The Poplars Nursing Home

The Poplars Nursing Home is a care home providing personal care to up to 58 people. The service provides support to older and younger people. At the time of our inspection there were 47 people using the service.

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

Care records required improvements to ensure all information and guidelines are accessible to staff when delivering care and support to people. The provider was not consistently working in line with the principles of the Mental Capacity Act which put people at risk of being deprived of their liberty without lawful authority. The home’s physical environment required some improvements. The provider had already identified this, and the home was undergoing refurbishments. Some people’s bedrooms required work to improve the appearance and provide a homely environment.

Staff knew how to recognise signs of abuse and how to report concerns. There were systems in place to record and investigate incidents and accidents. This included lessons learnt to mitigate incidents reoccurring. Staff were recruited safely.

Medications were managed and administered safely. Staff had received medication training and their competency to support people with their medicines had been checked.

People’s needs were regularly assessed to ensure they were receiving the right care and support. People were supported people to eat and drink safely and in line with their dietary requirements. Staff worked with external professionals to ensure a joined-up approach to people’s care.

People were supported by staff who treated them with kindness and respect. Staff ensured they upheld people’s dignity. People were encouraged to express their views and be involved in decisions around their care. People were offered choices and supported to maintain their independence.

People’s care records were person centred and captured people’s protected characteristics. Staff knew people well, and knew their routines, likes and dislikes. Staff communicated effectively with people to meet their communication needs. People were supported to maintain relationships with their loved ones and take part in activities which were socially and culturally relevant to them. Staff received training in end of life care and knew how to support people.

The manager had taken steps to improve the quality of care in the service since the last inspection. The manager engaged with people using the service, through feedback forms and meetings. Staff took pride in their roles. The manager understood their responsibility towards duty of candour.

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 information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

At our last inspection we found breaches of the regulations in relation to safe care and treatment, notifications of other incidents, dignity and respect and good governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider was no longer in breach of these regulations. However, we identified a breach of regulation in relation to safeguarding people from abuse and improper treatment.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last 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 have found a breach in relation to safeguarding people from abuse and improper treatment at this inspection.

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

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.

The Poplars Nursing Home is a care home providing personal and nursing care to 58 older and younger people. The service had a self- contained unit with 15 beds to care for people who had tested positive for COVID-19 in hospital and needed to be discharged.

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

At our last inspection we found people’s privacy and dignity was not always maintained. This continued to be a concern at this inspection. The provider's governance and auditing systems had failed to ensure people were consistently treated with dignity and respect. Although they had taken some action since the last inspection this had not been effective.

Audits were carried out by the manager and the provider had commissioned an external consultant, but they had failed to ensure that people always received safe care. Risks for one person had not been mitigated.

Where people received medicines ‘as and when required’ the appropriate process was not always followed. There were mixed views from people and staff as to whether there were enough staff. Staff knew how to recognise and report concerns about people’s safety and people told us they felt safe.

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 support this practice. Decision specific mental capacity assessments were not in place where people had restrictions such as sensor equipment to monitor their movements.

There had been some consideration to the environment to support people with dementia, but this required further improvement. People had oral care plans in place, but support in this area wasn’t always evidenced. We have made a recommendation the provider refers to best practice guidance to make improvements to the environment for people living with dementia and to improve oral care. People with specific dietary needs were supported.

People told us they would like more activities. People felt able to raise concerns although a review of the action taken wasn’t always completed. End of life care plans were in place which included peoples individual wishes, although we received mixed feedback from relatives about whether they were involved in these plans.

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 12 June 2020) and there was a breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about people absconding from 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 coronavirus and other infection outbreaks effectively.

Whilst we found evidence the provider had addressed the concerns in relation to people absconding, we found evidence that the provider needs to make improvements. Please see all the key questions of this full report. You can see what action we have asked the provider to take at the end 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 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 dignity and respect, safe care and treatment 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Poplars Nursing Home is a care home providing accommodation for persons who require nursing or personal care. The service supports people aged 65 and over, some of whom may live with physical disabilities or dementia.

The Poplars Nursing Home can accommodate 58 people in one adapted building. At the time of inspection, 42 people were receiving support.

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

People’s records were not always stored securely. People’s privacy and dignity was not always maintained. People did not always feel listened too. People’s care plans identified religious beliefs and culture needs.

Events had not been notified to CQC in line with legal requirements. People did not always feel care was person centred. The registered manager had implemented an incident and accident analysis system. People’s health needs were recorded appropriately. Staff communicated with health professionals.

