Number 9 Anson

9 Anson is a nursing home providing personal and nursing care to up to 20 people. The service provides support for people who have enduring mental health needs. At the time of our inspection there were 15 people using the service.

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

People received their medicines as prescribed. We have made a recommendation to follow best practice in observing people taking their medicines.

Care records identified people’s preferences, support needs and potential risks. Guidance was provided to manage these risks, which was regularly reviewed. People and relatives were complimentary about the staff and said communication with the home was good. Staff respected people’s privacy and dignity. They understood and responded to people’s individual needs. The home was clean throughout, and PPE was used appropriately.

Staff were safely recruited and there were enough staff to meet people’s needs, including accessing the local community. Staff received the training they needed for their roles. Additional breakaway training was being organised by the registered manager. Staff felt well supported by the management team.

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. Where appropriate, people had advocates to act on their behalf.

People were supported to maintain their health and nutritional intake. Referrals to medical professionals were made appropriately. Where required, people were supported to attend medical appointments.

A quality assurance system was in place, with a range of audits being completed. Incidents were recorded, reviewed and discussed in staff handover meetings.

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 16 May 2018.

Why we inspected

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

Recommendations

We have made a recommendation to follow best practice in observing people taking their medicines.

Follow Up

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

Victoria Nursing Home is a care home. The service provides care to people who have enduring mental health needs. 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.

Victoria Nursing home is situated in the Victoria Park area of central Manchester, close to local shops and several bus routes. The home is situated within its own grounds with large gardens and adequate parking. Accommodation was provided over three floors with all communal areas situated on the ground floor.

At the last inspection on 6 and 8 February 2017, the service was rated as requires improvement. We found four breaches of the regulations, as improvements were needed in safe recruitment of staff, we saw that people's dignity was not always maintained; we found risks to the premises were not monitored and the registered provider had not ensured good governance in the home.

At the time of this inspection the home was managed by a registered manager who was registered with CQC in. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff and the management team understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults. People we spoke with and told us they felt safe at the home.

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required. However, we found further work to home’s electrics was required, to ensure the safety of the home was not compromised. We were provided with assurances this work would soon be completed.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely and administered to people in a safe and caring way. We saw that people received their medicines at the correct times.

Staff understood how people consented to the care they provided and encouraged people to make decisions about their lives. Care plans reflected that care was being delivered within the framework of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been applied for when necessary.

We found there were sufficient care staff deployed to provide people's care in a timely manner. Recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date and forward planned. Staff told us they felt supported by the management team at the service.

Staff regularly reviewed people's health. Staff responded to changes in people's needs by making appropriate referrals to their GP or other healthcare professionals. People were assisted to attend appointments with external health care professionals to ensure they received treatment and support for their specific needs.

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.

The provider employed two activity co-ordinators who ensured activities took place seven days a week. We found people were provided a wide range of activities and support for people to access the community.

The service had safe infection control procedures in place and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

The provider had an effective complaints procedure in place. People who used the service and family members were aware of how to make a complaint. Feedback systems were used to obtain people's views about the quality of the service.

People and staff were very positive about the management of the home. The registered manager and operations manager both had a daily presence at the service. Both manager’s had taken action to address improvements around staff support and quality audits since our previous visit. They had also increased people's choices and family involvement at the service.

The previous inspection took place in January 2016 when we rated the service as “requires improvement”. We found breaches in two areas of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. Following our previous inspection, the service submitted and action plan dated 22 March 2016 stating how they would meet the requirements identified. At this inspection we found some improvements in these areas.

Victoria Nursing home is situated in the Victoria Park area of central Manchester, close to local shops and several bus routes. The home is situated within its own grounds with large gardens and adequate parking. Accommodation was provided over three floors with all communal areas situated on the ground floor. The kitchen is situated in the basement with a ‘dumbwaiter’ between there and the dining room. All floors can be accessed via a passenger lift. The home provides personal and nursing care to a maximum of 20 adults with mental ill health and/or people living with dementia.

