Background to this inspection
Updated
5 July 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 took place on 24 May 2016 and was unannounced. The inspection team consisted of two inspectors, a nurse specialist and an expert by experience. The expert-by-experience had a background in caring for elderly people.
Before the inspection we looked at previous inspection reports and notifications about important events that had taken place at the service, which the provider is required to tell us by law. The provider completed a Provider Information Return (PIR). The 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.
We observed the care provided for people. We spoke with 12 people and four relatives about their experience of the service. We spoke with nine staff including the registered manager, two nurses, one senior carer, the lead housekeeper, two care workers, the cook and activities co-ordinator to gain their views about the service. We also spoke with the provider for the service. We asked four health and social care professionals and a member of the local authority safeguarding team for their views about the service.
We spent time looking at records, policies and procedures, complaint and incident and accident monitoring systems. We looked at fourteen people’s care files, six staff record files, the staff training programme, the staff rota and medicine records. At the end of the inspection we asked for more information to be sent to us. The registered manager sent us further information about staff supervision and training and about how nursing staff updated their skills and knowledge after the inspection.
At the previous inspection on 30 August 2013, the service had met the standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Updated
5 July 2016
The inspection was carried out on 24 May 2016 and was unannounced.
The service provided accommodation, personal and nursing care for up to 50 older people. The accommodation spanned two floors and a lift was available for people to travel between floors. There were 49 people living in the service when we inspected. Thirty people were accommodated in part of the service which was designed for people who needed nursing care. Nursing staff and care staff assisted people to manage chronic and longer term health issues associated with aging or after an accident or illness. This included compassionate end of life care. The other part of the service provided residential accommodation and care to 19 people who had lower care needs.
There was a registered manager employed at the service. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills maintaining their registration with the Nursing and Midwifery Council (NMC). However, the registered manager had not ensured that a consistent system was in place for staff supervisions, appraisals and nursing staff revalidations.
We have made a recommendation about this.
There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely.
Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred. End of life care was delivered by consent and mutually agreed with people and their families. Additional specialist end of life nursing guidance and training was provided by staff from a hospice.
The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the service had been tested and well maintained.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.
The registered manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. A robust agency back up system was in place. The provider had a system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively and the registered manager provided nurses with clinical training and development.
People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.
We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Nursing staff understood their professional responsibility to safeguard people. The registered manager responded quickly to safeguarding concerns and learnt from these to prevent them happening again.
Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff.
People had access to qualified nursing staff who monitored their general health, for example by testing people's blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.
Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. This included checking nurse’s professional registration.
We observed staff that were welcoming and friendly. People and their relatives described staff that were friendly and compassionate. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.
If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with.
The registered manager of the service, nurses and other senior managers were experienced and provided good leadership. They ensured that they followed their action plans to improve the quality of the service. This was reflected in the changes they had already made within the service.