Care plans and risk assessments lacked detail but were being reviewed. External health & safety and infection control audits had been undertaken, significant improvements had been made in both areas. There were mixed views as to whether there were enough staff. Staff understood how to report concerns about people’s safety.

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. Not all staff training was up to date, the registered manager had prioritised mandatory training and was working through this. People were supported with their dietary needs.

People did not always feel there were enough activities. People felt able to make day to day decisions. Staff used various communication methods to support people. People knew how to complain, and formal complaints were dealt with appropriately.

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 (10 November 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about health & safety, data protection, poor accident analysis, a lack of recording of people’s health needs and lacking information in care plan and risk assessments. A decision was made for us to inspect and examine those risks.

We have found evidence the provider has acted to mitigate risk to people. However, the provider still needs to make improvements. Please see the safe, caring and well-led sections of this full 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 The Poplars Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to failure to notify and privacy and dignity 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 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.

We inspected the service as we were made aware a person’s advance wishes in respect of resuscitation had not been followed. The provider had taken steps to ensure this avoidable and concerning event did not reoccur for other people and had notified the appropriate external agencies.

The Poplars is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Poplars is registered to provide care, nursing and accommodation to a maximum of 58 older people, some with a physical disability. At the time of the inspection, there were 51 people living at the home.

There was no registered manager in post, an acting manager had been in the role since January 2018, but had yet to register with CQC. The acting manager was not available on the day of 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. The provider was taking measures to ensure that a registered manager was appointed.

This is the first time that the service has been rated Requires Improvement.

Administration and recording of medicines given was done safely. Medicines were not always stored adequately or safely. Staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed. Staff were available to people, but there were concerns over numbers of staff. Staff were not always recruited safely. Accidents and incidents were responded to appropriately, but recordings did not always reflect this. The environment was not always safe for people.

Staff had the skills and knowledge required to support people effectively. Staff had an understanding of the Mental Capacity Act and how best to support people in line with its principals. People felt the meals were adequate and staff were supportive when people required assistance to eat. Staff gained people’s consent before assisting or supporting them. Staff received an induction prior to them working for the service and could access ongoing training to assist them in their role. Staff could access supervision and felt able to ask for assistance from management should they need it. Staff supported people’s healthcare needs.

Staff were caring towards people. People were encouraged to retain an appropriate level of independence and choices were given to people where it was appropriate. Privacy and dignity were maintained on most occasions.

Care plans were in place and updated monthly, but were not reviewed annually with the person’s input. People’s preferences for how they wished to receive support were known and considered by the care staff. There was some level of activities, but this was not consistent. People knew how to raise complaints, but the recording of them was not clear. End of life care was considered.

There had been a lack of registered manager for some months and not everyone knew who the acting manager was. There had been a lack of opportunity for people and relatives to share their opinions on the service. Quality assurance audits were carried out, but these did not identify concerns in all areas and did not always give enough information. We received notifications as required.

The Poplars Nursing Home is a home for people who receive accommodation and nursing care. A maximum of 58 people can live at the home. There were 47 people living at home on the day of the inspection. At the last inspection, the service was rated Good and at this inspection we found the service remained Good.

People living in the home, their friends and relatives told us that staff support and guidance made the home safe. People told us that staff assistance maintained their safety and staff understood how they were able to minimise the risk to people’s safety. We saw staff help people and support them by offering guidance or care that reduced their risks. Nursing and care staff understood their responsibilities in reporting any suspected risk of abuse to the management team who would take action. Staff were available for people and had their care needs met in a timely way. People told us their medicines were manged and administered for the by the nursing staff.

Staff knew the care and support needs of people and people told us staff were knowledgeable about their care and support needs. Staff told us their training courses and guidance from senior care and nursing staff and managers maintained their skill and knowledge. People were supported to have 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 had a choice of where that ate their meals, and while there was two menu options there was mixed feedback from people and their relatives about this not always being offered. People had been asked the previous day, and on occasion we heard an alternative offered to people on the day of the inspection. The provider was given this feedback to look at how best to consistently support meal choice. Where people needed support to eat and drink enough to keep them healthy, staff provided assistance. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People were seen talking with staff and spent time relaxing with them. Relatives we spoke with told us staff were kind and friendly. Staff told us they took time to get to know people and their families. Family member were updated about their family member’s well being from staff. People’s privacy and dignity was supported by staff when they needed personal care or assistance. People’s daily preferences were known by staff and those choices and decisions were respected. Staff promoted a people’s independence and encouraged people to be involved in their care and support.

People’s care needs had been planned, with their relatives involvement where agreed. Care plans included care and support needs and were reviewed and updated regularly. People told us activities offered in the home. People also told us they enjoyed reading or socialising with others in the home.

