Redwalls Nursing Home

We found the following examples of good practice.

¿ Comments from people included; "The staff are all lovely and caring. They wear masks at all times and wear gloves and aprons as well when helping with my personal care", "I have been supported to have regular contact with my family as they do not live locally and cannot visit" and "I have had regular COVID-19 testing and feel very lucky to have had the vaccine."

¿ Comments from relatives included; "I visit regularly at the moment at a prearranged time for half an hour. The staff wear a mask and so do I", "I couldn't be happier with Redwalls. The manager, nurses and carers are all wonderful. In fact every single member of staff is wonderful" and "The communication is really good and I am always kept up to date."

¿ Relatives told us they had previously participated in garden visits and inside visits with screens in place. They said these were pre booked and well managed.

¿ All visitors were asked to complete a health screening form, have their temperature checked and were provided with face masks to wear throughout their visit. Full personal protective equipment (PPE) was available for all visitors along with access to handwashing facilities and hand sanitiser.

¿ The service had increased the cleaning schedules and routines to reduce the risks of cross infection. The environment was very clean and hygienic.

¿ We observed staff to be wearing the correct personal protective equipment (PPE) throughout the inspection.

¿ People and staff were taking part in regular COVID19 testing.

¿ People had individual risk assessments in place that reflected their specific needs in relation to COVID19.

¿ Staff had all received training to meet the requirements of their role and for the management of COVID19.

Further information is in the detailed findings below.

Redwalls Nursing Home is a residential and nursing care home providing personal and nursing care to 36 people at the time of the inspection. The service can support up to 44 people. Accommodation is provided in one adapted building.

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

We have made two recommendations in this report in relation to gathering people’s views on the service they receive and activities available to people.

Systems in place to monitor the quality of the service had improved and identified areas which could be further developed or needed attention.

The care planning and recording systems in place promoted the care and support people required. People felt safe using the service and received their medicines on time. Safe recruitment practices were in place to help ensure that only suitable people were employed at the service.

People’s needs and wishes were assessed prior to moving into the service. People received care and support from experienced staff who were supported in their role. People were offered a nutritious and balanced diet and their healthcare needs were understood and met.

People were protected from abuse and the risk of abuse and staff understood their role in relation to this. People and their family members told us that the service was safe. Infection control practices were followed to minimise the risk of the spread of infection. Regular safety checks were carried out on the environment and equipment.

Staff knew people well and were knowledgeable about individual's needs and how they were to be met. People and their family members had access to information as to how to raise a concern or complaint about the service. Staff provided care and support that the majority of people were happy with.

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 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 31 July 2018) and there were two breaches of regulation. 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

This was a planned inspection based on the previous rating.

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

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.

We issued a warning notice in relation to Regulation 19 and following the inspection the registered provider gave us evidence to show they had met the necessary standards in relation to this regulation. At this inspection we found that the registered provider was no longer in breach of these Regulations, however; we did Identify breaches of Regulations 12 and 17.

Redwalls Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to 44 people in one adapted building. At the time of the inspection there were 40 people living within the service. The service is situated over two floors, has access to a large garden to the rear and side of the premises and has on-site parking.

At the time of the inspection there was no registered manager in post; however, a new manager had started a few days before the inspection commenced. 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.

Parts of the environment were not always safe. We identified a shower in which the water temperature exceeded safe limits. In addition there was exposed pipework in the shower which also exceeded a safe temperature and posed a risk of scalds. This had not been identified during routine temperature checks that had been completed within the service.

In one room, boxes had been stacked one on top of the other. These boxes were unsteady and would cause injury if they fell on someone. This room remained unlocked which enabled one person to enter. We ensured the person safely left the room before requesting the room was made secure.

Fluid thickener was not stored securely in people’s rooms. This can pose a risk of death if ingested inappropriately. We raised this with management who immediately acted to ensure this was stored safely.

During the inspection we observed people being offered fluids throughout the day; however, records showed that people were not being offered the amount of fluids stated in their care records. We raised this with the registered provider for them to investigate.

Whilst quality monitoring systems were in place within the service, these had not always identified or addressed those issues found during the inspection. For example, whilst the registered provider had identified occasions where some doors had been left unlocked, this continued to be an issue at the inspection which showed that effective measures had not been implemented to prevent this issue from reoccurring.

You can see what action we told the provider to take in relation to these issues at the back of the full version of the report.

Records showed that not all staff training was up-to-date. The registered provider showed us that plans were in place to ensure that this training would be brought up-to-date. Following the inspection the registered provider informed us that training sessions were underway.

People were protected from the risk of abuse. Records showed examples where staff had appropriately reported concerns and these had been passed to the local authority. Staff knew how to report concerns and told us they wouldn’t hesitate to do so.

People received their medication as prescribed. Medication was being stored as required by law, and a review of the quantities being kept showed the correct amount was in stock. This showed that measures were in place to protect these substances from being misused.

People were supported to have maximum 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.

Deprivation of Liberty Safeguards (DoLS) were in place for those people who required them. This meant that where restrictions had been placed on people, this had been done in accordance with the law.

People told us that they enjoyed the food that was on offer. Kitchen records showed which people required special diets which meant that this information would be available in the event that regular staff were not on shift.

Staff were kind and caring in their approach to people. They spoke kindly and it was evident from interactions that positive relationships had been developed.

Care records were in place which contained personalised information about people’s likes, dislikes and preferred daily routines. This helped staff get to know the people they were supporting and facilitated the development of positive relationships.

There was information in people’s care records in relation to their end of life wishes. This helped ensure that people’s final wishes could be respected.

