16 March 2015
During a routine inspection
We conducted an unannounced inspection of Princess Louise Nursing Home on 16 March 2015. The service provides care and nursing services for up to 51 adults with continuing health care needs, including adults with dementia. There were 39 people using the service when we visited.
At our last inspection on 28 November 2013 the service met the regulations we inspected.
The service had a registered manager in post. 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 service had a procedure for safeguarding adults from abuse and staff understood how to safeguard the people they supported. The manager and staff had received training on safeguarding adults within the last year and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.
Risk assessments did not consistently provide enough guidance on people’s individual needs. We found some risk assessments did not contain up to date, accurate information.
Staff received advanced life support training and were able to explain how they would respond to a medical emergency which included accurate recording and reporting of matters.
There were enough, safely recruited staff available to meet people’s needs. Staffing numbers were adjusted depending on people’s requirements.
Medicines were managed safely. Records were kept when medicines were administered, and appropriate checks were undertaken by staff and external pharmacist and pharmacy technician. Records were clear and accurate and regular auditing of medicines was undertaken.
Staff were trained in the Mental Capacity Act 2005 which is a law to protect people who do not have the capacity to make decisions for themselves. Staff demonstrated a good understanding of their responsibilities and applied the principles of the Act to protect individuals who did not have the capacity to consent to their care and treatment. However, people's records did not always clearly document how decisions had been made in their best interests.
We did not see evidence that people and their relatives were consistently involved in decisions about their care and how their needs were met. Some care plans did not include information from people’s perspectives about the type of care they wanted and some were not signed by people.
There was an induction programme for new staff, which prepared them for their role. Staff were provided with a range of ongoing training to help them carry out their duties. Staff received regular supervision and appraisal to support them to meet people’s needs.
People were supported to eat and drink a balanced diet that they enjoyed and their nutritional needs were monitored. People were supported effectively with their health needs and had access to a range of healthcare professionals.
People told us staff treated them in a caring and respectful way. People’s privacy and dignity was respected, but we observed mixed interactions between people and staff throughout our visit. Some staff members did not interact with people when providing them with care.
Staff and people who used the service felt able to speak with the registered manager. They knew how to make complaints and there was an effective complaints policy and procedure in place. We found complaints were dealt with appropriately and in accordance with the policy.
The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified action plans were put in place to rectify these. Records audits were completed, however, these had not addressed the issues found during our inspection.
Staff worked with other organisations and healthcare professionals to implement best practice. This included their GP, physiotherapists, dietitians and occupational therapists.