Nelson House

Updated 29 April 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 Care Act 2014.

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

The inspection was carried out by one inspector.

Service and service type

Nelson House is a 'care home'. 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.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

This inspection was unannounced.

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 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 took the last inspection of Nelson House Inspection into account when we inspected the service and made the judgements in this report

We used all this information to plan our inspection.

During the inspection

We spoke with three people who used the service and three relatives about their experience of the care provided. We spoke with four members of staff including the registered manager, senior care worker and two care workers. We reviewed a range of records. This included seven people's care records and multiple medication records. We looked at three 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.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 29 April 2022

About the service

Nelson House is a residential care home registered to provide accommodation and personal care. Support is provided to older people and people living with mental health difficulties. At the time of inspection there were 17 people living at the home.

Nelson House accommodates up to 21 people in one adapted building. There are usually two care staff on day shifts including a senior carer as well as the registered manager and a cook. Nights are covered by two staff, with management on call if required.

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

There were no individual COVID-19 risk assessments for people living at the home or staff, and infection prevention and control policies (IPC) had not been followed. There were no appropriate areas to remove personal protective equipment (PPE). The provider had not completed environmental audits to check that environmental risks were assessed and mitigated. Audits for cleaning were not completed at the home. No cleaning spot checks, or audits were completed to verify that cleaning tasks were completed.

There is no evidence of formal supervisions taking place, and the provider was not following their own policies to ensure that supervision was timely and relevant for staff. There was a lack of oversight of staff recruitment procedures to ensure appropriate pre employment checks were completed and recorded in staff files. One staff member had a European passport copy and ID on file.

Systems were not in place to ensure staff reviewed care plans on a regular basis in accordance with the providers policies.

The provider was not following their own policies to monitor and record accidents and incidents.

There was inconsistent monitoring of people’s views of the service. The last residents meeting was held in August 2021.

Medicines audits were not occurring.

The training matrix identified that staff had no refresher training in end of life care or diabetes.

People, relatives and staff knew who the registered manager and provider were, and felt able to approach them regarding concerns. People told us they felt safe and staff knew how to recognise and report safeguarding concerns.

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

Rating at last inspection

The last rating for this service was good (published 22 May 2018).

Why we inspected

We received concerns in relation to Infection Prevention and Control measures. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to regulation 12, safe care and treatment in relation to concerns around infection control and regulation 17, governance in relation to poor performance management, at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.