Symphony House Nursing Home

Updated 22 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by one inspector.

Service and service type

Symphony House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Symphony House Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 25 May 2022 and ended on 17 June 2022. We visited the location’s service on 25 May 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

We used information gathered as part of monitoring activity that took place on 18 March 2022 to help plan the inspection and inform our judgements.

During the inspection

We spoke with three people who used the service and three friends and relatives of people using the service, about their experience of the care provided. We spoke with four members of staff including the registered manager, one nurse and two care workers.

We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 22 July 2022

About the service

Symphony House Nursing Home is a residential care home providing personal and nursing care to up to 25 people. The service provides support to older people and people with physical disabilities. At the time of our inspection there were 24 people using the service.

Symphony House Nursing Home provides accommodation across 2 floors with 2 communal lounge and dining rooms. The second floor can be accessed via a lift. Bedrooms have private en-suite facilities.

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

Systems and processes to protect people from the risk of abuse had not been followed for people on admission to the service. People living in the service felt safe and staff were trained in recognising and reporting concerns.

Individualised risk assessments were in place. However, measures were not always in place for staff guidance and to mitigate risk. Risks in the environment such as from fire and water safety and hygiene were assessed and mitigated with regular safety checks taking place.

People were not always supported to have maximum choice and control of their lives as mental capacity assessments were generalised to all decisions and did not consider what decisions people could make independently. However, staff were observed and feedback suggested that people were supported in the least restrictive way possible and in their best interests; the policies and systems in the service required improvement to support this practice.

Medicines required some improvement to ensure staff had clear guidance, people received their medicines as prescribed and effectiveness of medicines could be monitored. Medicines were stored and disposed of safely and staff were trained in specialist techniques for administration.

Systems and processes were not consistently effective in maintaining oversight of the safety and quality of the service.

The home was clean and free from odour, infection control measures were in place to prevent the risk of infection. Staff were trained and used PPE appropriately. Staff were tested in line with current guidance.

Accidents and incidents were recorded and analysed for trends and patterns and referrals were made to professionals where required to mitigate risk.

There was a supportive culture in the home with evidence of independence, choice and inclusion. Positive risk taking was supported.

Feedback was sought about people’s experience of care which was collated to look for where improvement could be made. People and their relatives had developed good relationships with staff and were leading their own care. Staff felt well supported, were able to share ideas and concerns and felt listened to. There was evidence of partnership working with other healthcare professionals to support people’s needs and improve the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (Published 21 November 2020) and there were breaches of regulation. The provider was issued with a fixed penalty notice following the last inspection which they paid.

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Symphony House Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding people and managerial oversight of the safety and quality of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider and work alongside them and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.