Nesfield Lodge

Nesfield Lodge is a residential care home providing personal and nursing care for up to 44 people aged 65 and over. At the time of the inspection, 40 people were living in the service. The building is purpose built with accommodation over two floors.

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

People told us they felt safe and enjoyed living at Nesfield Lodge. One person told us, “I like it here, am happy here.” Relatives also spoke positively about the home and were satisfied with most aspects of the care and support given to their loved ones. One relative said, “It’s a happy atmosphere.”

There were systems in place to minimise the risk of infection. The home was clean and cleaning records evidenced this, and some areas of the home were being renovated. The necessary checks on the building and equipment had been done to ensure its safety. Systems were in place to protect people from the risk of abuse. Medicines were managed safely. There were enough staff working at the service to meet people's needs and there were adequate staff recruitment practices in place.

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.

Governance systems were in place to ensure all aspects of the service were reviewed and checked regularly. The service worked well with other healthcare professionals to meet the needs of people. Staff enjoyed working for the provider and told us they felt well supported. The home had a quality action plan that identified areas for improvement and timescales. People, relatives and staff told us there was an open and honest culture at the home and the management team were always approachable.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 February 2021).

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention control, nutrition and hydration and the management of the home. A decision was made for us to inspect and examine those risks.

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.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nesfield Lodge is a residential care home providing personal and nursing care for up to 44 people aged 65 and over. At the time of the inspection, 36 people were living in the service. The building is purpose built with accommodation spread over two floors.

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

At this inspection the overall rating for the service has changed from good to requires improvement. This is because we found some aspects of cleaning and infection prevention practice needed improving and better records needed keeping. During the inspection, the registered manager started to take positive action to address these concerns.

Despite this, there were many positive aspects of the service. People and relatives consistently said the service provided good quality, person-centred care and everyone we spoke with said they were happy and content living in the home. We found staff were kind and compassionate towards people and treated them well. There was a person-centred approach to care and support.

The service had worked hard to ensure people received regular contact with their relatives through the COVID-19 pandemic through various means including using technology and supporting visits in a safe and appropriate manner. The registered manager understood the various COVID-19 support guidance for example relating to visiting, safe admissions, and Personal Protective Equipment and had implemented it appropriately within the home.

There were enough staff deployed to ensure people received good care and support and during the inspection we saw staff were attentive and supervised people appropriately.

Incidents and accidents were recorded, investigated and analysed for themes and trends. We saw evidence learning took place following incidents and the provider and registered manager had good oversight of these. People said they felt safe living in the home.

Overall risks to people’s health and safety were assessed with clear and detailed risk assessments in place. Staff understood people’s needs. In most cases we saw safe plans of care were followed although some inconsistencies were noted.

Overall medicines were safely managed. We felt assured people were receiving their medicines as prescribed. We found a small number of medicines were not properly accounted for and some guidance for staff on when to give “as required” medicines needed more detail.

People, relatives and staff praised the overall quality of the service and said t they felt engaged with and supported by the management team. Systems were in place to seek and act on feedback from people who used the service, relatives and staff.

In most areas the registered manager had good oversight of the home and undertook a range of audits and checks with actions being recorded on an action plan to drive improvement. However, issues relating to cleaning and hygiene should have been rectified sooner, particularly as many were identified by an infection control audit in 2020.

The service used an electronic care management system to record care interventions. This supported good oversight of care and support, although we found some inaccuracies with regards to information recorded on the system.

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 1 January 2019)

Why we inspected

Over the last year we received concerns in relation to hygiene and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. Following our inspection the manager added items to their action plan and began implementing new paperwork to ensure improvements to the management of cleaning within the service

Enforcement

We have identified a breach in relation to cleaning and hygiene within the home at this inspection. Please see the action we have told the provider to take at the end of this report. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Nesfield Lodge accommodates 44 people across two floors. Both floors specialised in providing care to people living with dementia. At the time of our inspection, there were 40 people living in Nesfield Lodge.

At the time of our inspection there was a registered manager in post at the service. 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 told us they felt safe living at Nesfield Lodge. Staff understood when and how they would raise any concerns if they suspected abuse was taking place. The registered manager kept a log of all safeguarding investigations and recorded what action had, or needed to be taken, to keep people safe from abuse.

There was enough staff to safely care and support people. The registered manager regularly reviewed this, to ensure staffing levels continued to be appropriate. Staff were recruited safely and appropriate employment checks had been undertaken before staff began working at the service to ensure they were of suitable character to work with vulnerable adults.

People’s individual needs were risk assessed and staff had the right information to support people safely when using equipment such as hoists and walking aids.

The provider had policies and procedures in place to prevent the potential spread of infection. Staff followed good infection control practises in their work. We looked in people’s bedrooms and found that these were clean and tidy.

People’s medicines were managed safely and people and their relatives confirmed this when we spoke with them. We looked at six medication administration records (MARs) and found the stock of medication held for each of these was correct.

Fire safety equipment was in place and serviced regularly. Arrangements were in place to safely evacuate people from the premises in cases of emergency.

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 told us they enjoyed the food. The menus showed an extensive choice of meals which included specialist dietary options, including vegetarian meals. People ate at their own pace and were supported by staff in a patient and relaxed manner.

People were supported to access healthcare professionals. We spoke with a visiting health care professional who told us the number of referrals to the on-call doctor had reduced since they had begun working in close partnership with the service.

Staff received regular supervision and annual appraisals. The registered manager also provided group supervision to staff.

We received positive feedback from people and their relatives about the kind and caring nature of the staff. Visiting times for relatives were unrestricted and the registered manager encouraged people to invite guests to celebrate special occasions with them.

Staff respected people’s privacy and they told us how they promote people’s dignity when proving personal care, by closing doors and curtains and by approaching people discreetly and sensitively.

People were supported to be as independent as possible and staff encouraged people to make their own decisions wherever they could. We heard staff asking people what they would like to do, where they would like to go and what they would like to eat.

People were provided with a varied programme of activities that promoted social interaction and were connected with people’s interests. This included, for example, joining in activities with children from the local primary school, hen-keeping, quizzes, bible study groups, karaoke and trips to the seaside.

Staff responded quickly to people’s needs and provided care in a way they preferred. Bespoke care plans, held on an electronic care planning system provided staff with up-to-date information at the point of care. A live feed showing people’s emotional status alerted staff to when people needed care and support.

People received personalised care, guided by people closest to them. Relatives were involved in care planning and reviews of care. Staff also spoke to people to ask if they were happy with how they were being cared for.

The service engaged with health care professionals and people’s relatives when planning end of life care for people to make sure the right support was in place.

People told us the service was well-led. The registered manager advertised in the weekly newsletter that they ran an open-door policy and welcomed anyone to ‘drop in’. People told us they could talk to staff or the registered manager if they had any concerns and were confident they would be listened to. Relatives told us the registered manager was approachable and accessible.

The service worked in partnership with other organisations in the local community, including a primary school, religious groups and charities. One charity group had recently painted the garden furniture to support the ongoing development of the dementia friendly environment.