Symphony House Nursing Home

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.

Symphony House is a residential care home that can provide personal and nursing care for older people. The service is registered care to a maximum of 25 people. At the time of inspection 24 people were living at the home.

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

The registered manager had failed to notify the commission when people using the service had died. The registered person is required to notify the commission when people die without delay. 21 deaths had not been reported to the commission since October 2018.

There were systems in place to assess the quality and safety of the service. However, the provider lacked oversight by failing to ensure that notifications were sent to the commission.

People using the service were safe. Staff were trained to safeguard people and knew how to keep them safe from risks to their safety and well-being. The registered manager had arrangements in place to maintain and service the premises and equipment to make sure they were safe. The premises were clean and tidy. Staff followed good practice when providing care and when preparing and handling food which reduced infection risks.

There were enough trained and competent staff to support people. The registered manager carried out safe recruitment checks on staff before they started work to make sure they were suitable for the role. They met with staff regularly to keep them up to date with any changes at the service.

Medicines were safely managed. Systems were in place to regularly check staff competency when administering medications.

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 24 September 2019)

Why we inspected

The inspection was prompted in part due to concerns about the lack of statutory notifications received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed following this focused inspection from good to requires improvement. This is because there was a breach of regulations. A breach of any regulation is a ratings limiter. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the well-led section of this 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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of regulation in relation to notifications of death of a service user at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Symphony House Nursing Home is registered to provide accommodation and nursing care for up to 25 older people. The service comprises of two buildings joined by a hallway. At the time of the inspection there were 24 people using the service.

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

People received safe care and were protected against avoidable harm, neglect and discrimination. Risks to people’s safety were assessed and strategies were put in place to reduce any risks. There were sufficient numbers of staff who had been safely recruited to meet people’s needs.

Peoples medicines were safely managed, and systems were in place to control and prevent the spread of infection.

People’s care needs were assessed before they went to live at the service, to ensure their needs could be fully met. Staff received an induction when they first commenced work at the service and ongoing training that enabled them to have the skills and knowledge to provide effective care.

People were supported to eat and drink enough to maintain their health and well-being, staff placed a strong emphasis on the dining experience to ensure it was enjoyed by all. Staff supported people to live healthier lives and access healthcare services.

The service had a vibrant and welcoming atmosphere where visitors were welcomed and encouraged. The premises were homely and adapted to meet the needs of people using the service.

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.

Staff provided care and support in a very caring and meaningful way. They knew the people who used the service very well and had built up kind and compassionate relationships with them. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was always maintained .

Care plans were detailed and supported staff to provide personalised care. People were encouraged to take part in a variety of activities and interests of their choice. There was a complaints procedure in place and systems in place to deal with complaints effectively. The service provided appropriate end of life care to people.

The service was well managed. There were systems in place to monitor the quality of the service. Actions were taken, and improvements were made when required. Everyone without exception praised highly the registered manager who was approachable, resourceful and provided strong leadership. All staff told us they were motivated to work with the registered manager to ensure people received good quality care.

The service worked in partnership with outside agencies. Staff, people using the services and relatives were encouraged to provide feedback which was analysed and acted upon.

Rating at last inspection (and update): The last rating for this service was Requires Improvement (published 28 September 2018) and there was one breach of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

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.

Symphony House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Symphony House Nursing Home is registered to provide accommodation and personal care to up to 25 people in one adapted building. At the time of the inspection there were 22 people living in the home.

At our last inspection on the 16 June 2017, this service was rated overall as “Requires improvement”. At this inspection, although some improvements had been made there were areas that needed further improvement. The service remains rated overall as “Requires improvement”.

There was a registered manager in post at the time of our inspection. 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.

Appropriate systems and processes were not in place to assess, monitor and improve the quality and safety of the service. Quality assurances processes were not always effective at identifying shortfalls and where shortfalls were identified these were not always addressed in a timely manner to minimise the impact on people.

The way in which staff had been deployed had not always been effective in ensuring people’s needs were met in a timely manner.

There were elements of environmental safety that needed to be addressed to ensure that the environment people lived in was safe.

