they had to carry out additional domestic duties or were supporting people with increased care needs. On our arrival on the 6 January staffing consisted of the manager who was administering medicines and two care workers. People, their relatives and staff told us that at times it felt like there were not enough staff, particularly at weekends or if care staff were covering the laundry and kitchen. We asked how staffing levels are decided. The operations manager told us that the organisation has a management tool that when populated with people’s levels of dependency calculates how many staff hours are required to support people safely. The registered manager told us that they would familiarise themselves with the tool immediately and use it to support decisions about staffing levels. We observed staff responding quickly to call bells. One person was receiving care in bed and not able to use their call bell. Records did not evidence how often they were checked by staff during the day or how they would be able to call for assistance.
We were told that some people at the service were living with a dementia. We observed potential hazards in the service that had not been risk assessed. The staircase had restricted access down from the first floor. A key pad had been fitted which prevented people accessing the stairs to the ground floor without a member of staff assisting. People had free access to the stairs from the ground floor and from the first to second floor of the building. The kitchen door was open both days of our inspection. This meant that people had free access into the kitchen area. The cook works alone and on one occasion we saw the door open and the kitchen unattended. The manager told us that she would complete a risk assessment and would look at restrictions to accessing areas of the kitchen that may be hazardous. We were told that a bolt would be fitted to the door immediately so that the door could be locked whenever staff were not in the kitchen.
Health and safety audits were completed monthly. Records showed us that staff had health and safety training every two years. Staff had not reported hazards to the manager. The manager told us that they would include staff in future health and safety audits to ensure they were competent in identifying hazards that could harm people.
We spoke with two care workers who were not able to demonstrate an understanding of whistleblowing. This meant that staff did not know what action to take if their senior staff were not responding to concerns being raised about the safety of the service. Staff meeting minutes showed us that whistleblowing had been discussed at a staff meeting in October 2015. We spoke with the manager who told us they would discuss with each member of staff to assess their level of understanding. Staff had completed safeguarding training. They were able to tell us how they would recognise abuse and the actions they would take.
Staff received fire safety training. We spoke to one care worker who was not able to explain what action they would take in the event of a fire. We discussed this with the manager who told us they would review the care workers fire safety competencies. A signing in book was in the foyer but did not have any empty pages for visitors to complete. This meant that there was no record of who was in the building in the event of an emergency. Each person had a personal fire evacuation plan. The service had an emergency contingency plan which contained information on how the service would keep people safe in the event of a major incident which affected the running of the service.
People had risk assessments in place. We spoke with care workers who had a good understanding of people’s risk and what they needed to do to minimise risk and support the person.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).
We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working within the principles of the MCA. People had mental capacity assessments completed. Where it was identified that they were unable to consent to a restriction on their freedoms a best interest decision was recorded and a DoLs application sent to the local authority to request authorisation. We observed staff asking people for their consent.
New care staff completed the Care Certificate induction course over their first three days of employment. The Care Certificate is a national induction for people working in health and social care who have not already had relevant training. Staff had received regular training to enable them to carry out their role. Training records were kept with review dates noted where required. Staff files contained certificates for completed courses.
We observed the manager and senior staff working alongside care workers when providing care and support to people.
People told us they enjoyed the food. We spoke with the cook who demonstrated a good knowledge of people’s dietary needs and their allergies. One person required a specialist diet. . Staff had a good understanding of how to support the person effectively. Where necessary, people had charts to ensure that were eating and drinking enough. We found that staff were aware of who had charts and had completed them accurately.
People had good access to healthcare. Files evidenced that people had access to GP’s, specialist health services, chiropodists, dentists, opticians and district nurses.
We found that the service was caring. People and their families told us the staff were caring, easy to talk with and listened to what they had to say. The manager and care workers had a detailed knowledge of each person. We observed interactions between staff and people. Staff patiently supported people and offered reassurance. They enabled people to maintain some control and independence whilst ensuring their safety. People felt their privacy and dignity were respected. People and their families were involved in decisions about their care. People had not been told about advocacy services that would be able to speak up on their behalf. We raised this with the manager who agreed to source this information and share it with people.
The service was responsive. Information had been gathered prior to a person moving to the service. Assessments had been carried out which included the person, their family and other professionals. This information had been used to identify risks and create an initial care plan. Care records were individual and included assessments and detailed support plans explaining how a person liked to receive their care. The plans gave clear guidance on how to ensure a person’s dignity and independence. Plans included communication, mental wellbeing and the physical aspects of a persons’ care and support needs. However people on short stay placements had limited care plans and if a risk had been identified a detailed care plan had not been produced that told staff what they needed to do to minimise risk and ensure consistent care. Plans were reviewed and updated regularly. People and their families did not always continue to be included. Staff identified and responded quickly to changes in people’s care and health needs.
