Netherton Green Care Home

Netherton Green Care Home provides personal and nursing care to older people, people with physical disabilities and people living with dementia. At the time of our inspection 37 people were living there. The service can support up to 120 people.

Netherton Green Care Home is purpose built and consists of four single story buildings named, Primrose, Windmill, Darby and Saltwells. At the time of our inspection Primrose and Saltwells were closed.

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

The provider had failed to have systems in place to adequately prevent and control infection. The provider did not always safely manage medicines. The provider had assessed people’s risks and implemented plans to mitigate this. Staff were recruited safely. People were safe from abuse.

People did not enjoy the food. The design and decoration of the service did not always meet people’s needs. The provider ensured assessments of people’s care needs and personal choices were completed. The provider worked well with other agencies.

Staff treated people well, with kindness, respect and compassion. People were involved in reviews of their care. People’s dignity was respected.

Care plans were person centred and specific to people’s needs. People’s communication needs were met. People’s complaints were managed well.

The provider’s governance systems failed to identify poor infection control practices and unsafe medicine management. The provider failed to ensure learning from accidents and incidents was shared. Staff felt supported in their role. People told us the provider communicated with them well.

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.

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 inadequate (published 17 February 2022) and there were breaches of Regulation 12 (Safe care and treatment), Regulation 17 (Good Governance) and Regulation 18 (Staffing). 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 Regulation 18. However, we found the provider remained in breach of Regulation 12 (Safe care and treatment) and Regulation 17 (Good Governance).

This service has been in Special Measures since 4 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

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

We have identified breaches in relation to safe care and treatment and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Netherton Green Care Home provides personal and nursing care to older people, people with physical disabilities and people living with dementia. At the time of our inspection 59 people were living there. The service can support up to 120 people.

Netherton Green Care Home is purpose built and consists of four single story buildings named, Primrose, Windmill, Darby and Saltwells. At the time of our inspection Primrose was closed. Saltwells is a step down service for people being discharged from hospital, Darby provides general nursing care and Windmill supports people living with dementia

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

Some people and relatives told us there were not enough staff to meet peoples' needs in a timely way. We observed this in two of the bungalows, and people were left in bed until after midday. Risks were not always accurately assessed or mitigated in a timely way. Medicine management required improvement to ensure medicines were stored correctly and administered safely as prescribed. Some infection control concerns had not been identified in relation to the cleanliness of the environment. Most people told us they felt safe, although some people told us they felt less safe at night when agency staff were used.

The management of the service was inadequate as the provider was not carrying out regular checks to ensure the care was being delivered safely and effectively. Audits were not being carried out in line with the provider's schedule due to lack of management staff. Staff told us they did not feel supported because of the number of management changes that had occurred. People and relatives told us they felt confident to raise concerns and they would be addressed.

We received mixed feedback about the food, some people told us the quality of the food could be improved but most people said there was choice and plenty of snacks were provided. The provider was gathering feedback from people about food, in order to improve the quality. Healthcare professionals were contacted when necessary, but guidance was not always recorded on care plans which meant there was a risk that advice was not consistently followed.

Most 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 mostly supported this practice. We did have concerns about one person where there appeared to be conflicting information and staff were unclear about whether the person had capacity to make decisions about their care.

People told us staff were kind and caring and treated them with respect and we observed this in practice. Staffing levels meant that sometimes people had to wait for their care which meant dignity was not always upheld.

Activity co-ordinators worked in each bungalow and people had opportunities to be involved in activities they enjoyed. This was limited in some bungalows as people enjoyed spending time in their rooms, there was only one co-ordinator in each bungalow and staff told us they didn’t have time to spend with people. People’s wishes for the end of their lives were explored.

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 04 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, support for people at risk of skin damage and the oversight of the service. 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 have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Netherton Green Care Home on our website at www.cqc.org.uk.

Enforcement

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. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

¿ Visitors to the home had their temperatures taken prior to entering the home, completed a short health screening questionnaire and consented to a lateral flow test.

