Background to this inspection
Updated
14 September 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 26 and 31 July 2018. The first day of our inspection was unannounced; the second day was announced.
The first day of our inspection was carried out by two inspectors, an inspection manager and an expert by experience. An expert by experience is someone who has personal experience of using or caring for someone who uses this type of service. They specialised in care for older people who had nursing needs and spoke with people who used the service and visitors to understand their views. They also observed interactions including the care and support provided in communal areas, with activities and at mealtimes. We were also helped on the first day of our inspection by a nurse from the Community Infection Prevention and Control Team. They provided specialist advice and guidance regarding the prevention and control of infection in a care setting. The second day of our inspection was carried out by one inspector.
Before the inspection we reviewed information we held about the service. This included notifications which providers send us about certain changes, events or incidents that occur and which affect their service or the people who use it. We contacted the local authority’s adult safeguarding and quality monitoring teams as well as Healthwatch, the consumer champion for health and social care, to ask if they had any information to share.
We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection, we spoke with nine people who used the service, three people’s relatives and four visiting healthcare professionals. We spoke with the registered manager and seven members of staff including nurses, care workers, the activities coordinator, housekeeper and chef.
We observed interactions in communal areas and had a tour of the service, which included, with people’s permission, looking in their bedrooms.
We reviewed six people’s care plans and risk assessments, medication administration records and four staff’s recruitment, induction and training files. We also looked at policies and procedures, meeting minutes, maintenance records, audits and other records relating to the running of the service.
Updated
14 September 2018
This inspection took place on 26 and 31 July 2018. The first day of our inspection was unannounced; the second day was announced.
Dunollie Residential and Nursing Home is registered to provide residential and nursing care for up to 50 older people who may be living with a physical disability or dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Accommodation is provided in an extended building across three floors and a smaller detached property on the same site. At the time of our inspection, there were 45 people using the service. Thirty-three people had nursing needs and 12 people were receiving residential care.
The service had a registered manager. They had been the registered manager since March 2016. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.
At the last inspection in May 2017, we identified breaches of regulation relating to the premises and equipment and the governance of the service. This was because areas of the service were unclean and infection prevention and control practices needed to improve. Audits had been ineffective in monitoring and maintaining standards of hygiene and promoting good infection prevention and control practices.
At this inspection improvements had been made and the provider was now compliant with these regulations. The service was clean and free from malodour. Systems were in place to make sure areas of the service were regularly cleaned. The registered manager acted on feedback about the storage of some equipment and developing cleaning schedules and checks of air-mattresses and cushions.
Records relating to medicines in stock and those administered were not always accurate. This placed people at increased risk of harm. We made a recommendation regarding managing and auditing medicines.
Staff were safely recruited. We received mixed feedback about staffing levels. Some people told us staff were busy at times and not always available to provide support. The provider used a dependency tool to monitor staffing levels and we observed sufficient staff were deployed to safely meet people’s needs.
People told us they felt safe living at Dunollie Residential and Nursing Home. Staff were trained to recognise and respond to safeguarding concerns. Risk assessments contained appropriate information to guide staff on how to safely meet people’s needs.
Maintenance checks helped make sure the home environment and equipment were safe. The provider had systems in place to minimise the risks associated with a fire occurring.
Action had been taken to create a ‘dementia friendly’ environment. We made a recommendation about changes that could be made to further develop this.
Staff received regular training; they told us they preferred face to face practical training to some of the online 'eLearning' courses on offer.
New staff provided positive feedback about the support and guidance provided during their induction. Staff received regular supervision and an annual appraisal of their performance to support their wellbeing and continued professional development.
Nurses completed additional training and were supported with their revalidation requirements.
We received positive feedback about the food. Staff supported people to eat and drink enough and worked effectively with healthcare professionals to make sure people’s needs were met.
People had choice and control over their daily routines. Staff supported people to make decisions and respected people’s choices. Mental capacity assessments and best interest decisions had been documented when necessary. The registered manager appropriately applied to deprive people of their liberty when necessary.
Staff were kind and caring in the way they supported people. People told us staff supported them to maintain their privacy and dignity.
Care plans contained appropriate information and detail to support staff to provide person-centred care. Staff showed a good understanding of people’s needs and the support they required. The registered manager had introduced changes to how care plans were reviewed to make they consistently contained more person-centred information about how people’s needs were met.
Staff worked closely with professionals to meet people’s complex nursing needs. This included working with the local hospice to meet people’s needs at the end of their life.
There were a range of activities on offer and people were happy with the opportunities available to them. Staff supported people to spend their time how they chose and to pursue their own hobbies and interests.
People told us they felt able to raise and issues or concerns. The provider had a formal system in place to manage and respond to any complaints.
People told us the service was well-led and gave consistently positive feedback about the registered manager.
The registered manager and provider completed regular audits to monitor the service provided. Records were organised and there were clear systems and processes in place to oversee and coordinate the effective management of the service.