People’s files contained information about social activities people enjoyed. We saw an activity folder which contained a record for each person and activities they had been offered each day. This included the group activities, family and friends visiting and one to one time with staff. People did not have individual activity plans. The manager told us that these will be introduced this year.
People were supported to maintain relationships with their families and friends. There were no restrictions on times people visited the service. The service did not provide opportunities for people to access the community. A secure fenced garden had been provided for people. The garden was not visible from most areas in the home and was accessed over a gravel parking area which reduced some people’s opportunities to freely access the area.
People and their families felt they could raise concerns with staff. The service had a complaints process that included a concerns log. The complaints records showed us that complaints were investigated, actioned and outcomes reported back to the complainant. People were given information on how to appeal against outcomes.
The service was well-led. . Staff felt happy in their work and felt part of a team. They had a positive view of the service. People and their relatives told us the manager was effective and proactive. The manager felt supported by the organisation.
Staff felt included in decisions about the service and that they could share their ideas and concerns with the manager. The service had introduced a carer of the year award. In December three staff were nominated. The award demonstrated achievements in good care practice. The home had a small staff team and we saw the manager worked alongside staff throughout our inspection. Staff had a relaxed but respectful relationship with the manager. The manager demonstrated a good knowledge of people, their families and the staff team.
The manager completed regular audits to monitor the services performance. Actions from audits were completed and shared with staff.
The Manager had a good understanding of their responsibilities for sharing information with CQC and our records told us this was done in a timely manner.
A quality assurance survey had been completed in August 2015. Forms had been sent to people, their families, staff and other professionals. The results had been analysed by the manager. The overall results were positive. The outcome of the survey was shared on the organisations web site but not within the service. The manager told us that they would arrange for the outcome of the survey to be shared with people, their families and staff.
We found that people spoke positively about the care they received. People told us they were very happy with the way they were treated and felt that they received care that met their needs. One person, for example, told us, "I am very happy with the way I am looked after", while a relative commented, 'We're very pleased with the care. My (family member) always looks well-cared for.'
We observed that staff were responsive to people's requests for support and found that, on the whole, people were treated in a respectful way which promoted their dignity and independence.
Improvements were needed to ensure that people's care was always carried out in line with their care plans. We found examples of people's care plans not being followed consistently which put people at risk of receiving inappropriate care.
Records about people's care were not always effective in ensuring that people's needs were clearly identified and being met.
Some improvements were needed to promote meaningful interaction between staff and people who used the service at all times and to encourage the use of activities to meet people's social and emotional needs.
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?
There were procedures in place for foreseeable emergencies. There were security systems in place in the home and also procedures for the event of fire and emergency hospitalisation.
People who lived at the home were supported to access different areas in the home and community. We saw that relatives visited the home during the inspection. We were told that no people who lived at the home were under Deprivation of Liberty Safeguards.
Is the service effective?
We saw that people had care plans in place to identify their needs. Staff told us that care plans and information provided by other staff members provided them with relevant information about how to support people.
We saw that care plans included information about people's likes and dislikes and that staff took this information into account when supporting people.
Activities took place for people who lived at the home. One person who lived at the home said, 'Last week we had activities. There are always activities around the place. I generally enjoy them. If I don't like them I don't go." One relative said, 'there are activities in the home, like cabaret." This showed that the service was effective in providing people with a choice of leisure activities.
People had access to enough food and drink and were offered a choice. We saw that alternative food choices were offered on the day of the inspection and that people were supported to eat where needed. One relative said, 'they have three cooked meals a day and biscuits and tea." One person who lived at the home said, 'I get enough food and drink. I can always go to the kiosk and ask for more and that's good." This meant that the service was effective in making sure that people received adequate nutrition and hydration.
Is the service caring?
We saw that staff spoke with people who lived at the home in a supportive and friendly manner. One person who lived at the home said, 'Staff are very good, caring." A relative said, 'Staff are friendly, they try to please."
People were treated with respect and dignity by the staff. One person who lived at the home described staff supporting them with personal care and said, 'They help. They have a manner and a way to make you not feel embarrassed."
One person who lived at the home said, "they help you do things that you want to do, they leave it up to you, they let you do what you want." Another who lived at the home said, "they help if needed, I've only got to ask." People who lived at the home and relatives described how staff would help with a range of needs including personal care, eating and drinking, medication, and arranging appointments with external professionals.
Is the service responsive?
We saw that care plans were updated regularly. The manager explained that this occurred on a monthly basis and when needed. This meant that staff were provided with up to date information to help them meet people's changing needs.
