Archived: Resthaven Nursing Home

There was 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.

Since the last inspection a new registered manager was appointed in October 2015. The previous manager had worked at the home for a 15 year period. The trustees engaged a consultant to review how the service was performing along with the new registered manager and a robust action plan had been put in place to address those areas where improvements were needed. Throughout the report we have identified those areas where the registered manager had already instigated changes and the plans for the immediate future.

Improvements were required ‘as soon as possible’ with care planning documentation and other care records related to how the staff monitored people’s food and fluid intake and summaries of the full care plan. Completion of the charts was not being monitored by the qualified nurses at the end of their shifts and had not been picked up by the head of care nurse. Care planning documents did not provide a clear picture of people’s needs and were not person centred. The service had already taken some steps to make improvements and planned to revert to a paper based care planning process. Despite this, people’s care and support needs were being met.

All staff received safeguarding adults training as part of the mandatory training programme. They knew what to do if bad practice was witnessed, alleged or suspected and would take the appropriate actions. The registered manager was aware of the need to report events promptly to the local authority and CQC. There were safe recruitment procedures in place to ensure unsuitable staff were not employed. The appropriate steps were in place to protect people from being harmed.

Risk assessments were completed for each person as part of the care planning process and where risks were identified appropriate management plans were in place. The premises were well maintained and all maintenance checks were completed to ensure the home and equipment was safe.

The registered manager regularly checked that the staffing levels were reviewed and the care and support needs of each person could be met because there was sufficient staff. Staffing numbers had been increased following feedback from people and their families. People were not put at risk because staffing levels were not low.

New staff completed an induction training programme and there was a programme of mandatory refresher training for the rest of the staff team. The registered manager had implemented a programme of face to face training on a monthly basis. Care staff were generally only employed if they achieved a nationally recognised qualification in health and social care.

People were supported to make their own choices and decisions. Staff were aware of the need to ensure people consented to their care and support. The registered manager was aware when people lacked the capacity to make decisions, best interest decisions were made involving healthcare professionals. Staff were aware of the Deprivation of Liberty Safeguards and able to act accordingly when there was a need.

People were provided with sufficient food and drink. Their specific dietary requirements were catered for. A GP visited the service regularly on a planned basis and at other times whenever necessary. Arrangements were made for people to see other healthcare professionals as and when they needed to do so.

People were able to participate in a range of different activities and external entertainers visited the home. There were plans to increase the number of activity organisers and to involve the care staff in meeting people’s social needs.

There was a staffing structure in place. Regular staff meetings were held in order to keep them up to date with any changes and developments in the service. There were also ‘resident and relative’ meetings and people were encouraged to express their views about things they wanted to happen. This feedback was listened to and acted upon.

There was a programme of audits and checks in place in order to ensure the quality and safety of the service was maintained. Some of the checks were completed on a daily basis, others on a weekly or monthly basis. The information collected from these audits was used to drive improvements. The trustees had an active role in monitoring the service, visited regularly and spoke to people and the staff team.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People were cared for in a clean, hygienic environment. We found high standards of cleaning. Bedrooms were checked and were found to be clean and tidy. We observed staff cleaning people's rooms thoroughly. All communal toilets were found clean and odourless and had anti-bacterial soap and paper towels in place to wash and dry your hands with.

We looked around the home and saw evidence that people's bedrooms had been maintained and decorated to a suitable standard. People had personalised their bedrooms with photos of family and friends. We noted that people living in the home had photographs and pictures with their name displayed on bedroom doors.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We looked at other records to ensure that people's safety was being maintained. These included compliments/complaints, falls audits, fire safety audit and water testing. These records were detailed, up to date and in order.

Each person we met and spoke with told us they felt safe living at the home. We observed and heard staff talk to people in a manner that showed empathy and respect. People told us that staff treated them very well and were always polite.

Staff we spoke with told us they had completed a comprehensive induction training programme. We were told that all new staff completed a number of shifts working with an experienced carer.

Records were kept securely and could be located promptly when needed. There was a designated area in the office that was used to store care files of people who lived at the home and staff.

People told us the manager completed a comprehensive assessment of their needs to find out what support they needed before they moved into the home. Comments included 'I was recommended the home and when my family enquired the home had a vacancy'.