The policies and systems in the service had not resulted in applications being made under the Deprivation of Liberty Safeguards when needed. However, people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Care plans were written in a person-centred approach and detailed how people wished to be supported. Staff discussed people’s care needs with them and supported them to make decisions about how their care would be provided. However, people did not always feel fully consulted and involved with their care plans.

People were supported and encouraged to eat well and maintain a balanced diet. People were supported to maintain good health. Staff had the knowledge and skills to support them and there was prompt access to healthcare services when needed.

Staff were aware of the importance of managing complaints promptly in line with the provider’s policy. People living in the home were confident that any issues would be addressed and that if they had concerns they would be listened to.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. People felt safe in the home and received care and support from staff that had a good understanding of their role in safeguarding people.

Staff were committed to the work they did and had good relationships with the people who lived in the home. People interacted in a relaxed way with staff, and enjoyed the time they spent with them.

At this inspection we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Symphony House Nursing Home is registered to provide support for up to 25 people who require accommodation and personal care or nursing care. At the time of this inspection there were 23 people living in the home.

There was a registered manager in post at the time of our inspection. 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 time of the inspection it appeared that we had not received statutory notifications of deaths or safeguarding referrals that had occurred in the home. These are notifications that are required to be submitted by the provider to CQC by law and we are currently looking into this matter.

Appropriate systems and processes were not in place to assess, monitor and improve the quality and safety of the service. The provider did not have sufficient oversight of the service and the registered manager’s workload had impacted on their ability to carry out their role effectively. Records related to training were incomplete and there was no plan in place for future training.

People's capacity to consent to their care and support was not always considered. Applications under the Deprivation of Liberty Safeguards (DoLS) had not been made as required for some people. Some staff had not received training in Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS); there was a risk that staff would not have sufficient understanding of the requirements of the MCA (2005).

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service; however there was no process in place to review criminal records checks. Although there were enough staff on duty, the way in which they were deployed meant that people sometimes felt rushed.

Arrangements in place for formal staff supervision required strengthening. Records showed that staff did not have regular opportunities to formally meet with their line manager to discuss their role.

People continued to receive safe care. People were consistently protected from the risk of harm and received their prescribed medicines safely. People were supported to maintain good health and had access to healthcare services when needed; relevant health care professionals were appropriately involved in people’s care. Staff supported people to have sufficient amounts to eat and drink to help maintain their health and well-being.

People developed positive relationships with the staff, who were caring and treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage complaints.

The service had a positive ethos and an open culture. People, their relatives and staff told us that the registered manager was a visible role model in the home. There were opportunities for people and staff to contribute to the running of the home.

At this inspection we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

We spoke with the relatives of two people who used the service, they all told us that they were happy with the care that was provided. One person told us that if they were in need for a nursing home, that they would be happy to live at Symphony House Nursing Home.

We spoke with six members of staff, they all told us that they had received training in the safeguarding of vulnerable adults and had their appraisals yearly.

We found that the home had improved by ensuring that there was an up to date safeguarding policy and the staff had received mandatory training. However, we found that the provider had not reported any deaths to the Commission since February 2013.

People spoke highly of the staff that looked after them. One person told us 'I can't find fault with the staff they are lovely', another person told us 'the staff help me maintain my dignity' and people told us that their visitors are always made to feel welcome.

We spoke with two relatives of people who used the service, they told us that the care was outstanding. One relative told us, 'I could not fault the excellence and commitment of the manager in providing the best care possible for my father.' Another relative told us 'the care is brilliant, we are kept well informed so we understand what is going on, the nurses really do care.'

We found that people's needs had been assessed and care had been provided safely. We saw that people's dignity was maintained and people were involved in planning their own care.

However, we found staff had not completed all of their mandatory training and there was no up to date information available to staff regarding procedures to make a safeguarding alert.

We found that people living in the home were well cared for that and their needs were provided for. We also found that there were initiatives to make living at the home more homely by involving relatives and friends in social activities. We found that people were given the opportunity to choose how they wanted to live and make plans for the future.