Background to this inspection
Updated
8 February 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is 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.’
This inspection which took place on 14 and 15 December 2015 was unannounced and was undertaken by two inspectors.
The last inspection took place in June 2014 where no concerns were identified.
Before the inspection we looked at information provided by the local authority. We reviewed records held by the CQC including notifications. A notification is information about important events which the provider is required by law to tell us about. We also looked at information we hold about the service including previous reports, safeguarding notifications and any other information that has been shared with us.
A Provider Information return (PIR) had not been requested as this inspection had been bought forward. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
Some people living at The Polegate Nursing Centre were able to tell us about their experiences of living at the home. Others were not able to tell us about their experiences; therefore we carried out observations in communal areas and spoke to visitors and relatives.
We looked at all care documentation for three people and a further four care files to follow up on specific areas of documentation. We read daily records, risk assessments and associated daily records and charts for other people living at The Polegate Nursing Centre. Medicine Administration Records (MAR) charts and medicine records were checked. We read diary entries and other information completed by staff, policies and procedures, accidents, incidents, quality assurance records, staff, resident and relatives meeting minutes, maintenance and emergency plans. Recruitment files were reviewed for six staff and records of staff training, supervision and appraisals for all staff.
We spoke with eight people using the service and 14 staff. This included the manager, deputy manager, care and activity staff, chef, housekeeping, maintenance and other staff members involved in the day to day running of the service.
We spoke with four relatives and one visiting professional to gain further feedback about the service.
Updated
8 February 2016
The Polegate Nursing Centre is part of the large Bupa organisation and is registered to provide residential nursing care for up to 44 older people. There were 43 people living at the home at the time of the inspection.
People required a range of help and support in relation to their care and welfare. This included personal support with nursing needs, poor mobility, dementia and end of life care.
The home is purpose built, with a passenger lift, and wide corridors to assist people to access all areas of the building.
This was an unannounced inspection which took place on 14 and 15 December 2015.
At the time of the inspection the registered manager was no longer working at the service and was in the process of de registering as registered manager with CQC. A new acting manager had been working at the service for four weeks, supported by the current registered manager. The acting manager had begun their application process to register as manager of The Polegate Nursing Centre. A registered manager is a person who has registered with the Care Quality Commission (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.
The acting manager was in day to day charge of the home. People told us they had met and spoken to the new manager. Visitors and relatives spoke highly of the manager and told us that there was always someone available to speak to when needed.
We found areas of medicine administration and documentation needed to be improved to ensure people received their medicines in a safe and consistent manner.
People’s privacy and dignity had not been maintained. People with dementia were not always spoken to in a patient and caring manner. People’s personal information was left on view regarding people’s personal care and health needs. Staff were seen to have discussions around care and each other within earshot of other people living in the home. People told us staff had spoken to them about the home, other staff and the work load whilst they were being assisted with personal care.
Care documentation, daily records and charts needed to be improved to ensure relevant information was captured throughout the day.
People’s dependency levels were reviewed and assessed to establish the number of care and nursing hours required. However we saw that people did not always receive assistance in a timely manner. People, relatives and staff we spoke with expressed concern around workloads, call bell answering and assistance with personal care and at meal times.
There were systems in place to assess the quality of the service however these had not identified shortfalls around daily documentation and end of life care. Appropriate maintenance, infection control and health and safety checks were carried out and regular servicing of equipment took place.
Feedback from staff was mixed and some felt that communication between management and care staff needed to be improved.
Fire evacuation plans and emergency evacuation equipment and procedures were in place.
Staff received training which they felt was effective and supported them in providing safe care for people. Recruitment checks were completed before staff began work and there was a programme of supervision and appraisals for staff.
Staff demonstrated a clear understanding on how to recognise and report abuse. Staff understood their responsibilities to ensure people were kept safe.
A weekly leaflet was produced informing people ‘Whats on’ for the following week. People were encouraged to participate in daily activities; we received positive feedback from people who attended.
People, relatives or significant people were kept informed when there had been a change to people’s health. Relatives told us that the acting manager and staff were very supportive.
Feedback was gained from people and staff in the form of questionnaires and meetings.
People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. Menus were reviewed and changes made when requested.
Notifications and referrals were made appropriately to outside agencies when required.
We found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.