Systems were in place to make sure that managers and staff learnt from accidents and incidents, complaints, and concerns. People who lived at the home and relatives said that they felt that they could raise any concerns with staff members and that they felt that staff would take steps to help. One relative said, 'If I had any recommendations I could raise these with staff." One person who lived at the home said, 'If I was unhappy I would go to the staff and manager. I feel they would be supportive on the whole."
Is the service well led?
Staff told us that they received supervision, appraisals, and training. One staff member told us that 'other staff are supportive. I have had mandatory training." This meant that staff received sufficient guidance and training to enable them to meet people's needs.
Staff members that we spoke with told us that they could seek advice from senior staff when needed. One staff member said "I always know I can go to the manager." This meant that staff received enough support form senior staff to enable them to provide good quality care.
We saw that the home conducted a number of audits for areas such as medication, infection control, and dignity. This meant that the provider had taken steps to reduce the risk of inappropriate care and treatment through monitoring the quality of the service. We also saw that incidents, accidents, complaints, and concerns were monitored. This information was then used to develop and carry out plans to improve the quality of the service. This meant that the provider had taken steps to ensure a good standard of care for people who lived at the home.
We spoke with four people who lived at the home but only two of these people were able to tell us about their experiences of the home. The other two people had a diagnosis of dementia and were not able to give an account of their experiences. We spoke with four members of staff, two senior carers, a care staff member, who was working as the cleaner for the day, and the chef.
We found that the manager and organisation had good systems in place to monitor the quality of service provided to people and good standards of care were being provided at Naseby Care Home.
The visiting relative told us, 'The manager has been fantastic, I am very happy with the way my father has been cared for; it has been a great relief to have found Naseby'. One person who lived at the home told us, 'Everyone has been very kind and I don't have any complaints'.
We found that mental capacity assessments were carried out to identify those people who could not consent to their care and support. We found that best interest decisions were clearly identified regarding people with dementia, with relatives being consulted about how people should be cared for. Those people who were able to consent to their care were consulted with forms signed by the person to evidence this.
People's care and welfare needs were being met at the home. People's needs had been assessed and care plans put in place to inform the staff on how people should be supported.
The home had suitable levels of staffing to be able to meet the needs of the people accommodated.
The home had systems in place to ensure that medication was managed safely in the home.
There were systems in place to monitor the quality of service provided to people.
We looked at how record keeping was managed at the home. There were good systems in place to make sure that record keeping protected people from the risk of receiving unsafe or inappropriate care.
Personal care records we looked at were stored securely so that personal information was kept confidential. Records we looked at were accurate and appropriate for the management of people's care and treatment.
We used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had complex needs which meant they were not able to tell us their experiences.
We spoke with a relative who told us that staff were thoughtful. They said staff remembered that the person they visited did not like the ceiling light on and they preferred small side lights.
We observed staff asking people if they were ready to settle down for the night.
Staff were calm and professional checking on people who were still awake and also checking on people who were settling down for the night. When a call bell rang staff answered it quickly.
On this visit we found the laundry room had been improved. The walls had been painted and the floor cleaned. There were no open red bags on the floor. All the washing machines were working.
Staff were polite did not seem rushed and told us that the additional person ensured they could meet everyone's needs according to their care plan.
We tested the water temperature in a number of bathrooms on different floors of the home. This was to check if the hot water was at a reasonable temperature. People had told us previously they were washed in cold water. We found the water ran hot after a minute or two.
We visited the home again unannounced on the evening of 29 November 2011 following concerns raised with us anonymously about night care.
People told us that during the day they had their needs met promptly by staff. They told us their experience at night was different, that staff were kind but they had to wait for their care needs to be met and their preferences were not always taken into account. People told us that staff were kind and explained why there was a delay in their care.
People told us the care was good and they felt safe when being supported. However, some people told us that the water was sometimes cold when they were washed.
Staff told us that at night they had no access to equipment such as continence aids for people and sometimes they ran out. They said that a number of people in the home need two staff to support them with personal care in the late evening and this meant other people had to wait for their personal care.
People who used the service were asked their views by the provider and this information was put together in a report for the home. Improvements were noted but the timescales in the subsequent action plan were not always met.
We visited the home again unannounced on the evening of 29 November 2011 following concerns raised with us anonymously about night care.
People told us that during the day they had their needs met promptly by staff. They told us their experience at night was different, that staff were kind but they had to wait for their care needs to be met and their preferences were not always taken into account. People told us that staff were kind and explained why there was a delay in their care.
People told us the care was good and they felt safe when being supported. However, some people told us that the water was sometimes cold when they were washed.
Staff told us that at night they had no access to equipment such as continence aids for people and sometimes they ran out. They said that a number of people in the home need two staff to support them with personal care in the late evening and this meant other people had to wait for their personal care.
People who used the service were asked their views by the provider and this information was put together in a report for the home. Improvements were noted but the timescales in the subsequent action plan were not always met.