Bendigo Nursing Home

People’s experience of using this service: The service was Good.

People told us they felt safe living at the home. One person said, “I am very happy here, I feel safe and there is no sign of abuse.” Risks to people were assessed and managed effectively. Staff understood their responsibility for safeguarding people and knew how to report abuse. There were enough suitable staff to care for people safely and the provider had robust recruitment procedures. People’s medicines were administered safely and infection control procedures were robust. Incidents were recorded and monitored and lessons were learned when things went wrong.

People told us they had confidence in the skills of the staff. Staff received the training and support they needed. Staff understood their responsibilities regarding the Mental Capacity Act 2005. 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. People’s needs were assessed in a holistic way taking account of people’s diverse needs and their preferences. People were supported to have enough to eat and drink and to access health care support when needed.

Staff were kind and caring. People had developed positive relationships with staff who knew them well. A relative told us, “The staff are excellent, it gives us great peace of mind.” Staff involved people in making decisions about their care and support. Staff maintained people’s privacy and treated them with dignity and respect.

Care was provided in a person-centred way. People were supported to maintain contact with people who were important to them. Staff were responsive to people’s needs and ensured that people’s information and communication needs were met. People were encouraged to access activities and to maintain their interests. People were confident that any complaints would be addressed. Staff supported people to plan for end of life care and respected their wishes.

People, their relatives and staff said that the home was well-led and spoke highly of the management of the home. There were a range of systems to monitor standards and to improve the quality of the service. People and their relatives told us their feedback was listened to. The provider shared information in an open and accessible way. Staff worked collaboratively with other organisations to meet people’s needs.

Rating at last inspection: The last rating for this service was Good (published August 2016)

Why we inspected: This was a planned inspection based on 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.

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

People who live at Bendigo required assistance with a range of nursing and personal care needs, with some needing support in relation to living with memory loss and dementia.

The home is a character building converted to provide communal areas and private rooms for people. The home has a passenger and stair lifts to assist people to access areas of the building.

This was an unannounced inspection which took place on 2 June 2016.

Bendigo Nursing Home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The registered manager was in day to day charge of the home, supported by a deputy manager. The registered manager was fully involved in all aspects of the day to day running of the home and had an excellent overview of the home and knew everyone well.

We received positive feedback from people, staff, relatives and visiting professionals. Everyone told us that the manager was passionate about ensuring people received the best care possible. Putting the person first to ensure the care they received was tailored to meet their needs. This was supported by clear up to date care documentation which was personalised and regularly reviewed.

Staff felt that training provided was effective and ensured they were able to provide the best care for people. Competencies had been completed after training to ensure that staff had a clear understanding and were appropriately trained to meet people’s needs

Registered Nurses (RN’s) were responsible for the medicines in the home. Medicine administration, documentation and policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing and checks were carried out to ensure high standards were maintained. People were supported to self-medicate if it was safe for them to do so and this was regularly reviewed.

There were robust systems in place to assess the quality of the service. Maintenance, for example water, electric and gas had taken place and all equipment and services to the building had been checked and maintained regularly. Fire evacuation plans and personal evacuation procedure information was in place in event of an emergency evacuation.

There a programme of supervision and appraisals for staff. Staffing levels were reviewed regularly. Staff received training which they felt was effective and supported them in providing safe care for people. Recruitment checks were completed before staff began work.

Care plans and risk assessments had been completed to ensure people received appropriate care. Care plans identified all health care needs and had been reviewed regularly to ensure information was up to date and relevant. People’s mental health and capacity were assessed and reviewed with pertinent information in care files to inform staff of people’s individual needs.

People were encouraged to remain as independent as possible and supported to participate in daily activities. Staff demonstrated a clear understanding on how to recognise and report abuse. Staff treated people with respect and dignity and involved people in decisions about how they spent their time. People were asked for their consent before care was provided and had their privacy and dignity respected.

Feedback was gained from people, relatives, staff and visiting professionals this included questionnaires and regular meetings with minutes available for people to access.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food. Fresh fruit and hot and cold drinks were freely available and people were able to have an alcoholic beverage if and when they chose.

Referrals were made appropriately to outside agencies when required and notifications had been completed to inform CQC and other outside organisations when events occurred.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

We spoke with five people who lived at the home, two relatives and two visiting GPs. We also spoke with six members of staff, including the registered manager, deputy manager, one nurse, two care workers and the chef.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found

Is the service safe?

People were treated with respect and dignity by the staff. People who used the service told us they felt safe. A relative told us "It's reassuring to know that (name) is safe and so well cared for here."

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager compiled the staff rotas, they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped ensure that people's needs were always met.

Policies and procedures were in place to make sure that unsafe practices were identified and people were protected.

The home had updated policies and procedures in relation to safeguarding adults at risk, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We were shown documentary evidence of a recent application that had been submitted, including details of the subsequent assessment and authorisation. Staff had received relevant training to understand and recognise abuse and knew the process for reporting any incidence of such abuse. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed with them and as far as practicable, they were involved in developing and reviewing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives said that they had been involved in reviewing care plans and they reflected their current needs. One relative told us 'They keep us informed of how she is and let us know of any changes, either by phone or when we come in.'

People's needs were taken into account with the accessible layout of the service, enabling people to move around freely and safely.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

The home had systems in place to assess and manage risks and to provide safe and effective care. Staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with complex needs.

We also found evidence of staff seeking advice, where appropriate, from the GP or social services. Two visiting GPs we spoke with described the effective working relationship with the service and the professional integrity of the nursing staff. They told us 'They know what they're doing here, the level of care is very good and if we get a call from Bendigo, we know it is genuine and we are happy to come out if necessary.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person using the service told us "The staff are very kind and caring and always have time to sit and talk." A relative told us "Although she doesn't know us now when we visit, she always looks clean, comfortable and well cared for."

We spoke with relatives who said they were able to visit at any time and they were always made to feel welcome. We saw that the staff took time interacting patiently and sensitively with people throughout the home. We observed that people were treated with consideration, dignity and respect.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People had the opportunity to take part in a range of social and recreational activities, reflecting their interests and preferences, both in and outside the service.

People's needs were assessed before they moved into the service and detailed and comprehensive care plans and risk assessments were maintained and reviewed regularly. This ensured that the care and support provided reflected any identified changes in people's individual needs.

We were told by the manager that the service had good systems in place to monitor its own standards of service delivery and to gain feedback from people using the service, their relatives and other stakeholders. As well as satisfaction questionnaires, the manager told us they frequently carried out a range of internal audits, including care planning, medication and staff training. The manger also told us that they operated an 'open door policy' so people who used the service and visitors to the home could discuss any issues they may have.

People told us they were asked for their views on the service and their feedback was heard and changes were made as a result. People and their relatives, who we spoke with, also knew how to make a complaint or raise any issue or concern that they might have. They were also confident that their concerns would be listened to and acted upon.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up and consistent way.

The service had established quality assurance systems in place and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service provision continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff showed a good awareness of the ethos of the service and a sound understanding of the care and support needs of people who used the service. They told us that they felt valued and supported by the manager and deputy manager and were happy and confident in their individual roles.

We found that care plans clearly documented the needs of people and how they should be met. Staff ensured that consent was obtained prior to providing care and support. Where appropriate, specialist advice and support was obtained to meet people's individual needs.

The home had a thorough recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were safe systems in place for the management of medication.