At the time of this inspection the home was managed by a registered manager who was registered with CQC in. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although the provider was undertaking the appropriate safety checks for legionella, gas and electric. We could not be assured the passenger lift had been tested correctly, due to no evidence of the passenger lift certificate being provided during or after the inspection

We checked staff recruitment files and found gaps in one staff member’s employment history. This meant the service was not completing all the required checks to ensure their staff were safe to work with vulnerable people.

We saw that people’s dignity was not always maintained. People were given plastic mugs to drink out of, regardless of their abilities and the service had not asked people’s views on this.

The service had not discussed end of life care for any of the people living at the home. Meaning their views and wishes with regards to whether they wanted to remain within the service or be taken into hospital, had not been taken into consideration.

We found that policies and procedures had been updated since our last inspection, but staff were not following these. We saw staff were wearing rings with large stones in them, despite the infection control policy stating that ‘only wedding bands’ could be worn.

The service was completing some quality assurance checks, however these were not always completed regularly and they did not provide details about who had completed them, when they had been completed or if any issues had been identified, what action had been taken.

People told us they felt safe living at Victoria Nursing Home and staff knew how to keep people safe and what action to take in the event of an emergency. People received their medicine in a timely manner by registered nurses who ensured the medicine was administered, stored and disposed of safely. Safeguarding incidents had been reported and accidents were recorded and action taken to minimise the risk of reoccurrence.

We observed caring interactions between people and staff who knew them well. Care plans reflect people’s current needs and were regularly reviewed and updated as required. Activities were provided daily, by care staff and an activities coordinator.

People told us they liked the meals on offer, there was always choice and people’s nutritional needs were being met. People who had health needs or cultural needs received appropriate meals to support them. Mealtimes were sociable occasions with staff sitting with people whilst they ate.

There were sufficient staffing levels on duty throughout our inspection. An inspection of the training records showed that staff had received training in areas to support them with the role. All staff were encouraged and supported to complete vocational qualifications in health and social care.

Staff we spoke with had a good understanding with regards to seeking a person’s consent before carrying out any care and support. Staff had undergone training in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and the service followed the requirements of the MCA Code of practice and DoLS. This helped to protect the rights of people who were not able to make important decisions for themselves.

The service had a formal complaints procedure in place, but this was not available in different formats to support people living with dementia to understand. Any complaint received was recorded and acted on in a timely manner.

Notifications were sent to the Care Quality Commission as required and the rating from our last inspection was displayed in the service.

During this inspection we found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014.You can see what action we have told the provider to take at the back of the full version of the report.

Victoria Nursing Home is situated in the Victoria Park area of Central Manchester close to local shops and several bus routes. The home is situated within its own grounds with large gardens and adequate parking. Accommodation is provided on three floors with all communal spaces situated on the ground floor. The home provides nursing care for up to 20 adults living with mental health issues and / or dementia.

The home had a manager registered with the Care Quality Commission (CQC) who, due to annual leave, was not present during the inspection. A registered manager is a person who has registered with CQC 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 and associated regulations about how the service is run.

We found two breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We found that the premises were not as safe or as well maintained as they should have been. This was in relation to the absence of some call bells, bedroom doors not shutting properly, discharging excessively hot water in a bathroom, an unsecured area into the eaves of the house posing a risk of entry and a broken toilet seat and cistern. The premises must be properly maintained to ensure that people are kept safe and their needs are met.

We found that some of the policies and procedures, including information in the staff handbook, were either not in place or were out of date. Policies need to be reviewed and updated to ensure information reflects current legislation and guidance.

We found that suitable arrangements were in place to help safeguard people from abuse. Inspection of training records showed that all staff had completed safeguarding training; however some long-serving staff had not received any updated training since October 2011. We recommend the service considers providing more up to date safeguarding training for the staff.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited and supported. We did note however that the recruitment policy and procedure was not detailed enough. The information contained within the policy and procedure did not reflect the home’s actual practice. There was no guidance in relation to checking with the Nursing and Midwifery Council (NMC) that the registered nurses who worked at the service had a current registration. There was also no information in relation to the decision making process to be used in the event of a disclosure of criminal activity being identified. We recommend the service updates their policy and procedure to reflect what they actually do.