People and relatives were aware of who they would make a complaint to if needed, but not all had seen the providers complaint policy. People told us they would talk though things with staff or if they were not happy with their care.

The manager provided leadership for the staff team and people had the opportunity to state their views and opinions with surveys. The provider had a range of audits in place to monitor the quality and safety of people’s care and support. Action plans were developed to maintain the home and care of people. The provider’s planned improvements were followed up to ensure they were implemented.

The Poplars is registered to accommodate and deliver nursing and personal care to a maximum of 47 people. People who live there may have needs associated with old age or physical disability. At the time of our inspection 30 people were living there.

The manager was registered with us as is required by law. 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.

We found that overall medicines were administered, stored and disposed of safely. There were systems in place to protect people from abuse and harm. Staff had a clear knowledge of how to protect people and understood their responsibilities for reporting any incidents, accidents or issues of concern. People felt there were a suitable number of staff on duty with the skills, experience and training in order to meet their needs. People using the service, their relatives and staff were satisfied that there were enough staff available within the service.

Staff supporting people had access to a range of training to provide them with a level of skills and knowledge to deliver care safely and efficiently. Staff were able to give an account of what a Deprivation of Liberties Safeguard (DoLS) meant for people subject to them and described how they complied with the terms of the authorisation when supporting that person. Mealtimes were structured in a way that encouraged people to identify it as a social event and an opportunity to interact with others. People felt they had good access to health care support when required and that staff responded to health care issues in a timely manner

People were happy living at the home and felt that staff treated them with dignity and respect. Staff interacted with people in a positive manner and used encouraging language whilst helping them to maintain their independence as far as was practicable. People told us they were provided with the information about the service and their care and treatment that they needed. People were supported to observe their cultural preferences and spiritual beliefs.

People were supported to make decisions about their lives and discuss things that were important to them. Staff were responsive to people when they needed assistance. People’s life history, likes, dislikes and preferences were known and staff were knowledgeable about how to meet their needs in line with these. Information was on display about how to make a complaint. The provider demonstrated to us how they had effectively acknowledged, investigated and responded to complaints that they had received.

People and staff spoke confidently about the leadership skills of the registered manager. People were involved in meetings and were able to influence how the service was run. People were confident that the registered manager would respond positively to their requests and staff were happy working at the home. The registered manager undertook regular checks on the quality and safety of the service.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?'

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with three people using the service and two of their relatives, four care staff supporting them and looking at six care records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service and their relatives told us that they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported.

The home had appropriate policies and procedures to protect people's rights and choices and gain their consent to the care and support they received. The home's policies reflected the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had received training in how to protect people's rights and understood legal requirements.

Staff knew about risk management plans and we saw that they supported people in line with those plans.

The registered manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way. The staff had the training and support required to ensure that people's needs were met.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

Is the service effective?

People's health and care needs were assessed with them and where people wanted family members were involved. People told us they were involved in the care planning and reviews of care. We saw that care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the care staff.

Care staff received the appropriate training to meet the diverse needs of people who used the service.

Visitors confirmed that they could visit when they wanted to and spend time alone in privacy if they wished.

Is the service caring?

People were supported by staff that were kind and caring. We saw that care staff gave people encouragement and were patient with them. One relative told us, 'I visit my relative regularly and the staff are very caring'.

People's preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to engage in a range of different activities each day.

People were aware of the home's complaints procedure and knew how to raise concerns. One relative told us, 'They are responsive to my relative's changing needs'.

Where care staff had noticed people's changing needs, their care plans had been updated to reflect this.

Is the service well led?

The service had quality assurance and risk management systems in place. Records seen by us indicated that shortfalls in the service were addressed promptly.

The staff were well supported to ensure they had the skills and knowledge to carry out the care people needed. Care staff were given feedback about their performance so improvements could be made where needed.

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Staff told us the home was well organised and they felt supported by their manager.

We saw good interactions between people who lived there and staff. We observed that people were at ease in the company of staff. One person told us, 'The staff treat me well here.'

We saw that people's needs had been assessed by a range of health professionals and people's healthcare needs had been monitored and met. A relative told us, 'My relative is well cared for here.'

People were encouraged to eat a healthy and nutritious diet. People told us that they had a choice of what to eat and liked the food provided.

Systems were in place to ensure that people were safeguarded from harm and the risk of abuse.

Staff had the skills and knowledge to know how to safely support people who lived there to meet their needs. Staff told us that they were well supported in their role and this helped them to know how to support people who lived there.

People were asked for their views about the home and these were listened to. We saw that audits were completed and action was taken to make improvements where needed.