Retired Nurses National Home

Retired Nurses National Home is a residential care home providing personal care and support for up to 52 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 32 people using the service.

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

People were not always protected from harm and abuse as safeguarding concerns had not been identified by staff and referrals were not always made to the local authority. Staff had received safeguarding training but had not always reported concerns. Some records completed by staff, did not demonstrate dignity and respect were given to people living at the home. Risks people faced were not always assessed robustly enough to support their safety. Risks regarding people’s health conditions were not always mitigated, especially where they could develop into a medical emergency.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The service had not notified the CQC of all incidents that took place within the service as legally required. The provider wrote to us following the last comprehensive inspection to tell us how they would ensure they would meet the regulations. We found that some of these actions and improvements had not been sustained.

Management oversight within the home and at provider level was not robust. This was because their systems had not identified the shortfalls found within the inspection. During and after the inspection the provider had been responsive to address the issues identified and took action to make improvements.

People and their relatives told us they were happy with the care they received from the Retired Nurses National Home. Recruitment processes were in place to ensure staff had the right skills to work with people and various checks were carried out. People were protected from avoidable infections as safe procedures were in place which promoted a safe, hygienic environment. People were able to move safely around the home including to outside spaces.

People had access to healthcare and the home worked well with health and social care professionals. Staff had training for them to carry out their role. People received their medicines as prescribed. People had enough to eat and drink. The home sought feedback on the care it provided, people were consulted through meetings. Staff received training to support them in their role.

Staff felt appreciated and were complimentary about their colleagues. We received positive feedback about the management of the home.

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 requires improvement (published 26 January 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last two rated consecutive inspections.

Why we inspected

We received concerns in relation to safeguarding people from harm and abuse, safety of medicines and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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 remained as requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safeguarding people from harm and abuse, consent, safe care and treatment and the management of the home.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Retired Nurses National Home is a residential care home registered to provide care and support to up to 52 people. The purpose built home provided care over two floors with stairs and a lift as access. There were 34 people living at the home at the time of inspection.

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

Improvements had been made in the home since our last inspection. 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.

Assessments carried out under the Mental Capacity Act 2005 (MCA) were person centred and were related to individual decisions. Decisions made in people’s best interests had involved their family members and those close to them. People told us they were happy living at Retired Nurses National Home.

Infection control procedures were robust. Staff had received training and there were enough supplies of personal protective equipment (PPE). Staff were wearing correct PPE in line with government guidance.

Quality assurance systems operated effectively, and this meant the registered manager able to monitor the quality and safety of the service. Audits were used to drive continual improvements within the home. The registered manager was supported by the provider.

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 26 January 2022).Following the inspection, we told the provider when they must be compliant and meet the regulations. At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 11 and Regulation 17.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

The Retired Nurses National Home is a residential care home registered to provide care and support to up to 52 people. The purpose built home provided care over two floors with stairs and a lift as access. There were 32 people living at the home at the time of inspection.

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

Improvements had been made in the home since our last inspection. People had risk assessments in place for all their care and support needs. The provider and registered manager had introduced a system to ensure these were kept up to date.

People told us they were happy and safe living at the home and were supported to live well by staff who had the necessary information to keep people safe. Assessments were completed and included risk of falls, malnutrition and specific risks from individual health conditions.

Infection control procedures were in place and continued to help keep people safe. There were enough stocks of personal protective equipment (PPE) and staff were wearing it in line with the current government guidance.

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 26 January 2022). At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 12.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

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

The Retired Nurses National Home is a residential care home registered to provide care and support to up to 52 people. The purpose built home provided care over two floors with stairs and a lift as access. There were 33 people living at the home at the time of inspection.

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

Improvements were needed to the governance systems within the home. The systems for monitoring and checking the home operates in a safe way were not effective. People did not have their risks identified and plans put in place to mitigate them.

People were not always supported to have maximum choice and control of their lives and the service did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Capacity assessments were not completed in accordance with the Mental Capacity Act 2005 and people were not always lawfully restricted. Staff did not always feel supported or appreciated. People had access to enough food and drink, but feedback was mixed about the quality and variety. Accidents and incidents were recorded, and relevant referrals made. The home did not formally learn lessons from events in the home.

There were enough staff on duty, and staff were recruited safely. Medicines were managed safely, and maintenance checks were carried out including fire safety. Staff were well trained, and people had access to healthcare when needed.

People and their relatives told us staff were kind and caring. Staff encouraged independence and acknowledged differences in people. Staff were respectful and courteous appreciating individuality. People had personalised care plans in place and access to a wide range of activities.

People and their relatives knew how to make a complaint and records showed the homes policy was followed by the registered manager. People had confidence the registered manager would deal with any concerns appropriately.

Staff felt proud to work for The Retired Nurses National Home and we received positive feedback about the management of the home.

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

Rating at last inspection

This service was registered with us on 28/05/2019 and this is the first inspection.

Why we inspected

This was a planned 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 COVID-19 and other infection outbreaks effectively.

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 the assessment and management of risks to people, consent, safeguarding and the management of the home 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.