Henry Nihill House

Henry Nihilll House is a residential care home providing personal and nursing care to up to 30 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 29 people using the service.

People’s experience of the service and what we found:

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.

People and families told us the home was safe. Risks of harm were identified and mitigated as much as possible. Overall medicines was managed safely; however, we have made a recommendation about medicine. Staff were recruited safely. Staff understood their responsibility regarding protecting people from risk of harm or abuse. The home was clean and well maintained. Staff were relaxed and there was a warm and friendly atmosphere in the home during our visit.

There was a range of activities for people to choose. Some people did not always want to participate in activities. People who were unable to come out of their rooms were involved in 1:1 sessions with staff if that was what they wanted. The service had a robust complaints system in place, complaints were investigated in a timely manner. People's care plans were comprehensive, end of life care wishes were recorded and acted upon as much as possible. People's communication needs were assessed and met. Care was delivered in a person-centred way.

Most staff and people told us the home was well managed. Managers and leaders had clear systems in place to review the quality of care. Most staff told us they felt supported in their role. People and families told us they were involved in the home and had opportunities to give their feedback. The registered manager was clear about their role and their responsibility regarding statutory notification procedures.

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 17 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, staff training, medicine errors. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe, responsive, and well-led only. 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 Henry Nihill House on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The last comprehensive inspection of the service was on 11 November 2015, at which a breach of the regulations related to governance of the service was found. This was followed up with a focused inspection to review the ‘well led’ domain on 10 May 2016 at which improvements were found and the service was no longer in breach of this regulation. The overall rating for the service across the two inspections was ‘good’.

Henry Nihill House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is located in a purpose-built block, on two floors with access to a front and back garden area. The service adjoins the Anglican convent owned by the Community of St Mary at the Cross. The service offers a service to people of all or no faiths.

Henry Nihill House has a registered manager at the service. 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 enjoyed living at Henry Nihill House and they felt safe. People told us staff were kind, caring and patient and they were treated with dignity and respect. We saw this was the case and this was confirmed by relatives.

Care records were person centred and outlined people’s needs. Risk assessments were in place to provide guidance to staff on minimising and managing risks. Care provided to people was of a good standard and the service provided outstanding end of life care to people, some of whom moved to the service to receive palliative care.

The management team provided good leadership at the service and to the wider network of care homes locally. This was illustrated by the systems to monitor care through quality audits, supervisions and staff meetings, and the registered manager’s involvements in supporting student nurses at the service. The registered manager and other staff members was involved in a local initiative to promote and offer good end of life care. The registered manager received positive feedback from local health and social care professionals for their professionalism and commitment to providing a good service.

The management of medicines was safe as was the recruitment of staff. Staff told us they enjoyed working at the service and were supported in a range of ways to carry out their role, through supervision, training and care meetings.

Staff understood about abuse and their role in reporting any concerns. The service had effective systems in place to manage any safeguarding concerns.

The service provided a broad range of activities and also organised trips out in the provider’s bus which people told us they enjoyed.

We found the premises were clean and tidy. The service had effective infection control processes in place. There was a record of essential inspections and maintenance carried out. The building was fully accessible and maintained to a good standard.

We undertook this unannounced focused inspection of 10 May 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this matter. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Henry Nihill House on our website at www.cqc.org.uk .

Henry Nihill House is registered to provide accommodation and nursing care for up to thirty people. On the day of the inspection there were thirty people living at the service. The service consists of three units split over two floors. The service is located in a purpose built block, on two floors with access to a front and back garden area. The service adjoins the Anglican convent owned by the Community of St Mary at the Cross. They are the providers and commissioners of the service. The service offers accommodation and care to people of all or no faiths.

Henry Nihill House had a registered manager at the service. 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.

At the last inspection we could see that whilst the leadership offered by the registered manager was good, there had been resourcing issues within the senior management support offered by the St John of God organisation (SJOG the contracted organisation providing the care service).This had impacted on the level of quality assurance and support offered by senior managers to the registered manager and the service.

