Pax Hill Nursing Home

Updated 14 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 5 and 6 November 2018 and was unannounced. The inspection team included two inspectors and an expert by experience on the first day and an inspector and an expert by experience on the second day. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had experience of caring for older people.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, for example, statutory notifications. A notification is information about important events which the provider is required to tell us about by law.

Prior to the inspection we received feedback from a specialist nurse and a GP, both were very positive about the care people received at the service. During the inspection we spoke with 16 people and three people's relatives. As people who lived on Montgomery unit experienced dementia and could not all speak with us, we used the Short Observational Framework for Inspection (SOFI) to enable us to understand their experience of the care provided. We also spoke with the provider, the registered manager and 13 staff, including three care staff, four nurses, the head of housekeeping and the chef.

We reviewed records which included seven people's care plans, five staff recruitment and supervision records and records relating to the management of the service.

The service was last inspected on 4 and 5 July 2016 and no concerns were identified.

Updated 14 December 2018

Pax Hill Nursing Home is a 98-bed nursing home registered to provide care for older people and younger adults. The service is registered to provide care for people who experience physical or mental health conditions including dementia. Care is provided on three separate floors. Balmoral unit provides residential care; Montgomery unit provides nursing care for people living with dementia or with a diagnosis of mental illness and Windsor unit provides nursing care. At the time of the inspection there were 73 people accommodated.

At our last inspection we rated the service good overall and requires improvement in well-led with no breaches of the regulations. The service was rated as requires improvement in this key area, as the provider had not always consistently created an open and transparent culture within the service.

The service had an experienced 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.

People’s needs were holistically assessed and their preferences about how they wanted their care provided were considered. There was a strong focus on providing individualised care to people living with dementia, which enhanced their experience of the care provided. Staff had been supported by their dementia care consultant to develop their skills, knowledge and confidence when working with people with dementia.

Staff were highly skilled at responding rapidly to a deterioration in people’s health and providing the correct interventions to enable them to receive their care, including end of life care where they chose, at Pax Hill. Staff had been trained to provide Namaste care to people living with dementia when approaching the end of their life which provided comfort and connectivity for people.

Social activities provision was exceptional. The activities which were planned with people where possible, enabled them to try new things, to contribute to society and to feel a sense of self-worth. Staff had built strong links with the local community for peoples’ benefit, with both members of the community coming in to the service and people going out regularly.

The service was well-led, with enthusiastic and motivated leadership which kept people at the heart of everything they did. There was a very positive and forward-thinking culture underpinned by a desire to drive service improvements for people.

Rigorous and constructive challenge was welcomed and used to improve the service for people and had been used to find innovative and empowering solutions to issues for people. The views of people were sought in a variety of ways. Processes were in place to continually audit and evaluate the service provided.

The service was a role model for other services. They worked in partnership with others, they shared their ideas and practice to ensure good experiences and outcomes for people across services.

People were kept safe from the risk of abuse through the robust training and processes to prompt staff to consider if a safeguarding referral was required to keep people safe following any incidents. There were processes in place to ensure staff felt able to report any concerns and to ensure relevant actions were taken for people’s safety.

Risk assessments had been completed in relation to all aspects of people’s care and for peoples and staff’s safety within the service. Relevant checks had been made in relation to fire, equipment and utilities safety. People received their medicines safely from trained, competent staff. Processes were in place to protect people from the risk of acquiring an infection.

There were sufficient suitable staff to meet people’s needs. Recruitment safety checks had been completed and the registered manager took swift action during the inspection to ensure that any staff without the required full employment history provided this information as legally required.

People’s needs were effectively assessed and their care and support was delivered in line with current legislation and recognised good practice guidance. Staff had the skills, knowledge and experience to provide people with effective care. Staff received regular support and supervision of their work.

People were very positive about the quality of the meals provided. People were offered both a range of nutritious meals to meet their dietary requirements and the level of staff support they required to eat their meals.

Staff worked effectively together to ensure people’s needs were identified and they were referred promptly to other services as required. People were supported to access the healthcare services they required.

People’s individual needs were met by the design and decoration of the service, particularly on the dementia unit, where people experienced a relaxed and stimulating environment.

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.

There was a person-centred culture. Staff consistently treated people in a kind and compassionate manner. There was written information for staff about people’s communication needs and how to meet them. Staff asked people for their views and respected them. Staff ensured people’s privacy and dignity were upheld during the provision of their care.

Further information is in the detailed findings below