The Polegate Care Home

The Polegate Care Home is a residential care home providing nursing and personal care for up to 44 people. At the time of the inspection there were 25 people living in the service. People were living with a range of nursing and support needs.

People’s experience of using this service and what we found

There were a number of staff vacancies throughout the home. This meant agency staff were being used to ensure staffing levels were maintained. New staff working at the home had not been able to read people’s care plans. There was an over reliance on verbal information sharing and new staff were not always being supported by an experienced member of staff.

Care plans and risk assessments were in place. Care plans were reviewed monthly or more frequently if changes occurred. However, daily records had not been maintained appropriately. Elements of people’s personal care, including mouthcare, repositioning and regular checks were not consistently documented. Staff were not aware which daily charts should be completed for people.

There had not been a registered manager at the service since July 2022. A ‘turnaround’ manager had been put into post by the provider to manage the home until a new manager was recruited. A new manager was due to start in January 2023.

Visitors to the home gave mixed feedback and everyone was aware that there had been a number of staff changes. People told us they wanted more consistency. The provider and manager were working hard to recruit new staff including recruitment from abroad.

Safe recruitment procedures were in place. All appropriate checks were completed before new staff began working at the home. Staff received a three-day induction which included a period of shadowing experienced staff.

There were safe medicine practices and people told us they received their medicines at the right time. Staff administering medicines received training and had their competencies assessed. Staff demonstrated a good understanding of protecting people from abuse. Safeguarding procedures were discussed with staff during group supervisions and any learning taken forward.

Infection control procedures were being followed and the home was clean and tidy. Staff and management were aware of any actions to follow in the event of any outbreaks of COVID19.

People were able to provide feedback about the way they received their care. Resident and relatives’ meetings had been scheduled and staff received group supervisions. Staff told us meetings were a helpful way of communicating any changes. All feedback was being used to implement positive changes to improve the home.

Quality assurance checks and had been completed. This included a programme of auditing which incorporated all aspects of care delivery and services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received in relation to staffing, person centred care and documentation. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home was clean and hygienic. There was a designated housekeeping team and cleaning schedules reflected that high touch areas were being cleaned regularly throughout the day. A visitor pod had been created to facilitate safe visiting.

The home was following current government guidance on supporting visits to the home. Visits to the home were booked in advance and staggered throughout the day. Visitors took a lateral flow test before entering the building, signed a COVID-19 declaration form and had their temperatures taken. Visitors had the option to visit people in their bedrooms or in the designated visitor pod. Visitors that chose to see people in their bedrooms were asked to wear full personal protective equipment (PPE) throughout the visit. The visitor pod had an external entrance and a full length screen between the person and their visitor. There was a two-way speaker system in place to support people to be able to clearly hear. The visitor pod was cleaned between each use and the times of the pod visit were different to the in-house visits in order to reduce footfall in the home. People were also supported by staff to use video calling technology to keep in touch with their loved ones.

Visits to people receiving end of life care had been supported throughout the pandemic. There were limited restrictions on end of life visits in that two designated family members could come and go throughout the day following a negative lateral flow test result.

People were supported to socially distance where possible. Staff had tried to balance safety with people’s wellbeing and encouraged people to get involved in in house activities. People who chose to stay in their bedrooms or were being supported with care in bed were supported with one to one activities.

Staff were wearing PPE in line with government guidance. There were PPE stations around the home. For people isolating in their rooms there were PPE stations outside their bedroom doors. Staff had received training in putting on and taking off PPE safely and the infection control lead completed regular competency checks to ensure staff were following correct procedures. Staff had also received infection control training.

There were risk assessments for people and staff to assess for factors that could increase their risk from COVID-19. People had COVID-19 care plans and individual visitor plans in place.

The Polegate Nursing Home is a residential care home providing personal and nursing care for up to 44 older people. At the time of the inspection 39 people were living at the home. Most people needed support from staff for personal care and moving around the home safely and were living with a range of healthcare needs. This included living with diabetes, physical disability, Parkinson’s Disease and frailty linked to age.

14 of the rooms at the home were booked by local hospitals for people who were ‘Non-weight bearing’. These were used for short term support, usually between two to six weeks, for people following surgery or care in hospital for fractures (broken bones) and injuries due to accidents at home.

