Evergreen Manor Care Home

Platinum Nursing Care is a residential care home providing personal and nursing care to up to 32 people aged 65 and over. At the time of our inspection, the care home accommodated 32 people across three wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia. People with nursing needs were supported on other units.

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

Risks to people's health and safety were assessed and well managed. Safeguarding concerns were reported and referred to the local authority and notified to us, The Care Quality Commission (CQC) as required. Medicines were managed safely, and we were assured by the infection control measures within the home. There were enough staff and staff were recruited safely. Lessons were learnt and changes made to improve the care provided and systems within the home.

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 provided regular monitoring and audits of the quality and safety of care provided. When issues or areas for improvement were identified, actions were taken to address them. Staff, people, relatives and professionals spoke positively about the home and the staff. Staff felt well supported, valued and included. Relatives were kept informed and told us the home was well managed and organised. Important events and incidents were notified to us as required. People, relatives, visitors and staff were encouraged to give feedback and make suggestions for improvements. Staff were supported to undergo further training and development, and some were supported to undertake their nurse training. The provider worked closely with external health professionals to improve people's outcomes.

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 19 August 2022). 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.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 and 13 July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 .

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 changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

Platinum Nursing Care Limited is a residential care home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The care home accommodates 32 people across three wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia. People with nursing needs were supported on other units. Not everyone in the home was receiving nursing care.

People’s experience of the service and what we found

Some improvements were made since our last inspection to mitigate risks to people’s health and well-being. However, further improvements were still required to ensure risks were consistently managed. Auditing and quality assurance checks were carried out by the deputy manager. However, further time was needed for these systems to embed and ensure effective oversight and monitoring of risks. The registered manager recognised that the inspection identified areas of governance that could be further improved, to ensure identified risks to people are communicated back to the management team in a timely way and measures to mitigate those risks implemented.

On the day of our inspection there were enough staff on duty to meet people’s needs and there was improved oversight of communal areas to maintain people’s safety. Staff were recruited safely. Staff knew how to protect people from abuse and when concerns should be raised with the manager and the provider. Improvements were made to the storage and administration of medicines. We were assured by infection, prevention and control processes. There were improvements to the recording and monitoring of accidents and incidents. Staff understood their responsibility to record accidents and incidents and there was a system to monitor these for trends or patterns.

Assessments were carried out to identify people's needs, choices and wishes regarding their care. Mandatory training in The Care Certificate was provided and staff were encouraged to undertake qualifications in health and social care. Improvement has been made to make lunch time a positive experience that encouraged people to socialise and eat more. Staff had a good understanding of the Mental Capacity Act and the importance of respecting people’s right to make their own choices and decisions. Records showed that referrals were made to external health professionals including the G.P, Speech and Language Therapist and Dieticians to ensure people had access to the support they needed. Improvements had been made to encourage people to use and enjoy the communal areas in the home.

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.

Some positive and caring interactions took place between people and staff. Assessments showed that people's views and wishes had been gathered regarding decisions about their care. Staff protected people’s privacy and dignity and recognised people’s desire to retain their independence as much as possible.

The service had 'getting to know you' information about people in care plans which contained information about their past lives, hobbies and interests. This encouraged meaningful conversation between staff and people. Visual communication aids were available for staff to promote people’s understanding if they struggled with the spoken work. There was a range of activities and entertainments to provide people with opportunities for social engagement. There was a system to record and respond to complaints. Staff received online training in end of life care. The deputy manager was in the process of arranging more specialised, face to face training to improve staff confidence and emotional resilience.

There was a positive approach to the whole team sharing expectations and identifying when practice may have fell short of expectations during staff meetings. The registered manager understood their responsibility to notify us about important events that affected people living at Platinum Nursing Care. The provider worked with other health professionals in response to changes in people's needs.

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 8 July 2021). This service has been rated requires improvement for the last two consecutive 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 we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out 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.

The provider took immediate action during and after the inspection to mitigate risks to people.

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

Enforcement and recommendations

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 Good Governance at this inspection. Please see the action we have told the provider to take at the end 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.

Platinum Nursing Care Limited is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The care home accommodates 32 people across three wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia. People with nursing needs were supported on other units. Not everyone in the home was receiving nursing care.

People’s experience of this service and what we found

A lack of governance systems and clinical oversight meant that issues identified during our inspection were not picked up by the provider. There was no system to regularly analyse falls or other incidents in the home to mitigate the risk of them happening again. We identified a number of falls which had occurred at the home which had not been identified by the provider. We also identified where people had wounds and/or pressure injuries which the provider was not aware of. Quality assurance systems of care records had failed to identify gaps in records found during our inspection.

Staff gave positive feedback about the registered manager and provider and said they felt well supported. However, there was no formal system in place to regularly gather feedback from people, their relatives, staff or professionals and some relatives told us that communication between them and the service was poor.

Risks to people’s safety were assessed but not consistently reviewed following changes in their health or falls. We found records did not routinely include recommended information to help staff mitigate risks to people such as daily monitoring of catheters, or how to spot complications related to specialist feeding tubes. Records relating to the management of people’s skin did not always evidence repositioning was being done in accordance with people's care plans. Although there were enough staff on the day to provide care safely, we received mixed feedback about staffing levels.

People did not always receive enough encouragement and prompting to eat and drink, and a lack of social interaction at mealtimes meant many people ate alone in their bedrooms. Staff were provided with training the provider considered mandatory and staff spoken with could tell us how they monitored people’s health for any changes and would report those changes to senior staff or management. However, training records showed that a number of staff required their training to be refreshed and some had not completed training considered mandatory by the provider.

We observed some caring interactions between staff and people, and people spoke positively about care staff. Communication from staff was warm and friendly and people were supported in a dignified way.

Staff told us they enjoyed speaking with people about their past lives, families and interests and used the information contained in people’s care plans to support these conversations. However, there was little opportunity to engage people in meaningful activity to encourage stimulation and prevent boredom. The dementia wing lacked objects of interest or décor that could provide a more stimulating environment to prevent boredom and restlessness. The provider had recognised improvements were required to offer people more stimulus and social interaction and had employed an activities co-ordinator.

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. People’s views regarding their care and treatment were identified and included in assessments.

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

Rating at the last inspection

This service was registered with us on 16 January 2020 and this is the first time the home had been inspected.

Why we inspected

This was a planned inspection because the service was unrated. 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 improvements. Please see the Safe 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.

Enforcement

We have identified breaches in relation to regulation 12 (Safe Care and Treatment) and regulation 17 (Good 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.