Activities were in place to help keep people entertained and prevent social isolation. We observed people joining in a quiz and spending time in the garden.

There was a complaints process in place which people had made use of. A response had been given to each complaint in a timely manner and action taken to address any issues.

We had previously carried out an unannounced comprehensive inspection of this service on 14 October 2015 and found there to be breaches in legal requirements. The purpose of this inspection was to check if the registered provider now met legal requirements and to ensure that people who receive the service are provided with safe and effective care

Redwalls Nursing Home is registered to provide personal and nursing care for up to 44 older people. The home has 41 single and two double rooms the majority of which have en-suite facilities. At the time of our inspection the home had full occupancy. Four rooms were utilised by the clinical commissioning group to provide rehabilitation to minimise a person’s length of stay in hospital or to avoid it in the first place.

The service had registered manager. 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.

Following the inspection on October 2015, the registered provider submitted an action plan telling us they would be compliant with the legal requirements by the end of July 2016. On this inspection, we found that the registered provider had made some improvement and had met some of the previous breaches in legal requirements. However, we identified two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Recruitment processes were still not robust. Staff had commenced their employment without appropriate checks from the Disclosure and Barring Service and without appropriate or verified references. This meant that adequate measures were not in place to ensure that people were only supported by people of suitable character and skill.

There were some positive interactions between staff and people and staff were observed to treat people with respect. However, we identified some areas of practice where people’s dignity or safety were at risk of being undermined due to a lack of attention to privacy, comfort or social inclusion.

People told us that they felt safe and were well cared for by staff. They said they had a good relationship with the staff that provided their support; and this had improved now that there more continuity in the staff team. On the day of the inspection, there was not a full complement of staff available due to staff sickness but people’s needs were met and call bells were responded to in a timely manner.

Accidents and incidents were recorded but there was no detailed analysis of overall themes and trends. This process had recently been put in place by the registered provider but had not yet been utilised.

Staff kept daily records such as the support offered/delivered or food and fluids consumed. These were not always up to date to reflect accurately what had occurred. This meant that there was a risk that concerns may not be picked up and acted upon.

Care plans were updated where there had been a change of need and information around the risk of harm was clearly available to staff. Care plans were personal to the person and contained information about their needs and wishes. This meant that staff had information available to them to respond appropriately to a person’s needs.

People were offered choices in relation to their care and support. Staff understood the principles of the Mental Capacity Act 2005, and said that they would be able to make a judgement around a person’s mental capacity in regards to care and support. The staff had a basic knowledge of the Deprivation of Liberty Safeguards and where an application may be required. Care Plans and assessments reflected this. Staff had been supported to undertake training in these areas. This meant that people could be more assured that their human rights would not be infringed and support would be provided with the consent of the relevant person.

People needed medicines to keep them well. The registered provider had processes in place to ensure that medicines were ordered, stored and administered safety. There were measures in place to ensure that a consistent approach was taken with people who had “as required medicines.”

People’s health and safety was better protected because improvements had been made to the environment to ensure it was well maintained, secure, and clean and the risks of infection minimised.

Staff said that they worked in a supportive environment and that they had a good relationship with management. Staff now received supervision, appraisal, training and developmental opportunity. They told us they felt far more happy, confident and competent in their roles.

People who used the service and their relatives felt that they could go to the registered manager with any concerns, and felt confident that these would be addressed to their satisfaction.

The registered provider has statutory obligation to inform the CQC about a range of occurrences that may affect the health, safety and welfare of people who use the service. This is so that CQC can take follow-up action to safeguard the interests of people if required. The registered provider reported such events. CQC was, therefore, able to better monitor the events that affect the health, safety and welfare of people who used the service.

The registered provider had implemented a number of quality audit systems in order to monitor the safety and effectiveness of the support and the service. Whilst this was in place, it needed to be more robust in order to highlight some of the issues identified as part of this inspection.

We spoke with six people who used the service and four relatives. They all told us they had no concerns with the care and treatment that was provided. Comments included: "My relative is kept warm, clean and well fed. Their needs are always met" and "I'm satisfied and I couldn't be happier."

We sat with people who used the service during the lunchtime period in one of the dining rooms. We saw that staff were present as people had lunch and assisted people to eat where required. We saw that people who used the service and staff interacted positively throughout this period.

From examination of records and discussions with staff, people who used the service and their relatives we found there were enough qualified, skilled and experienced staff to meet people's needs.

We found that records were kept securely and could be located promptly when needed. This included staff personnel files and clinical records for people who used the service. The service also had data protection policies and procedures in place. We saw they were in line with the Data Protection Act 1998.

'It's a lovely place. The staff look after me well.'

'I'm well looked after. The staff are nice people. I like the food.'

'I have been here for five years and I am very happy. The staff are very nice and helpful.'

We spoke to one relative who told us that they were happy with the care provided. They said they were kept informed about their relatives' well-being. They described the staff as professional, caring and attentive.

There were practices in place to ensure that people who used the service were consulted and that their views were obtained.

People had been assessed before they began to use the service and they had a care plan in place which gave guidance to staff on the support they needed.

We found that the home was clean with and there were systems in place to promote infection control.

There were suitable recruitment checks in place for staff at the time of our visit.

There was a system in place to ensure that complaints were effectively managed.

No information of concern was reported by Cheshire West and Chester Council.

Cheshire West and Chester Local Involvement Network visited the service in October 2012. They said that the home was warm and friendly and that people looked well cared for. They made some recommendations for the improvement of the home environment.