We undertook an unannounced inspection on 29 September 2016. At our previous inspection on 13 May 2014 the provider was meeting the regulations inspected. Chegworth Nursing Home provides accommodation and nursing care for up to 43 older people. At the time of our inspection 42 people were using the service, some of whom were living with dementia. The home specialises in supporting people requiring end of life care and wound management.
A registered manager was 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.
There were sufficient staff at the service to meet people’s needs. Staff were allocated to support individuals and this enabled them to build caring trusting relationships with people. Staff had the knowledge and skills to meet people’s needs and these were updated through the completion of regular training courses and discussion during supervision sessions.
Staff treated people with respect. They spoke and interacted with them in a caring and friendly manner. Staff knew the people they were supporting and provided care in line with their wishes and preferences. Staff respected people’s privacy and maintained their dignity.
The registered manager assessed people’s needs and developed care plans outlining how those needs were to be met. People and their relatives were involved in discussions about their care needs. The staff had the knowledge to support people with wound care. When people had been admitted to the service with pressure ulcers staff had provided people with the care they required in order for these wounds to heal.
Staff assessed the risks to people’s safety and plans were in place to manage and mitigate those risks. This included providing people with the equipment they required. Risk management plans were reviewed in response to incidents that occurred at the service to prevent recurrence of similar incidents.
Processes were in place to keep people safe. This included ensuring staff were aware of their responsibilities to safeguard people and to report any concerns of possible abuse to their manager and the local authority safeguarding team so appropriate action could be implemented to protect people, where required.
Staff were prompt to identify when people required support with their health. Staff undertook some screening processes to identify possible infections so prompt treatment could be sought. Staff liaised with the GP and undertook weekly ‘ward rounds’ to review people’s health needs. Staff liaised with other healthcare specialists as required and supported people in line with the advice provided. This included seeking advice about people’s nutritional needs.
The service was part of the Vanguard initiative. This initiative was about supporting people with their healthcare needs within the care home by trained and knowledgeable staff in conjunction with other community healthcare professionals and about smoother transitions between the care home and admissions to hospital. The registered manager felt being part of this process had strengthened their processes to support people with their healthcare needs and ensured people received the support they required in a timely manner.
Staff provided people with end of life care and support in line with their wishes and preferences. Advance care plans and ‘co-ordinate my care’ records were available so all professionals involved in the person’s care were aware of their wishes. Staff supported people to be at their preferred place at the end of their lives and staff stayed with the person so they did not die alone. The service had been accredited as part of the Gold Standards Framework (GSF) recognising the ability of the staff to provide quality end of life care.
People received their medicines as prescribed and accurate records were kept of medicines administered. The registered manager had worked with the community pharmacist to further strengthen and streamline medicines management.
Staff were aware of their responsibilities to adhere to the Mental Capacity Act 2005. Staff asked for people’s consent before providing support and respected their decision. The registered manager organised for people to be reviewed under the Deprivation of Liberty Safeguards to help ensure their rights were upheld while their safety was maintained.
Activities were available to provide people with stimulation. This included one to one engagements and some group activities. The provider was supporting the activities coordinator to develop their knowledge and build links with other activities coordinators to further strengthen the activities programme. A minibus had recently been purchased to provide further opportunities for people to engage in the local community.
A complaints process was in place. People and their relatives felt able to speak with the registered manager if they had any concerns or complaints. We saw that these were investigated and addressed as required. People, their relatives and staff were asked for their feedback about the service through regular meetings and completion of satisfaction questionnaires. Feedback received was used to further improve service delivery.
There was clear leadership at the service with strong management in place. Staff felt well supported by their manager and able to approach them for advice and guidance. They were able to express their opinions and that their suggestions were listened to.
There were processes in place to review the quality of the service. This included a programme of audits and review of key performance data. The registered manager worked with the local authority, clinical commissioning group and other healthcare professionals to review and improve service provision.