Archived: Nethercrest Residential Home

Below is a summary of what we found. The summary is based on our observations during the inspection. We spoke with nine of the 33 people who used the service, four staff and the registered manager.

We found that the provider had made the necessary improvements with respect to supporting people with their needs and ensuring they received their medicines when they needed them. We saw care records had been improved to show how people's needs should be met safely

Is the service safe?

We saw that plans were in place which identified people's needs and any risks they faced to their safety or health. The plans included information about how to reduce risks such as falling or fragile skin, to help keep people safe.

We saw that monitoring records were in place. These reflected that care interventions were consistently carried out for people with fragile skin, or people at risk of not eating or drinking enough. This meant people had the care they needed to avoid further risks.

Effective systems were in place to ensure that people's medicines were managed appropriately. People had their medicines on time and in a way they preferred or needed. This was because plans detailed how people's medication should be provided. We saw systems were in place to guide staff in the safe handling of medicines. Checks had been made on staff competencies to do this safely. The manager had robust weekly checks to ensure there was a supply of people's medicines and to check records were completed properly. One person told us, 'I do sometimes need pain killers and the staff provide these'. We saw people had plans in place to ensure they had safe and effective pain management.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. For example staff understood how to keep people safe who were at risk of leaving the building. We saw a 'missing persons' procedure' was in place and staff were aware of those people who needed their whereabouts to be monitored to keep them safe. This meant that lessons had been learned from previous incidents.

We saw that checks had been carried out on staff before they commenced working. The manager understood and had used disciplinary action to make sure that unsafe practice is identified and people are protected.

Is the service effective?

People had their needs and wishes assessed and had been involved in choosing how they were supported.

Arrangements were in place so that people had access to health care professionals so that their medical needs could be met. People had the equipment they needed to manage such things as fragile skin.

We saw that staff had training and support to meet the complex needs of people to ensure they met their needs effectively. The manager had reviewed staff training, observed care practices and provided guidance to staff to ensure staff gained the skills and used them effectively in meeting people's needs. A staff member told us, 'We have guidance in meetings, written records, handovers and we are observed. I think we now do a much better job in meeting people's needs'.

Is the service caring?

We spent time in the communal areas observing staff interactions with people. We saw they made time to chat to people and checked regularly that they were comfortable.

People told us that they were happy with the care they received. One person said, 'I get my privacy and staff are really good at helping me when I need it'.

We saw that staff protected the dignity of people by ensuring they were observant of such things as ensuring people wore their own clothing and were dressed appropriately.

People said their preferences and interests were being met. We found this information was recorded and care and support had been provided in accordance with their wishes. We saw staff knew people's support needs as well as their personality, and took an interest in them. One person said, 'He's lovely always chatting to me, he's a nice bloke, makes sure I'm ok'.

Is the service responsive?

We saw that people attended regular meetings to talk about things they wanted to do. We saw examples of where people's comments had been addressed by staff, such as changes to menus, arranging trips out and bringing in community amenities such as the ice cream van weekly and a visit from the armed forces. Staff had supported people to enjoy activities they were interested in. One person told us, 'It's so refreshing to do exciting things, I'm not too old you know'.

We found that the manager had worked with other external agencies to ensure people's needs were responded to properly.

We saw that staff were well informed of changes to people's care needs. We saw there were systems to monitor accidents and incidents to identify how staff could improve responses.

Is the service well-led?

The service had a quality assurance system in place. We found the monitoring of the service had significantly improved. Records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and had been involved in carrying out audits. This meant staff's understanding of standards had been enhanced and helped to ensure that people received a good quality service.

The manager told us they received good support from their management team and had no concerns about the operational running of the home. Staff told us they felt supported by the manager and had effective working relationships with their team.

We observed a senior care assistant administering medicines during the morning medicine round. They were caring and allowed people time to take their medicines. We also spoke with one person who looked after their own medicines. They told us, ‘’I am very happy here. I like looking after my own medicines especially my painkillers. I can take them when I am in pain without waiting. Not a lot to grumble about really.’’

The service had support from health care professionals. We found that people’s medicines were reviewed and changes made when necessary. The manager told us, ‘’We have had some people’s medicines reviewed by their doctor because they were refusing to take them’’. This shows that the service helped to ensure people were given medicines based on their current needs and lifestyle.

We found that some people had not been given their medicines because they were not available. We were told that due to ongoing problems with the supplying pharmacy the service was changing to a new pharmacy, therefore taking action to address this issue.

Although arrangements were in place to check that medicine records documented what people had been given, we found some people’s medicine records had not been accurately completed. It was not always possible to determine if people had been given their prescribed medicines. The manager agreed that this had been identified as an ongoing problem. We were shown documented evidence that action was being taken to address this issue with staff.

Medicine management issues were clearly identified and recorded by the management team. At the inspection we identified the same issues. The manager agreed this was disappointing due to the ongoing checks and meetings with staff. The manager told us that staff training on safe medicine management was part of the ongoing action plan to ensure medicines were handled safely.

Arrangements were not fully in place to ensure that medicines were managed safely. However, we found that the level of management support available to staff together with ongoing monitoring was ensuring that errors were identified quickly and lessons were learnt to prevent then happening again.

We spoke with 11 of the 39 people living there, the manager, deputy manager, senior care and two care staff. Prior to our inspection we spoke with other visiting health care professionals about their concerns specifically related to the management of fragile skin and the risk of pressure sores.

We found some improvements had been made to people’s care plans so that they reflected their specific health care needs. We saw some care plans had been updated to provide sufficient information to guide staff in the management of health conditions such as diabetes and epilepsy. One person told us, “I’m fine I know about my diabetes and the staff help me”.

Areas of the home that had been redecorated and risks previously identified in relation to the safety of the fire escape had been addressed. This meant that people had an improved living environment.

A lack of appropriate recording in monitoring records meant that care interventions for people with fragile skin was not always clear, and we could not be sure people had the care they needed to avoid further risks.

A health professional said, “Staff have made improvements but do require support and training as some areas are missed”.

People had a care plan that reflected some but not all of their needs. People with specific health care needs did not have sufficient information in their care plan to guide staff. We saw for some people that this meant their needs were not always met.

People were very happy with their meals, one person said, "You always have a choice and if you don’t like what is offered the cook will do something else”. Appropriate arrangements were in place to support people who did not eat or drink enough.

Areas of the home were in need of redecoration, and odour management. Risks were identified in relation to the safety of the fire escape which could compromise people’s safety.

There were enough staff members on duty to meet people’s needs. One person told us, “The staff is lovely they can’t do enough”. Some staff had not received the training necessary to do their job. People told us that they had confidence in the care staff.

People had opportunities to voice any complaints and were confident these would be resolved.

We saw that people’s needs were assessed and their care and treatment was planned and delivered in line with their individual care plan. People told us”, “Staff support in way want more or less” and, “If needed help they (staff) are there to ask”. We observed staff provided care that acknowledged people’s individual needs and gave choice.

People and staff we spoke with told us that they felt able to raise concerns about the service. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Systems to identify risks to effective infection control to reduce the risk and spread of infection were in place. The provider had made improvements that promoted the ambience and cleanliness of the environment.

We saw that there was enough equipment to promote the independence and comfort of people who used the service.

The provider had effective systems in place that identified, assessed and managed risks to the health, safety and welfare of people who used the service and others.