Nettlestead Care Home

Nettlestead care home, is a care home providing personal care and accommodation for up to 20 older people in one adapted building. At the time of our inspection there were 20 people using the service.

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

People told us they felt safe. Staff understood the types of abuse that could occur and the action to take if they had any concerns. Risks to people were assessed, identified, and safely managed. The home had a system in place to record accidents and incidents and acted on them in a timely manner. Medicines were stored, administered, managed safely and accurate records were maintained. There were enough staff deployed to meet people's needs in a timely manner and the provider followed safe recruitment practices. People were protected from risk of infection as staff followed practices that reduced the risk of infection.

Staff were supported through regular training and supervisions so that they were effectively able to carry out their roles. People's needs were assessed prior to moving into the home to ensure their needs could be met. The registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA). 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. Staff told us they asked for people's consent before offering support. People were supported to have enough to eat and drink and had access to healthcare professionals when required to maintain good health.

People told us staff were caring, considerate and respected their privacy, dignity, and independence. They said staff involved them in making decisions about their daily care and support requirements.

People's care plans were reflective of their individual care needs and preferences and care plans were reviewed on a regular basis. A variety of activities were on offer and available for people to enjoy and take part in. People were aware of the home's complaints procedures and knew how to raise a complaint. People's cultural needs and religious beliefs were recorded, and they were supported to meet their individual needs. Where appropriate people had their end-of-life care wishes recorded in care plans.

The provider had effective quality assurance systems in place to monitor the quality and safety of the service. Regular staff and residents' meetings were held, and feedback was also sought from people about the service. Staff were complimentary about the registered manager and the home. The provider worked in partnership with health and social care professionals to ensure people's needs were planned and met.

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 25 May 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

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

People’s experience of using this service:

• People and their relatives gave us positive feedback about their safety and told us that staff treated them well.

• The registered manager and staff understood what abuse was, the types of abuse and the signs to look for.

• Senior staff completed risk assessments for every person and they were up to date with clear guidance for staff to reduce risks.

• There were enough staff on duty to support people safely and in a timely manner. Staffing levels were consistently maintained to meet the assessed needs of people. The provider carried out comprehensive background checks of staff before they started work.

• Medicines were managed safely. The provider had a medicines policy which gave staff guidance on how to support people to manage their medicines safely.

• Staff kept the premises clean and safe.

• The service had a system to manage accidents and incidents to reduce the likelihood of them happening again.

• Staff carried out pre-admission assessment of each person’s needs to see if the service was suitable and to determine the level of support they required.

• Staff received appropriate support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach their line manager, and the registered manager, at any time for support.

• Staff assessed people’s nutritional needs and supported them to have a balanced diet. People told us they had enough to eat and drink.

• The service had strong links and worked with local healthcare professionals in a timely manner.

• The service met people’s needs by suitable adaptation and design of the premises.

• Staff completed health action plans for everyone who used the service and monitored their healthcare appointments.

• The provider worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their care.

• People’s mental capacity had been assessed relating to specific decisions about the support they received where staff suspected they may not have capacity to make the decision for themselves.

• Staff showed an understanding of equality and diversity. They supported people with their spiritual needs where requested.

• Staff involved people or their relatives in the assessment, planning and review of their care.

• Staff respected people’s choices and preferences.

• People told us staff treated them with dignity, and that their privacy was respected.

• Staff recognised people’s need for stimulation and supported them to follow their interests and take part in activities. People responded positively to these activities.

• Staff had developed care plans for people based upon their assessed needs.

• Care plans were reviewed on a regular basis and reflective of people’s current needs.

• People told us they knew how to make a complaint and would do so if necessary.

• The provider had a clear policy and procedure for managing complaints.

• The provider had a policy and procedure to provide end-of-life support to people. However, no-one using the service required end-of-life support at the time of our inspection.

• The service had an effective system and process to assess and monitor the quality of the care people received. As a result of these checks and audits the provider made improvements.

• The service had a positive culture, where people and staff told us they felt the provider cared about their opinions and included them in decisions.

• The registered manager had detailed knowledge about people living at the home and made sure they kept staff updated about any changes to people’s needs. They encouraged and empowered people and their relatives to be involved in service improvements through periodic meetings.

• The provider had worked effectively in partnership with a range of healthcare professionals.

Rating at last inspection: Good (report published on 21 December 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. We found the service continues to meet the characteristics of Good in all areas.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Nettlestead Care Home on our website at www.cqc.org.uk.

We found improvements had been made around the management of medicines and we have revised our rating to good for the safe question. There were now appropriate arrangements in place for the storage, administration, recording and disposal of medicines. Medicines kept on behalf of people using the service were being administered correctly with up to date records kept.

Nettlestead Care Home is a family owned business registered to provide residential accommodation and care for up to 22 older people.There were 19 people using the service at the time of our inspection.

The home had 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.

People and their relatives were positive about the care and support provided. Staff knew people well and treated them in a kind and dignified manner. We observed positive relationships between staff and people at the service and their relatives throughout our visit. A range of activities were provided to people to participate in both in and outside of the home.

We found improved arrangements needed to be put in place in place for the recording, auditing and administration of medicines. This was with particular regard to medicines supplied to the home in their original containers.

Staff understood how to help protect people from the risk of abuse. The service had procedures in place to report any safeguarding concerns to the local authority. Risk assessments were completed to help keep people safe addressing areas such as mobility, falls and behaviour.

Staff received the training and support they needed to effectively carry out their job roles. Staff had received training in the MCA (Mental Capacity Act) and understood the importance of gaining people’s consent before assisting them.

People and their relatives felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues.

The service was well led. Managers monitored the quality of the service and made changes to improve the service provided when required. Staff and people who used the service found the management team approachable and responsive.

The service was employee owned which meant that staff were committed to maintaining high standards within the home. There was also a programme in place to identify and develop care staff within the organisation as future potential managers.

At our inspection we found that people and their relatives received information about the care and support, and were involved in their care planning. Most people received suitable care and staff worked with other health and social care professionals to ensure people using the service received a safe and effective care. The provider had made improvements to the staffing levels and appropriate checks were in place to ensure suitable staff were employed at the home. However, we also found that in some instances people's care records were not accurate.

We found that the people who used the service were involved in their care planning and received a personalised care and support which was based on an assessment of their needs. Staff received support and training in different aspects of care and demonstrated an understanding of safeguarding of vulnerable adults. Care records were accurate and stored securely.