Aldbourne Nursing Home

We found the following examples of good practice.

People were supported to have visits from family and friends in the safest way possible. There were clear policies in place and visitors were supported to wear Personal Protective Equipment (PPE) and complete testing in line with current government guidance.

Staff were following infection control guidance such as handwashing, use of PPE and barrier nursing where appropriate. Staff had received additional infection control training in response to the coronavirus pandemic. The registered manager and clinical lead completed spot checks to ensure handwashing was completed correctly and PPE was worn appropriately.

The service was completing regular testing for staff, people living at the service and their essential care givers. These were recorded and registered in line with current guidance.

Cleaning was completed regularly throughout the home using appropriate cleaning chemicals. The home had purchased additional equipment such as a steam cleaner to clean floors and soft furnishing. Additional high touch point cleaning had been implemented in response to the coronavirus pandemic.

The home had been arranged in a way that allowed for social distancing as much as possible in communal areas. Rooms had been repurposed in response to the Covid 19 pandemic. For example, the service had converted bedrooms into visiting rooms, testing rooms, a staff shower room and donning/doffing areas. ‘Donning and Doffing’ is the process of putting on and taking off PPE safely. Additional refurbishments had been made to the home such as repainting with antimicrobial paint and replacing pull cords with easy clean alternatives.

The management team had implemented a number of measures to support staff with their wellbeing throughout the pandemic. This included support from a clinical psychologist, healthy snacks for staff prepared by the chef and a WhatsApp group for staff to share information and support one another. The registered manager had also created guidance documents for staff such as their ‘top tips’ for staying physically and emotionally well throughout the pandemic.

People’s experience of using this service:

People were happy with the care they received and complimentary about the staff. People could follow their own routines and take assessed risks. People’s privacy and dignity was promoted although not all had been asked about the gender of staff supporting them. People enjoyed the meals, which were based on preferences and fresh produce. People received regular support from a range of health and social care professionals to remain healthy. People were encouraged to give their views about the service and could join in with a range of social activities. There were strong links with the local community and the home was very much considered part of the village.

Trained staff administered people’s medicines and their competency was assessed. However, information about “as required” medicines was limited in detail. This did not ensure the medicines were administered as prescribed and to maximum effect. Records did not show people’s topical creams had been appropriately applied.

Whilst staff asked people’s consent before interventions, records did not show the principles of the Mental Capacity Act 2005 had been followed. Information was limited in detail and did not show the least restrictive options had been considered.

Risks to people’s safety had been identified yet records did not always show action had been taken to minimise these. For example, food and fluid monitoring charts were not consistently completed or analysed. Information did not always show people had been repositioned, as per their care plan, to minimise risks of pressure ulceration.

Focus was being given to the building and extensive building work was being completed. This was to enhance people’s communal space and included a new dining room, hairdressing room and activities room. Whilst all areas were light and airy, the corridors lacked colour and signage to help people find their way around more easily. The home was clean and there were no odours.

There were enough staff to support people. Staff had received training in areas such as safeguarding and fire safety, as well as topics associated with health conditions and older age. Work had been completed regarding staff’s strengths and learning styles to ensure a good skill mix within the team. Staff felt well supported and received one to one meetings with their supervisor to discuss their role. Safe practices were followed when recruiting new staff.

There was a strong management presence and a clear desire to ensure people received a good standard of care. Daily ‘walk arounds’ and regular audits took place but shortfalls with people’s documentation had not been identified. There was a strong caring ethos, which was adopted throughout the staff team.

Rating at last inspection: At the last inspection on 5 and 6 July 2016, the service was rated as Outstanding. The report of this inspection was published on 10 August 2016.

Why we inspected: This was a planned, comprehensive inspection, based on the rating at the last inspection.

Action we told provider to take: We made two recommendations as part of this inspection. This was to improve the content of Mental Capacity Assessments and the information regarding “as required” medicines and the application of topical creams.

Follow up: We will monitor all intelligence about the service and complete another inspection in line with this and our frequency of inspection guidance.

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

At the time of our inspection there were 38 people living there.

The inspection took place on the 5 and 6 July 2016. The first day of the inspection was unannounced. At our last inspection of Aldbourne nursing home in May 2015 we found the provider did not meet some of the legal requirements in the areas we looked at. The provider wrote to us with a plan of what actions they would take to make the necessary improvements. We found during this inspection that the provider had undertaken all the necessary improvements required to fully meet people’s needs.

The service had a registered manager employed at the home. 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 were supported by very kind, caring and compassionate staff that would go the extra mile to ensure people received an excellent and personalised high standard of care. We found staff had an excellent knowledge and understanding of people’s needs, interests, likes and dislikes. We observed a range of warm and affectionate interactions during our inspection, with people using the service sharing jokes with staff and not hesitating to seek assistance where required.

People received personalised care that was responsive to their individual needs. People had access to activities that included their individual hobbies and interests. Links with the local village community had been established and people were supported to participate in events held within the local village such as fetes and other events that were meaningful to them. Time was spent on a one to one basis with people who chose not to attend group activities.