Although we were aware that the registered manager and the nursing staff were qualified as Registered Mental Health Nurses (RMN), it was noted that there was no specific mental health training for the majority of the care staff. To help staff develop their knowledge and skills we recommend the service considers providing mental health training for care staff, with particular emphasis on dealing with challenging behaviour.

The care records we looked at showed that risks to people’s health and well-being had been identified, such as the risk of self- harm, choking, pressure sores and poor nutrition. We saw that plans were in place to help reduce or eliminate the identified risks. The care plans gave detailed information about the person’s individual preferred routines and their likes and dislikes. This showed a person-centred approach to providing care. We saw however that two of the care plans did not have sufficient information in place to show how people were to be supported with certain aspects of their health. We recommend that, to help ensure the health and well-being of people is protected, the service looks for a best practice solution to ensure that all care records reflect the care required.

Although systems were in place to monitor the quality of the service provided there was not always enough information to show whether any areas for improvement had been identified and addressed. We recommend the service considers current good practice guidance in relation to the auditing of the service and facilities provided.

During our visit we saw staff treating people with respect and dignity. People living at the home were complimentary about the support and care that the management and staff provided.

Social and recreational activities were being provided and interactions between staff and the people who used the service were warm, friendly and relaxed.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and people were able to choose what they wanted for their meals.

We found the system for managing medicines was safe and we saw how the staff worked in cooperation with other health and social care professionals to ensure that people received timely, appropriate care and treatment.

We saw that procedures were in place to prevent and control the spread of infection and risk assessments were in place for the safety of the premises. Systems were in place to deal with any emergency that could affect the provision of care and we saw that the equipment and services within the home were serviced and maintained in accordance with the manufacturers’ instructions. This helps to ensure the safety and well-being of everybody living, working and visiting the home.

Appropriate action had been taken with regards to the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People told us the manager and staff were approachable and felt confident they would listen and respond if any concerns were raised.

As part of this inspection we spoke with one person who used the service, the registered manager, the provider and a member of the support staff. We also reviewed records relating to the management of the home which included a care plan and daily care records.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. Please read the full report for the evidence supporting our summary.

The registered manager sent us an action plan in July 2014, telling us what improvements they would make to care records in order to safeguard the health, welfare and safety of people admitted to the home.

When we inspected the service in April 2014 we found that a person had been living in the home for two months, with no care plan in place. This meant that support staff did not have written guidance on what they should do to support the person in a safe and consistent manner.

During this visit, we saw that improvements had been made by making sure people had care plans in place at the point of admission. One person had been admitted to the home since our last visit. We saw that their needs had been thoroughly assessed and care plans, risk assessments and risk management guidelines were all in place.

A member of the support team confirmed that they had been given sufficient information to safely meet the person's needs when they moved into the home. They said they had read the care records and had also been given verbal information from the nurse in charge when they passed on details about people's care and support needs at each shift change.

The action taken to implement care plans and risk assessments at the point of admission, meant that support staff had the appropriate information to provide people with safe and consistent care and support.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

Bedrooms belonging to people accommodated in the home were personalised with photographs and pictures and the rooms were clean and tidy. A person showed us their bedroom and told us, "I like to spend time in my room and keep it clean." They told us the manager had bought them a new TV and radio. We saw evidence that systems were in place to ensure electrical and gas equipment in the home was maintained and serviced in safe working order.

The staff we spoke with were aware of the importance of risk assessment and the steps they needed to take to keep people safe from accidental harm. Incident records showed that a person recently admitted to the home had fallen out of bed soon after they moved in. In consultation with the person bed rails had been fitted to keep them safe from further risk.

Protective bumpers had been fitted to beds rails, where used, to minimise the risk of entrapment.

