29 May 2018
During a routine inspection
This was an unannounced inspection which took place over three days on 29 and 30 May and 4 June 2018. The inspection team consisted of three adult social care inspectors, a pharmacy inspector and two ‘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 care service.
There was a registered manager in post. 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 the last inspection in November 2017 the home was owed by BUPA Care Homes Limited who have since sold the home to HC-One Limited. The home is again in transition as HC-One Limited are now selling the home on. At the last inspection there were outstanding breaches of regulations. This inspection was comprehensive and was the homes first inspection under the new providers.
Overall, we found the service had been stabilised over the past six months. There have been concerns reported in areas such as personal care and nursing assessment and observation, including management of falls. These have been reduced in number and seriousness with respect to the homes previous history. We looked at these areas of concern as part of the inspection.
Of the four outstanding breaches of regulations – two have been met and two remain. We have given the home a quality rating of ‘Requires Improvement’. This is the ninth consecutive time the service has been rated Requires Improvement since January 2014.
At the last inspection we observed there was not always enough staff to carry out care in a timely manner. There was a high use of agency staff cover which had inherent risks around the effectiveness of communication and knowledge around people’s care needs. On this inspection we found improvements and did not find people at serious risk. We did find, however, continued inconsistencies in staff cover which had the potential to put people at risk of unsafe care at times.
HC-One Limited are a large national organisation with established systems in place to continually assess and monitor the delivery of care in the home. We found the introduction of a new care planning system and documentation had not been delivered effectively and gaps in the documentation and care records. One of the key management objectives, to ensure appropriate staffing at all times, had also not been fully met.
You can see what action we told the provider to take at the back of this report.
At the last inspection in November 2017 we found people were not protected against the risks associated with medicines because the provider’s arrangements to manage medicines were not consistently followed. There was a risk associated with the use of agency staff. On this inspection we found improvements and systems in place helped ensure safe delivery of medicines. The breach had been met.
We made a recommendation for improved practice.
Previously we had found inconsistencies in assessing some people’s health care needs and delivering effective outcomes. We found this had improved and there was more consistent delivery of care and people’s health care needs had been reviewed appropriately. The breach had been met.
Similarly, we had found on the previous inspection some examples evident where people’s dignity was clearly compromised. We found this had improved and all the people we spoke with and their relatives told us they felt privacy and dignity was upheld by staff and their approach to care. The breach had been met.
Staff were aware of the first aid procedures and equipment used in case of an accident or emergency.
People’s clinical risks such as falls, pain and diet were routinely assessed and monitored. This helped to maintain people’s safety and welfare.
Staff files showed appropriate recruitment checks had been made so that staff employed were ‘fit’ to work with vulnerable people.
People we spoke with and their relatives told us they felt safe in the home. People knew who to speak with if they felt concerned about anything. Nobody we spoke with or observed expressed any issues regarding their safety.
There had been several safeguarding investigations at St Nicholas Care Home since our last inspection. Staff had assisted the local authority safeguarding team and agreed protocols which had been followed in terms of investigating. This helped ensure any lessons could be learnt to ensure safe and effective care.
We found that the home was overall clean and hygienic.
We found the home was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). People were being appropriately supported to make key decisions regarding their care and treatment.
We observed meal times and saw that meals were served appropriately and people who needed support to eat had sufficient staff time allocated and that staff took time to talk with and socialise with people.
Staff told us the training they received was good. The ‘training matrix’ we saw showed that some staff needed training updates and this had been identified and was organised. There was an established induction programme for staff.
We saw references in care files to individual ways that people communicated and made their needs known. We also saw good examples where people had been included in the care planning, so they could play an active role in their care although this was not always apparent.
A complaints’ procedure was in place and people, including relatives, we spoke with were aware of this procedure. We spoke with the registered manager who showed us how complaints were recorded and responded to.
We saw that people were provided with some social activities. These were not however always evident on the units we inspected. There was a need to further review how activities were planned and implemented.