People, relatives and health and social care professionals spoke positively about staff and felt they had an excellent understanding of people’s individual needs to ensure they received personalised care from all staff. Health professionals told us that the service was committed to supporting people to remain independent or regain any independence lost. They gave examples of how people were supported to live the lives they wanted.

People were safe living at Aldbourne nursing home. There were enough staff on duty to meet people’s care and support needs safely. People received their medicines as prescribed and at the correct times. We saw that risks were managed through regular assessments and associated care plans and reviewed periodically throughout the year. Staff displayed a good understanding of how to keep people safe from potential harm or abuse.

The staff had received appropriate training and supervision to develop the skills and knowledge needed to provide people with the necessary care and support Training was comprehensive and regularly refreshed, with staff attending a range of training as well as training specific to the needs of people using the service, for example dementia awareness.

People spoke positively about the food and told us they received enough to eat and drink. Catering staff were knowledgeable about people’s likes, dislikes and dietary requirements. Action was taken by staff when they were concerned about people’s health and well-being.

There were effective pre-employment checks for the safe recruitment of staff, including criminal records checks and obtaining character references. New staff were inducted into the role with a combination of attending core training, shadowing experienced staff and completing the care certificate workbook.

We checked whether the service was working within the principles of the Mental Capacity Act 2005. We found related assessments and decisions had been properly taken and the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS).

The registered manager investigated complaints and concerns. People, their relatives and staff were supported and encouraged to share their views on the running of the home. The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks or reoccurrence.

The then acting manager and Nominated Individual sent us an action plan stating the work had been undertaken to address the shortfalls we identified.

At this inspection, there was a new management structure in place. We were told a new Nominated Individual and manager had been identified and would register with us shortly. Staff described the management team as 'very approachable and effective.'

We saw improvements had been made. Appropriate assessments had been completed by the Speech and Language Therapist and their recommendations were being followed. Guidance regarding use of thickening agent and use of equipment for moving and handling was available for staff. One member of staff said 'there is more information available for us now so it is clear what is expected.'

People told us they were happy with the service they received. Comments made included "the staff are very nice, caring, polite and respectful." A relative explained "X always looks clean and comfortable when I visit, they tell me they are happy here and that the staff help them as they want and expect. The important thing for me is that X is happy."

We spoke with one relative who was visiting at the time of our inspection, and another relative by phone shortly after our inspection.

We saw people had varying levels of dependency with most people requiring some support with their personal care and mobility. The care we observed was patient and unhurried. For example people were supported to mobilise independently with the use of walking aids. This promoted independence and reduced the risk of pressure ulcer development and other risks associated with immobility.

We observed people were well presented following assistance with their personal care. They seemed relaxed in their home. Some people were engaged in an activity in the lounge which they seemed to enjoy. One relative explained there was always "a nice atmosphere, happy home."

Staff communicated in a friendly, professional manner. One person told us 'they (staff) are very good. They are busy and I sometimes wait for help, but that happens everywhere.' Another person explained the staff are "pleasant and gentle." A relative told us the staff "are kind but there is a lot of bank staff which does not provide continuity."

People's care records were concise and easy to follow. Each person had a summary of their care needs in their room. However they did not always correlate with people's nursing care records which were kept in the manager's office. The nursing records included a more detailed plan of care and communication records from visiting healthcare professionals. A relative said "the care plan in the bedroom is not current."

We saw people in their bedrooms had drinks, some were in easy reach for the person, others were not. Some drinks were thickened as stated in the person's care plan, others were not. There was varying degrees of guidance available for staff to follow. This resulted in descrepancies when staff described to us the consitency when using thickening agent.

The general manager told us no staff had been employed since our last inspection. We saw the policy for staff recruitment had been revised since our last inspection.

We had received notifications without delay. The registered person (provider or manager) must notify us regarding certain incidents effecting people, and when a person has passed away.

The views of everyone we spoke with, along with our findings were summed up

through what people told us.

People told us 'they (staff) don't ask you to do things you don't want to do.' Other people told us 'it's ok here.'

We spoke with two staff, both were able to explain their understanding of consent, however they were not able to describe their understanding of mental capacity assessment and Deprivation of Liberty Safeguards (DoLS). We discussed this with the registered manager as an area for improvement.

People were satisfied overall with the care and support they received.

People told us their home was clean.

During lunch time, we observed staff providing support to people in a patient manner. People were using specialist adapted crockery to enable them to eat their meal independently. Staff helped people to cut their food in an unobtrusive way.

We were asked by two people (on separate occasions) where their bedrooms were. No signs or aids were available to assist people to find their way around the home and gardens.

SOFI was used during mid afternoon to observe two people in the lounge area. During a period of 25 minutes there were two staff in the same area laying tables, but they did not speak to the people sitting there.

A healthcare professional told us staff were proactive at following their instructions, and were available to provide information about a person when requested.

People we spoke with had not had to make a complaint but knew how to do so if they needed to.

The service has not notified the Care Quality Commission appropriately of certain incidents which had occurred in accordance with legal requirements.