This inspection took place on 24 February and 2 March 2017 and was an unannounced inspection.The home had 47 bedrooms over two floors; there was access to each floor via a lift. Upstairs on the first floor the home provided nursing care for 26 people, on the ground floor the home provided residential care. At the time of our inspection 45 people were living at the home.
The home was clean, well maintained and tastefully decorated. Design factors had been added so that people with dementia may find it easier to navigate around the home. People told us they liked their rooms and the building. One person told us, “I like it here, it’s a lovely room”. People had been supported to personalise their rooms with family pictures, items of furniture and personalised signs on their doors.
The home had a registered manager; the registered manager had been registered with the CQC since September 2016. 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.
During our inspection we found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager had not always effectively assessed and monitored the safety, risks and quality of the service provided to people. You can see what action we told the provider to take at the back of the full version of the report.
A high percentage of nursing care was provided by agency nurses from three different agencies. The newly appointed clinical lead nurse was responsible for overseeing nursing care plans and monitoring nursing practice at the home. The clinical lead at the home did not have the allocated time to be able to do this effectively. There was no system in place or plan outlining how the clinical lead would fulfil their role of overseeing the nursing practice of the agency nurses used at the home. This meant they were not able to do so effectively and this could increase the risk of people not receiving appropriate care.
We were concerned with how agency nurses were introduced into the home and of the information available to them. The registered manager had limited information about many of the agency nurses. The registered manager told us that the current use of agency staff for nursing care was not a long term plan. We saw that recruitment was underway for the home to employ more nursing staff.
The registered manager undertook audits and checks to monitor and improve the standard of care provided at the home. We found that these audits had not always been effective in assessing and monitoring the quality of the care provided. For example in assessing the communication with and oversight of agency nursing staff that the home relied upon. Also audits of staff files had not highlighted that safe recruitment practices had not consistently been followed. Audits of people’s care plans had not highlighted problems with screening tools not been used correctly; which meant that the resulting score was not a true indication of the level of support the person needed. Audits had not highlighted some gaps in the supervision and appraisal given to staff. We spoke with the registered manager who told us they would review these areas of the home.
Some people at the home were at high risk of falling. We saw that each fall was recorded and action was taken by the managers and staff to reduce the risk of falls happening again. We saw people using protective equipment to reduce the impact of a fall and some people also had adaptations to their environment in place to reduce risks. The home made use of assistive technology to alert staff if people started moving independently, so they were able to assist promptly. Some people had increased support levels if they were at high risk of falling. The home worked in partnership with outside professionals in their approach to supporting people.
People’s medication was stored safely and clearly identified in people’s medication files. Medication was audited by the registered manager by selecting a rotating sample. We found that medication was not always administered safely. We found some recording errors; one person’s stock of medication was incorrectly recorded and there were three blanks where a nurse should have signed to record medication was administered.
Staff had not always been recruited in a safe way. We spoke with the manager about the need to be more robust with regard to obtaining references from previous employers, particularly those in health and social care.
The home was clean and fresh smelling. There was good hygiene and infection control practices at the home. The home had scored 94% on an infection control audit in February 2017. The building was safe and regular, tests, servicing and repairs of the services and equipment had been made and records kept of risk assessments and safety audits.
People told us they felt well cared for. One person said, “I find it perfect, excellent staff, they are very good”. Another said, It’s great, the staff are lovely”. People’s relatives told us that they liked the approach of the staff at the home. One relative told us, “Here it’s excellent. Staff are very pleasant and they have always got time for my mum. Nothing is too much trouble for my mum”.
We saw and people told us that they had been supported to maintain their faith and celebrate special occasions in the way they wanted to. People were communicated with in a variety of ways, for example by having a picture of their keyworker so they could recognise them.
People and their relatives told us that they found the staff, the deputy manager and the registered manager approachable and helpful. Relatives told us when they had reason to speak with the manager they were happy with his approach.
We saw that people were offered regular drinks and snacks throughout the day both in the lounges and in their rooms. People told us they liked the food offered to them and that there was a varied menu and choices available.
When we spoke with people’s relatives told us they were involved in care planning for their family members. Care plans contained important personal information about the person, including their care and support needs and preferences. The plans we looked at were person centred and contained appropriate detail about the person.
People and their relatives that we spoke with told us that they liked the activities offered at the home. There was a mix of individual and group activities both in and outside of the home. The home had recently recruited a second activities co-coordinator to be able to offer more variety of activities.
During our inspection the registered manager was open, candid and was keen to make improvements. He had taken or started to take considered action on information that he became aware of before and during the inspection. He held daily update meetings at the home. The registered manager kept in communication with people’s relatives through monthly relatives meetings. People relatives told us they were well communicated with in significant and day to day matters.
We saw records that showed that the owners of the home made periodic unannounced visits and completed audits to help them remain up to date with how the home was operating.