¿ Personal protective equipment was available for visitors to use.

¿ Visits were currently restricted due to the recent out-break; however, the provider had ensured people continued to have contact with their family members through, window visits, social media and telephone calls.

¿ Arrangements had been introduced for staff to appropriately socially distance as much as possible during their breaks.

¿ People who had tested positive for Covid-19 self-isolated in line with current guidance.

¿ Clinical waste and laundry were handled in line with government guidance.

¿ The senior management team had shared learning and updates about COVID-19 to ensure staff worked in line with best practice and government guidance.

People’s experience of using this service:

People’s care needs were not always responded to in a timely way. There were some errors in the recording of medication. People were supported by staff who knew how to manage risks to keep them safe and report any concerns of abuse. Staff followed safe practices in relation to infection control.

People were supported by staff who were trained in how to meet their needs. People’s needs were assessed prior to moving into the home. People had their dietary needs met and had access to healthcare services where required. People had their rights upheld in line with the Mental Capacity Act.

People were supported by staff who were kind and caring to them. People were treated with dignity and their independence was encouraged. People were supported to make choices and be involved in their care.

People’s needs were met by staff who knew their likes, dislikes and preferences with regards to their care. People who required end of life care had been asked about their wishes. Complaints made had been investigated and resolved.

There were systems in place to monitor the quality of the service and identified areas for improvement were being acted upon. People were given opportunity to feedback on their experience of the service.

Rating at last inspection: Requires Improvement (Published 05 March 2018)

Why we inspected: This was a planned inspection based on previous rating.

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

Netherton Green is purpose built and consists of four separate single storey buildings each accommodating up to 30 older people. It provides nursing care older people whom live with dementia and people who require rehabilitation and palliative care. At the time of our inspection 104 people were using the service.

There was a registered manager in place who was present during our inspection. 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.

During our inspection visit we received information of concern about people experiencing unpleasant odours, falls, poor support with personal care and how people who lived with dementia were supported to stay safe. We found the provider was taking action to address these issues however improvements in staff training was required to support people living with dementia.

Staff were attentive and supported people promptly, however staff did not demonstrate they had sufficient skills and knowledge to support people who lived with dementia. The premises were suitable to meet the needs of the people who used the service however, further work was required to meet the specific needs of people who lived with dementia. We have made a recommendation about staff training on the subject of dementia.

People told us they felt safe. The registered manager had taken action to ensure there were enough suitable staff. Staff demonstrated that they were aware of signs which may indicate that someone was being abused and the action to take. The risks to people had been assessed and practices were in place to reduce the possibility of harm. There were process in place to ensure the premises and equipment were regularly checked so they remained safe and the risk of injury to people was reduced. The provider had taken action to ensure people received their medicines appropriately. People were protected from harm by the prevention and control of infection. There was a system to review incidences and learning when things went wrong.

People were supported by staff who had the skills and knowledge to do their job. Staff were aware of the provider’s policies to prevent discrimination and promote equality and diversity at the service. People received sufficient amounts of foods and drinks they enjoyed. People received continuing support from healthcare services and received ongoing healthcare support. Staff sought people’s consent before supporting them and respected their choices. Staff we spoke with were aware of the DoLS process and their responsibilities.

People told us that the staff were caring. We saw many positive interactions and staff spoke fondly about the people who used the service. People were supported by staff who respected their privacy and dignity and promoted their independence.

There were dedicated ‘activities co-ordinators’ to support some people engage in things they liked and maintain social contacts. People were confident staff would respond appropriately to any concerns. There were processes in place to ensure people would receive appropriate care at the end of their lives.

Processes to improve the quality of the service had not been effective at ensuring good practice was consistent across all the units. The registered manager had worked closely with other agencies to monitor and improve the quality of the service. People who used the service and staff expressed confidence in the leadership of the service. The registered manager prompted a clear vision and set of values which staff understood. People and staff had the opportunity to influence and develop the service.