At this inspection we found that the service improvement manager employed by SJOG was closely involved with the service, and was visiting monthly, and was supervising the registered manager regularly. The service improvement manager told us key areas for improvement in the coming 12 months were supporting the registered manager to effect a cultural change of acceptance of responsibility at all levels within the staff team, and supporting staff to identify and work through the complaints process. We could tell from discussions with the registered manager and the service improvement manager, they were working in partnership to support the staff team to learn and reflect on their work.

On a practical level within the service we could see from records that care plans were up to date, were being reviewed monthly and this was audited by the registered manager or the deputy. A new system had been implemented in relation to roles and responsibilities of nursing staff on each shift. There was now a lead nurse who could direct the work of each shift more effectively and both nurses gave medicines simultaneously so the medicines round was completed in a more timely manner. We also saw new fluid charts had been introduced with a running total of intake and a target intake so staff could easily identify if there was an issue.

Regular staff meetings and supervisions took place at which best practice issues were discussed as well as day to day issues that arose.

The registered manager told us they were aiming to qualify for a ‘gold standard’ in hospice provision in the coming year. The registered manager viewed this as an area of expertise within the staff team and good end of life care fitted entirely with the objectives of both the organisations, of compassion, hospitality, respect, justice and trust.

Following our 12 & 13 December 2013 inspection the provider sent us an action plan setting out how they had addressed these matters. At this inspection we identified that action had been taken. We saw that the findings of our inspection had been discussed with people using the service, staff and relatives. We saw that staff had received additional supervision and training on how to provide the service with dignity. We saw that call bells had been checked, that night care had been monitored and that systems had been set up to monitor people each day. An occupational therapist had been employed to check manual handling arrangements and provide advice for staff. This meant that steps had been taken to make sure that people were being treated with consideration and respect.

People using the service were positive. Comments we received were that staff were, 'helpful' and 'considerate'. We observed warm relations between staff and people using the service and we witnessed staff talking to people in a friendly, respectful manner.

Staff told us that they had been disappointed, after the December 2013 inspection, that the service had been non-compliant. However, all the staff we spoke with said there had been improvements. For example, one staff member said that teamwork had improved, 'we help each other more now,' they said.

We saw that the provider's action plan was being carried out. For example, there had been meetings with people using the service, staff and relatives where service quality had been discussed. There was a clear plan with timescales for actions. This meant that people were being protected from the risks of inappropriate or unsafe care.

However, some of the people we spoke with expressed concerns. One person said, 'sometimes it's not brilliant'. Other people told us that they felt 'told off' when they rang their call bell for help and one person said, 'I have to ask staff for help and sometimes they don't help.' Some people told us they had concerns about night care. We saw that other similar concerns had been identified by the provider through a relatives survey, a complaint and at a quarterly monitoring meeting.

Care plans were detailed and provided evidence that people's needs had been assessed and that there were plans in place to meet people's needs. This included obtaining people's consent and acting in people's best interests where they may not have had capacity to make specific decisions. People's nutritional needs had been identified and a range of nutritious food and drink was provided.

The majority of staff told us they felt supported and received regular supervision, appraisal and training. Additional training was planned for early 2014. Staff were knowledgeable about safeguarding matters and had received training. Medication arrangements were suitable and the provider was on track to meet their medication action plan which had been put in place earlier in 2013 after a medication error.

Although there were systems in place to assess and monitor the quality of the service there had not been prompt action taken to address concerns.

Many of the staff have worked in the home for some time. One said that she stayed because she was able to provide proper care to people. Two thirds of the people living there are over 80 and the service is proud to have three people who are over 100. There was a warm, friendly and open atmosphere and the overall quality of care provided was good.

The home is under relatively new management and there are efforts being made to encourage people to be more proactive and involved in respect of their care and wellbeing where this is possible. Arrangement for staff supervision and appraisal were found to need some attention.