People’s experience of using this service and what we found

People were very positive about the care and support they received. They told us they felt safe because the staff looked after them, “Very well” and “Not one member of staff who is not willing to help, the night staff are brilliant too.” Staff had a good understanding of people’s needs and people said they were kind and caring.

An effective quality assurance system monitored all aspects of the services provided and action was taken when areas for improvement were identified. People, relatives and staff were empowered to be involved in how the service developed. Regular meetings and satisfaction surveys encouraged feedback, in addition to daily talks and discussions.

There were enough staff working in the home and a robust recruitment procedure meant only suitable staff were employed. Staff attended training and had a good understanding of people’s needs. Regular supervision supported staff to be aware of their roles and responsibilities and enabled them to discuss their professional development; with additional training provided 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 home supported this practice.

People were protected from the risk of abuse, harm or discrimination because staff had completed safeguarding training and knew what action they should take if they had any concerns. Medicines were managed safely, and staff were required to complete appropriate training and competency assessments.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good. (Published 29 April 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

This was an unannounced inspection which took place on 13 March 2016.

The Polegate Care Home was inspected in December 2015. Three breaches of regulation were identified. Regulation 12, Safe care and treatment, Regulation 10, Dignity and Respect and Regulation 18, Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Since this inspection there has been a change to the provider name, however, The Polegate Care Home is still owned by the Bupa Group and the registered manager remains the same. The provider sent us an action plan stating they would have addressed all of these concerns by February 2016. At this inspection we found the provider was meeting the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Polegate Care Home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was in day to day charge of the home, supported by a clinical lead nurse/ deputy manager. People told us that they felt supported by the management there was always someone available to support them when needed. Staff told us that the registered manager had a good overview of the home and knew everyone well.

People, relatives and staff told us the home was organised and well led. Staff felt supported and encouraged to provide person centred care for people and were motivated to improve people’s day to day lives. Staff demonstrated a good understanding of people’s needs and displayed kindness, patience and compassion when providing care. Care delivery was person centred and people and their next of kin if appropriate were involved in reviews of their care plans and how care was provided. Staff were prepared to give their own time to support people to attend events or do things that were important to them.

Environmental and individual risks to people were assessed and reviewed. Whilst encouraging people to maintain independence when possible people’s choices and wishes were supported. Management and staff had a good understanding of mental capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff demonstrated a clear understanding of how to recognise and report abuse. Staff treated people with respect and dignity and involved people in decisions about how they spent their time. People were asked for their consent before care was provided and had their privacy and dignity respected. Feedback was gained from people this included questionnaires and regular meetings with minutes available for people to access.

A full and varied programme of activity was provided. People told us they enjoyed the activities and were supported to stay active and do the things they enjoyed. Information was provided to inform people what had been planned and people were invited to give feedback.

Medicine policies and procedures were in place to ensure people received their medicines safely and all medicine procedures were checked and audited. People told us they received their medicines when they should and staff supported them to stay healthy.

People gave positive feedback about the meals provided. People had a choice of meals and staff knew people’s likes and dislikes. People’s nutritional needs were monitored and reviewed.

All required maintenance and servicing of equipment had taken place. Fire evacuation plans and personal evacuation procedure information was available in event of an emergency evacuation.

Staffing levels were reviewed regularly to ensure people’s needs were met. Robust recruitment checks were completed before staff began work and all new staff completed an induction and training before commencing work. There was a programme of supervision for all staff. Staff told us they valued the regular supervision as it was their opportunity to discuss their development and talk about their role. Staff said communication had improved and staff felt involved in any changes to the way the home provided care and felt their views listened to. Staff had received effective training to ensure they had the knowledge and skills to meet the needs of people living at the service.

A complaints procedure was available for people to access if needed. People told us they would be happy to raise any concerns if needed. People and relatives told us that the registered manager had an ‘open door policy’ and they could discuss any issues with them if they arose.

There was a system in place to continually assess and monitor the quality of service provided. Audit information was used to continually improve and develop the service.

People were supported to have access to healthcare services and maintain good health. Referrals were made appropriately to outside agencies when required. For example, GP visits and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred.