We carried out a review of the data available to us about Pax Hill Nursing 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 Pax Hill Nursing Home, you can give feedback on this service.
At our last inspection we rated the service good overall and requires improvement in well-led with no breaches of the regulations. The service was rated as requires improvement in this key area, as the provider had not always consistently created an open and transparent culture within the service.
The service had an experienced 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.
People’s needs were holistically assessed and their preferences about how they wanted their care provided were considered. There was a strong focus on providing individualised care to people living with dementia, which enhanced their experience of the care provided. Staff had been supported by their dementia care consultant to develop their skills, knowledge and confidence when working with people with dementia.
Staff were highly skilled at responding rapidly to a deterioration in people’s health and providing the correct interventions to enable them to receive their care, including end of life care where they chose, at Pax Hill. Staff had been trained to provide Namaste care to people living with dementia when approaching the end of their life which provided comfort and connectivity for people.
Social activities provision was exceptional. The activities which were planned with people where possible, enabled them to try new things, to contribute to society and to feel a sense of self-worth. Staff had built strong links with the local community for peoples’ benefit, with both members of the community coming in to the service and people going out regularly.
The service was well-led, with enthusiastic and motivated leadership which kept people at the heart of everything they did. There was a very positive and forward-thinking culture underpinned by a desire to drive service improvements for people.
Rigorous and constructive challenge was welcomed and used to improve the service for people and had been used to find innovative and empowering solutions to issues for people. The views of people were sought in a variety of ways. Processes were in place to continually audit and evaluate the service provided.
The service was a role model for other services. They worked in partnership with others, they shared their ideas and practice to ensure good experiences and outcomes for people across services.
People were kept safe from the risk of abuse through the robust training and processes to prompt staff to consider if a safeguarding referral was required to keep people safe following any incidents. There were processes in place to ensure staff felt able to report any concerns and to ensure relevant actions were taken for people’s safety.
Risk assessments had been completed in relation to all aspects of people’s care and for peoples and staff’s safety within the service. Relevant checks had been made in relation to fire, equipment and utilities safety. People received their medicines safely from trained, competent staff. Processes were in place to protect people from the risk of acquiring an infection.
There were sufficient suitable staff to meet people’s needs. Recruitment safety checks had been completed and the registered manager took swift action during the inspection to ensure that any staff without the required full employment history provided this information as legally required.
People’s needs were effectively assessed and their care and support was delivered in line with current legislation and recognised good practice guidance. Staff had the skills, knowledge and experience to provide people with effective care. Staff received regular support and supervision of their work.
People were very positive about the quality of the meals provided. People were offered both a range of nutritious meals to meet their dietary requirements and the level of staff support they required to eat their meals.
Staff worked effectively together to ensure people’s needs were identified and they were referred promptly to other services as required. People were supported to access the healthcare services they required.
People’s individual needs were met by the design and decoration of the service, particularly on the dementia unit, where people experienced a relaxed and stimulating environment.
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.
There was a person-centred culture. Staff consistently treated people in a kind and compassionate manner. There was written information for staff about people’s communication needs and how to meet them. Staff asked people for their views and respected them. Staff ensured people’s privacy and dignity were upheld during the provision of their care.
Further information is in the detailed findings below
The service had 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. The registered manager was unavailable during the course of the inspection; however, we were supported by the unit managers on each unit.
People told us they felt safe within the service. Staff had undergone relevant safeguarding training or this was booked for new staff who needed to complete this training. Staff understood their role in relation to safeguarding people from abuse.
Risks to people had been regularly assessed. People were supported to move and transfer by the relevant number of staff using the correct equipment to ensure their safety. There were processes in place to ensure people received safe care after an accident. Risks to people were well managed.
People told us there were plenty of staff. The provider used a staffing level calculator to determine the required level of staffing for each unit. We observed people’s needs were met by staff and call bells were answered promptly. People were cared for by staff who had undergone relevant pre-employment checks to ensure their suitability to work with people.
Processes and policies were in place for the safe ordering, storage, administration and disposal of medicines and trained staff administered people’s medicines. People received their medicines safely.
Staff underwent an induction to their role and received on-going training. Staff received supervision and an annual appraisal of their work. Staff received appropriate support in their role to enable them to provide people’s care effectively.
People told us staff sought their consent to provide their care. Staff had undertaken training on the Mental Capacity Act 2005, or this training had been arranged for new staff. Where people lacked the capacity to consent to decisions about their care; legal requirements had been met. Deprivation of Liberty Safeguards applications had been submitted where required for people as per legal requirements to ensure their human rights were upheld.
People were offered a variety of nutritious food and drink across the day which met their dietary needs and preferences. Risks to people associated with eating and drinking had been assessed and managed effectively to ensure their safety.
People were supported by staff to access health care professionals as required in response to their identified health care needs.
People told us staff were caring. Staff were observed across the course of the inspection to be kind and polite to people, they told us they spent time getting to know people. Staff were quick to attend to people who showed signs of distress to reassure them. People were supported by caring staff.
People were supported by staff to express their views. Staff were observed to provide people with guidance and information to enable them to make decisions.
Staff ensured people’s privacy and dignity was maintained throughout the inspection. Staff understood the measures they were required to take to uphold people’s privacy and dignity.
People told us they had been involved in their care planning. People had care plans which addressed their identified needs in relation to various aspects of their care. These were reviewed monthly by the nursing staff. Although people did not have regular formal reviews of their care, they and their families were consulted about any changes and updates to their care.
Staff understood people’s needs and how to engage with them. A range of activities were provided on each unit to meet people’s needs. Work was being completed on the corridors of Montgomery unit to theme them in order to make it easier for people who experienced dementia to orientate themselves.
The provider had a process in place to enable people to make a complaint. Records demonstrated people’s complaints had been investigated, actions taken and feedback provided to people.
Staff understood the objectives of the service and were observed to uphold them in their work with people. The service has good links with the local community. People and their relatives told us they had observed that the provider did not always ensure staff issues were addressed with staff in private and it did not make them feel comfortable. This did not ensure a consistently open and transparent culture within the service. The provider has told us they will be reviewing how they can address this to ensure staffing issues were addressed by them appropriately.
People’s fluid charts did not document an individual objective for their fluid intake, nor was their intake totalled at the end of the day. This was brought to the attention of staff during the course of the inspection. Staff told us they were taking action to ensure this information was recorded for people. However, it will take time for the service to be able to demonstrate these changes have been implemented and embedded within staffs practice.
People told us the service was well managed by the registered manager. There was a clear management structure within the service. There were sufficient management staff to provide good daily leadership of the service for people.
There were processes in place to enable the registered manager to audit the service for the purpose of identifying any areas for improvement. Feedback from people and professionals was used to improve the service for people.
We carried out an unannounced comprehensive inspection of this service on 24 February 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to care and welfare and records.
We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pax Hill Nursing Home on our website at www.cqc.org.uk.
Pax Hill Nursing Home is a 98 bed nursing home registered to provide care for older people and younger adults. The service is registered to provide care for people who experience physical health or mental health conditions including dementia. At the time of the inspection there were 82 people using the service.
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.
Staff had followed the provider’s guidance in relation to people’s care following a fall. Records showed people had been assessed when they fell to identify if immediate medical assistance was required. People were then monitored for a period of time following the fall to enable staff to assess if their condition had deteriorated and their falls care plan had been updated where required. Risks to people following a fall were managed safely and clearly documented.
Changes had been made to the lunchtime service on Montgomery unit which accommodated people who experienced dementia. Staff had received additional dementia awareness training to enable them to increase their understanding of the needs of people who experience dementia. The changes to the lunch service supported people to be more actively involved in making choices about their lunch. People had a positive lunchtime experience as consideration had been given to their needs and staff understood how to meet them.
Staff now completed a comprehensive record of the care provided to people at night in order to demonstrate at what time people had been checked and by whom. Appropriate information was recorded in relation to people’s care at night. This protected people in the event any potential investigation was required in relation to the care they had received at night.
The inspection took place on 24 February 2015 and was unannounced. Pax Hill Nursing Home is a 98 bed nursing home registered to provide care for older people and younger adults. The service is registered to provide care for people who experience physical health or mental health conditions including dementia. Care is provided on three separate floors. Balmoral unit provides residential care; Montgomery unit provides nursing care for people experiencing dementia or mental illness and Windsor unit provides nursing care. At the time of the inspection there were 84 people using the service.
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.
Staff had not followed the provider’s post-falls protocol for monitoring and observing people following a fall. People’s falls care plans were not always updated by staff when they fell. People were not consistently safe following falls as staff had not implemented the guidance provided. Following the inspection the registered manager took action to ensure staff followed guidance.
People who experienced dementia did not receive consistent effective care. At lunchtime processes to order and serve meals did not take into account the specific needs of people who experienced dementia. Staff focused on the task of serving meals rather than interacting with people. Staff training on dementia awareness was insufficient to enable them to effectively support people who experienced dementia to have an enjoyable lunch time service that met their needs effectively.
Records did not accurately demonstrate what care people received at night. This placed people at risk of receiving unsafe or inappropriate care.
Staffing levels were sufficient to meet the needs of the number of people accommodated. On occasions staff worked excessive hours to cover staff sickness. We have made a recommendation in relation to legislative requirements for staff rest periods.
People’s needs were met by staff who had undergone comprehensive pre-employment checks to ensure their suitability for their role.
People had assessments in place in relation to various risks. Where risks to people had been identified plans were in place to reduce the risk of their occurrence. People told us they felt safe. Staff understood what might constitute a safeguarding risk to people and how to report incidents. People were safe from the risk of abuse. People received their medicines safely from staff who had received relevant training and whose competency had been assessed.
Staff received an induction to their role and training. Staff were supported through supervisions and an annual appraisal of their work. People received their care from staff who received appropriate support to carry out their role.
Where people lacked the mental capacity to make specific decisions staff were guided by the principles of the Mental Capacity Act 2005. This ensured any decisions made were in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLs applications had been submitted for people where required. People’s liberty was only restricted where this was legally authorised.
People were happy with the meals they received. People’s nutritional intake was monitored and the cook was informed of any relevant dietary information. People’s nutritional needs were met.
Where staff identified the need for people to see the speech and language therapist, dietician or mental health nurses, they identified this need with the GP. The GP determined if people required referral. People were supported by staff to see healthcare professionals.
People had caring relationships with staff. People were treated with respect and dignity. People had been consulted about their care and preferences about how it was provided.
People had care plans in place that addressed their individual needs. When people’s care needs changed the service recognised this and made changes to their care.
There were systems in place to monitor the quality of the service people received. When issues were identified by the registered manager and provider actions were taken to drive improvements.
People’s complaints were responded to appropriately by the provider.
People told us the service was well led by the registered manager. The registered manager was supportive to staff and accessible to people. Even though there was a whistleblowing policy in place not all staff felt the provider had created a culture of openness within which they felt able to freely express their views to them.
We found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.
We found that staff sought people's consent to their care where they had the capacity to give this. When people lacked the capacity to make specific decisions the correct processes had been followed.
People's needs had been assessed and they had care plans in place to meet their identified needs. Risks to people had been identified and managed effectively.
There were processes in place to ensure that medicines were stored and administered safely within the home.
The provider had effective recruitment processes in place.
There was a complaints process and we found that when complaints had been received they had been investigated and responded to appropriately.