Care plans contained assessments of need and identified risks had been appropriately assessed. Clear guidance was in place for staff to follow in keeping people safe from accidental harm.

Suitable systems and protocols had been developed to make sure people living in the home received their medicines exactly as prescribed by their doctors. People who had been assessed as at risk of weight loss were receiving good support to maintain healthy weights.

Is the service effective?

We saw evidence of people being fully involved in the development of their care plans. These documents had been written in a person centred way, which meant that the specific needs of the individual were reflected in the care and support they received. However, we were concerned to find that a person admitted two months before our visit did not have a care plan. This placed them at risk of receiving inappropriate or unsafe care and support. The manager told us what action they intended to take to make sure each person had a basic care plan in place at the point of admission.

Is the service caring?

During our visit we saw staff interacting with the people they supported in a patient, caring and compassionate manner. We also saw staff offering comfort to a person who became distressed and responding to people's requests for information and guidance.

Care plans were detailed and emphasised the right of the individual to privacy, dignity, respect and independence. Clear written protocols in care plans guided staff on what they must do to provide safe care and support, such as health and nutritional monitoring.

One of the people we spoke with said, "I am treated with dignity and respect and I am able to choose what time I get up, go to bed, go out and what I eat. I like spending time in my room and I like to keep it clean and tidy. Nobody bothers me. It's much better than where I used to live."

Is the service responsive?

The home had a suitable policy and procedure for recording, investigating and responding to complaints. The people we spoke with told us if they had any concerns they would speak to a member of staff, the manager or provider. One person said, "I've never had to make a complaint. If something's not right you just have to speak up and it will get sorted."

We asked three people about their experience of living in the home. They told us they felt safe and they had good relationships with the staff providing their support. Two people praised the provider for installing a small kitchen so they could help themselves to breakfast, snacks and drinks at all times. Similarly, a flexible breakfast routine had been implemented to give people more choice and promote their independence. The three people we spoke with told us these changes had enabled them to be more independent and have more choice in relation to their daily routines.

Is the service well led?

The manager in post at the time of our visit had been registered with the Care Quality Commission (CQC).

Staff told us they were well supported and had access to training and regular supervision. In addition the staff we spoke with told us the manager was always available to discuss any concerns or issues.

We saw evidence of staff meetings and the nurse told us there was a handover of information at the start of each shift. This ensured all staff were kept up to date with important information.

There was a system of audits in place that included care plans, medication and health and safety.

We saw the home's record of incidents and accidents. Each incident or accident had been subject to review and follow up action to reduce potential risks to the health and safety of people living and working in the home.

We found systems in place for people who used the service to give appropriate consent to their care and treatment. People who used the service said they were asked for their permission in relation to care and treatment and were able to do what they liked. We were told: 'I can do what I want.'

Food and nutritional needs were met and people who used the service were provided with the food they liked. One person told us: 'The food's not bad, if you don't like it you can have something else.'

People who used the service felt safe at Victoria Nursing home. We were told: 'The staff are outstanding.' Another person told us: 'We're alright, everyone's nice.'

We found that care and support promoted people's wellbeing and met their individual needs.

We found that the nominated individual and the registered manager dealt with safeguarding issues in keeping with the requirements of the Health and Social Care Act 2008.

We found systems in place to monitor and improve the quality of the service provided at Victoria nursing home.

At this October 2012 visit we checked whether the service had improved in the seven standards identified.

At the previous compliance inspection in May 2012 we found that people at Victoria nursing home enjoyed living there, although one person told us they felt unsettled. During this October 2012 inspection visit we spoke again with the person who had felt unsettled. They told us:

'I feel more settled now that everyone (additional staff employed in response to an event in the home) has gone, and I now feel safer.'

At this October 2012 visit we found improvements in all the standards because the provider now had effective systems in place to identify, assess, and manage risks to health, safety, and welfare.

We also found that the registered provider and manager dealt with safeguarding issues in keeping with the requirements of the Health and Social Care Act 2008.