Nairn House Care Home

Nairn House is a residential care home providing personal and nursing care to up to 61 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 45 people using the service.

The home is a large detached building over three floors. People had access to en-suite facilities and adapted bathrooms.

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

We received positive feedback from relatives about the quality of care provided to people living at Nairn House. Relatives told us they felt staff were kind and caring. During the inspection we observed people being treated with respect and dignity.

We identified concerns around people’s risks relating to skin integrity and falls not always being assessed correctly. For people placed at the home for a period of rehabilitation, there was insufficient information in their care records to show how they should be supported.

There had been an unstable management structure with several managers overseeing the home. We found that whilst there was an activities coordinator and activities timetable in place, there was a lack of interaction or stimulation for people who remained in their rooms. Audits had not identified the concerns found during the inspection.

Staff had received training on safeguarding and understood how to report any concerns. People received their medicines safely and on time. There was good oversight of medicines management. The home recognised how important visitors were to people’s wellbeing. There were no restrictions on visiting and we observed relatives and friends visiting throughout the inspection. 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.

Staff recruitment was safe and all relevant background checks were completed before they started work. There were some difficulties around staffing and the home had multiple vacancies. At the time of the inspection the home was using agency staff to cover this. Following the inspection, we were told five new nurses and some care staff had been recruited.

Staff told us they felt supported in their role and were able to discuss any concerns with the manager. There were regular staff meetings. There were various mechanisms for people, relatives and healthcare professionals to give feedback.

The provider was responsive to feedback given at the time of the inspection and quickly responded to any issues raised. The home also worked closely with the local authority to help improve the quality of care.

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 2 March 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve the service. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider followed guidance on safe management of medicines. We also made a recommendation that the provider ensured people’s risks were consistently and appropriately assessed. At this inspection we found the provider had addressed previous concerns around medicines. However, we continued to find concerns around how people’s risks were documented and managed.

Why we inspected

We received concerns in relation to people’s nursing care needs, assessing of people’s risk and rehabilitation following fracture and overall management oversight of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement and recommendations

We have identified breaches of regulation in relation to assessing and managing risk and management oversight of the home. This was a breach of regulation 12 (Safe care and treatment) and regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

We found the following examples of good practice.

The provider was sharing observations about people’s health with healthcare professionals in advance of appointments. This had reduced the need for external visitors to the home, and allowed many consultations with healthcare professionals to be carried over video link..

The provider was following best practice guidance to ensure visitors to the home did not introduce and spread COVID-19. They had a visitors’ code and visitors’ policy that family members and other visitors had to sign and adhere to. The home were not currently accepting family visitors due to a recent outbreak. A system of allocated appointments was developed for family visiting which would ensured visitors to the home were minimised.

During the inspection we saw that staff were following Personal Protective Equipment (PPE) and social distancing guidance. Posters giving guidance on infection prevention were displayed around the home.

The provider's admission process included a COVID-19 assessment. The provider liaised with hospitals and social services as appropriate for all admissions and requested a COVID-19 test be carried out before discharge from hospital. New residents took a test and then had a period of isolation when first arriving at the home. The provider ensured family members knew what was going on throughout this period.

The provider had designated 'taking off' and 'putting on' PPE stations around the home.

Staff had been trained in the use of PPE and infection control processes. Testing of people who used the service and staff took place as per government guidance and people had been supported to have the vaccine.

We were assured that this service met good infection prevention and control guidelines.

Nairn House is a nursing home providing the regulated activity of personal and nursing care to older people, some of whom were living with dementia.

Nairn House accommodates up to 61 people in one adapted building. At the time of the inspection there were 51 people living at the home.

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

Throughout the inspection we generally observed people to receive appropriate care and support at Nairn House. However, we found significant concerns with management oversight systems and the lack of these which would enable the registered manager and senior managers to effectively monitor the quality of care people received. People and relatives did not know the registered manager, and stated that they did not feel the presence of the registered manager in the running of the home.

We also identified concerns around medicines management and administration, risk management, accident and incident, safeguarding and complaints oversight and management and documentation relating to care which could place people at the risk of harm.

Staff understood safeguarding and how to keep people safe from abuse. Staff told us that they received the mandatory training to support them in their role. However, records seen did not always confirm this.

Infection prevention and control processes in place were followed to minimise the risk of transmission. Staff were seen to wear the required PPE appropriately.

People were seen to eat and drink well and were supported to maintain a healthy and balanced diet. People were supported to maintain healthy lives and had access to health and social care professionals where required.

People 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.

Staff recruitment checks were complete and provided assurance that staff employed had been appropriately assessed as safe to work with vulnerable adults.

We have made a recommendation about risk management, medicines management and administration and the implementation of the Mental Capacity Act 2005.

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 good (published 16 September 2017).

Why we inspected

We received concerns in relation to poor communication, training of care staff and resident safety. The service had last been inspected in 2017 and so the length of time since the last inspection was also taken into consideration. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nairn House on our website at www.cqc.org.uk

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report. We have identified one breach of regulation around good governance.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can see what action we have asked the provider to take at the end of this full 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.

Nairn House is a home for older people who are in need of nursing care. It provides accommodation to a maximum of 61 people some of whom were living with dementia. At the time of our inspection there were 53 people using the service.

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.

People told us they were well treated by staff and felt safe with them.

Risks to people’s safety had been identified and ways to mitigate these risks had been recorded in individual care plans and were understood and being followed by staff.

Staff understood their responsibilities to keep people safe from bullying, harassment, avoidable harm and potential abuse.

Systems were in place and being followed to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they worked well as a team and appreciated the support they received from the registered manager.

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.

People told us they enjoyed the food provided and that they were offered choices of what they wanted to eat.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences.

People told us that the management and staff listened to them and acted on their suggestions and wishes.

Both people using the service and their relatives told us they were happy to raise any concerns they had with any of the staff and management of the home.

People were included in monitoring the quality of the service and we saw that their suggestions for improvements and preferences about how they wanted to live their lives were respected and acted on.

There were effective recruitment and selection processes in place. Staff told us that they had been through a detailed recruitment process that included completing an application form, interviews and references being taken up from their former employers.

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted on. One relative said, 'on the whole I'm quite happy with the way they are looking after my relative. I have no complaints." People told us that staff listened to them and responded to the requests. Regular audits had been carried out covering a range of areas such as medications management and care planning. These showed that the quality of service provision was assessed and monitored. Where issues were identified improvements were made.

We saw that medicines were not always recorded appropriately. On 4 charts there were no records of receipts and/or balances of medicines carried forward from the previous month's medication cycle. This made it differicult to reconcile stock balances to see if medicines were being given as prescribed. One person was prescribed the drug warfarin with a blood test due in March 2013. We saw no medication record for this person We could not reconcile records and stocks for a total of 8 supplies. There were too many tablets remaining for medicines to treat heart disease, rheumatoid arthritis, diabetes and infection and mood. We were unsure whether the correct doses of these medicines were being given as prescribed or whether nurses were signing the MAR but not actually giving the medicine.

People said that staff were available to help them. People told us that staff were, "always helpful." People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals.