Service to the Aged

Service to the Aged (known as Sage) is a residential care home providing nursing and personal care to older people of the Jewish faith. The home is registered to accommodate 60 people. At the time of the inspection there were 39 people living in the home.

The home is purpose built consisting of three separate floors with their own lounges, kitchenettes and bathrooms. In addition the home has a number of communal rooms on the ground floor for dining, activities and visitors. One floor specialises in caring for people who live with dementia and two floors accommodate people with nursing needs. There is always a nurse in charge of each of the three floors.

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

Risks to people’s safety and wellbeing had been assessed and action taken to help keep people safe from harm, however we found some risks relating to catheter care and dysphagia. Medicines were managed and administered safely. People experienced good care and treatment.

The home followed appropriate procedures for reporting any accidents or safeguarding concerns. Incidents and accidents were reflected on to see if any improvements were needed.

There were enough staff deployed to meet people's needs and ensure their safety. The home’s recruitment procedure was not always followed properly in checking applicants’ conduct in previous employment. We made a recommendation to improve recruitment practice.

People living in the home and their relatives told us they enjoyed living at this home and felt their religious and cultural needs as Jewish people were met well. The food, activities and daily and weekly routines met their requirements. They told us they were happy with the care and support they received. 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 received training for their roles. Staff were caring and kind in their interactions with people and asked their consent during daily tasks. Staff knew people’s needs well. Staff supported people to meet their health and nutritional needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 November 2019) . At this inspection the rating has deteriorated to requires improvement.

Why we inspected

The inspection was prompted in part by notifications of three specific incidents. Two of the incidents had been investigated by the local authority and one was being investigated at the time of the inspection. As a result, this inspection did not examine the circumstances of the incidents.

The information CQC received about the incidents indicated concerns about the management of catheters, dysphagia and communication between staff employed at the home and externally employed care workers. This inspection examined those risks. 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. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 some improvements.

Enforcement

We found a breach of regulations relating to safe care and treatment (managing risks). You can see what action we have asked the provider to take at the end of this full report.

The provider acted immediately to try to mitigate the risks to ensure people would receive safe care and treatment.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Service to the Aged (Sage) is a residential care home providing personal care, nursing and accommodation to 60 people of the Jewish faith. The service has two floors offering nursing care and one floor with a focus on supporting people with dementia. At the time of the inspection there were 58 people living at the service. The service also offers a respite service.

People’s experience of using this service:

People told us staff were kind and caring. We witnessed kind interactions between staff and people at the service.

Care plans and risk assessments were comprehensive and up to date. People were safeguarded against the risks of abuse and harm by the systems in place and by the staff. Risks to people were assessed and mitigated. There were enough staff to meet people’s needs and provide flexible, responsive care.

The service was person-centred and staff understood people’s needs and preferences well. Medicines and staff recruitment were safely managed. The service was clean with infection control processes were in place. People were supported to access external health professionals to help promote good health and wellbeing.

Staff undertook training and received regular supervision and told us they felt well supported by the registered manager.

The registered manager and deputy ensured the service provided good quality care through a range of checks including quality audits in key areas. The building was safely maintained.

The service encouraged inclusion with the local community by facilitating daily religious prayer services and encouraging involvement of friends and family at the service. In addition, at the care home a range of activities took place.

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:

The last rating for the service was good (published 21 June 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

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.

Service to the Aged is a nursing home for up to 60 older people, it provides nursing care to people of the Jewish faith so they can continue to practise their faith and be a part of their local community. Some of the people living in the home have dementia; the home has a dedicated Alzheimer’s unit. At the time of the inspection 56 people were living in the home.

We completed a comprehensive inspection on 16, 18 and 19 February 2015 where we found breaches of regulations relating to staffing, staff training, and consent. We carried out a further inspection on 10 November 2015 and found that improvements had been made to address these breaches of regulations.

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.

Medicines were managed safely by staff trained to administer them and safeguarding procedures and records were robust.

Risk assessments were reviewed and incidents were analysed to see how they could be learned from to reduce the risk of them happening again.

The home was free from odour and clean and staff were using infection control equipment appropriately.

The home had in house physiotherapists to help people mobilise and exercise. Referrals were made in a timely way for health needs and nurses were knowledgeable and confident.

Staff fed back the training could be more classroom based. We saw evidence that staff were supported through supervisions, appraisal and regular staff meetings at all levels.

The principles of the MCA were being followed but some staff lacked knowledge in this area which identified a training need.

People said the food could improve. The registered manager had listened to this and people were going to meet with the caterers to make suggestions.

People said they were happy in the home and staff were kind and caring and respected their dignity and privacy. Relatives told us they thought the care was consistently good.

Activities were regular and well attended and provided a range of mental and physical stimulation.

Care files were person centred and captured needs well. People and relatives said they knew how to complain and complaints were recorded and responded to in line with the provider’s policy.

Robust audit systems were in place and the management team were passionate about improving care standards. Relatives and people fed back to us that they had seen an improvement in the home over time.

We made a recommendation that the home provide additional training to staff in the area of consent and MCA.

Shortly after our inspection, the provider sent us an action plan in response to the concerns we identified and when we inspected again on 6 March 2014, we saw that improvements had been made. For example, MAR sheets we looked at had been completed and there were no enteral feeds stored in people's rooms.

We saw evidence that people's care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People using the service appeared well cared for and were dressed appropriately, frames and wheel chairs were carefully labelled with the owner's name and we saw notices on some residents' doors advising staff on the resident's preferred manner of room entry i.e. 'knock and wait.'

Peoples' feedback on care and support provided was generally positive. One person remarked 'they look after me very well. I am spoilt' whilst another person commented 'it's an extremely difficult job to run a place like this. They [staff] do very well.' However, one person told us that care staff were rough when assisting with dressing.

We saw there were not appropriate arrangements in place for recording the administration of medicines. We found omissions in the records were made when medicines were given to people. There was also no guidance for staff in the administration of medicines that were required on an 'only when needed basis.' Medicines were not kept safely, or being stored securely for the protection of people who use the service. We saw that a medicines refrigerator, situated in a service user lounge, was not locked.

When we inspected on 21 June 2013, we looked at provider records and saw that some staff were overdue mandatory training. We asked the provider to take action. When we inspected on 3 October 2013, we saw that some mandatory training sessions had now been delivered. When we inspected in June we also saw that the provider did not have a performance appraisal system in place for the Registered Manager. We asked the provider to take action. When we inspected on 3 October 2013, we saw that the Registered Manager had had an appraisal meeting in September 2013.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. After our October 2013 inspection, we were sent a copy of the provider's 2013 Resident Survey. We saw that that 83% of the 31 respondents agreed with the statement 'do you feel that the nursing and care staff treat you with respect?'

We spoke with two care workers: one of whom who had been in post for two years, the other recently started. The longer serving care worker was able to outline symptoms of abuse. They told us that they were scheduled for safeguarding training in July 2013. The provider may wish to note however, that the newer care worker was not able to demonstrate an understanding of safeguarding issues. They told us that they would also be attending safeguarding training in July 2013.

Shortly after our inspection, we were sent a staff training spread sheet. This showed that some staff were overdue mandatory training in accordance with the provider's policies. We were also sent a training schedule and advised that by December 2013 all staff would be up to date regarding mandatory training.