Sandwood Care Home

The Firs Nursing Home can accommodate 31 older people and people living with dementia and nursing needs in one adapted building. Accommodation is provided on three floors; a passenger lift is available. At the time of our inspection 18 people were living at the service.

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

Improvements had been made to the systems and processes that monitored the quality and safety of the service. Audits and checks were robust and up to date. The provider had a detailed action plan to continually drive forward improvements and a more stable, positive and committed staff team.

A new experienced registered manager had been appointed, who had provided good support and leadership to the staff team. Staff were clear about their roles and responsibilities and supported people effectively. People received person centred care and treatment and achieved positive outcomes. The registered manager had developed an inclusive and transparent service.

People who used the service were positive about the care and treatment they received. They felt involved in their care and spoke postivly about the registered manager and staff team.

Staff moral had improved, and staff were positive about their role and felt well supported. Staff spoke highly of the registered manager and their leadership style and support.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 January 2020) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made in the breach of regulation we followed up and the provider was no longer in breach of this regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Firs Nursing Home can accommodate 31 older people and people living with dementia and nursing needs in one adapted building. Accommodation is provided on three floors; a passenger lift is available. At the time of our inspection 26 people were living at the service.

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

People did not receive consistent safe care. People’s dependency needs had not been consistently reviewed, to ensure staffing levels were sufficient in meeting people’s individual care needs and safety. Risks associated with people’s care needs and health conditions had been assessed. However, documentation to confirm care needs had been provided at the frequency required showed gaps. Pressure relieving mattresses to assist in the prevention of pressure ulcers developing, were not set correctly. Best practice guidance in the administration and management of medicines were not followed. Equipment was not consistently clean.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm. Safe staff recruitment checks were completed before staff commenced. Health and safety checks were completed on the environment. The provider had a process that analysed accidents and incidents, but this information was not available during the inspection.

People did not receive consistent effective care. Where people had been identified at risk of malnutrition and required additional snacks, this was not seen to be provided. People’s pre-admission assessment showed gaps in important information such as a person’s religion, social history, interests and hobbies. The environment required some refurbishment work, it was not clear of the plans in place to complete this. Best interest decisions completed for people who lacked mental capacity to consent to their care, did not consistently show who had been involved in the decision-making process.

Staff received an induction, ongoing training and opportunities to discuss their work. Staff worked with external health care professionals in supporting people’s health care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People did not receive care that consistently respected their dignity. Staff used good communication skills and understood people’s needs and involved them as fully as possible in their care. Advocacy information was available for people should they have required this support.

People did not receive care that was consistently responsive to their individual care needs. Staff were not always responsive to requests for assistance, resulting in a delay of care and support. Social activities and opportunities for people to pursue interests and hobbies were very limited. Complaints had not always been responded to in a timely manner.

People received good end of life care.

The leadership of the service had been poor, and this had resulted in staff not being sufficiently supported and guided. Staff were task focused and there was a lack of direction. Whilst audits and checks monitored quality and safety these had not been fully effective in driving forward improvements.

People received opportunities to feedback their experience of the service. The provider had met their registration regulatory requirements.

Rating at last inspection

The last rating for this service was Requires Improvement (published 4 December 2018). The service remains rated Requires Improvement. This is the provider's third consecutive rating of Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

During this inspection, we identified three breaches of the Health and Social Care (Regulated Activities) 2014. This was in relation to people's nutrition and hydration needs being met, care not being consistently respectful or dignified, and the governance of the service.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The Firs Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Firs Nursing Home can accommodate 31 older people and people living with dementia and nursing needs in one adapted building. Accommodation is provided on three floors; a passenger lift is available. At the time of our inspection 21 people were using the service.

There was a registered manager 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.

At the previous inspection in September 2017 we identified some improvements were required in three key areas we inspected; ‘Safe’, ‘Caring and 'Well-led'. This resulted in the service having an overall rating of 'Requires Improvement'. We identified four breaches in Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to how risks were assessed and managed, staffing levels and deployment of staff, how staff respected people’s dignity and the governance of the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions to at least good. The provider sent us an action plan and told us they would make the improvements by 31 January 2017.

At this inspection, we found the breaches in regulation had been met. However, further time was required for improvements and new systems and processes to be fully imbedded and sustained.

Improvements had been made to how risks associated with people’s needs were assessed and managed. Staff had received additional training and guidance in how to mitigate risks. Following the last inspection, staffing levels had increased but had recently decreased, without appropriate assessments being completed. Senior management agreed on the day of the inspection, to increase staffing levels with immediate effect and to complete an assessment of people’s dependency needs. Safe staff recruitment procedures were in place and followed.

Improvements had been made in how staff respected people’s dignity and people’s meal time experience was positive. However, there remained some inconsistencies in staff’s approach.

National best practice guidance in the management of medicines were not consistently followed. This included the administration and record keeping of medicines. Accidents and incidents were reviewed and action was taken to reduce further reoccurrence, but were not consistently sustained. Infection control practice was used and understood by staff, but two people were exposed to unnecessary risk of cross contamination due to seating that could not be cleaned effectively.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm. The management team had worked with the local authority safeguarding team to investigate safeguarding incidents and concerns.

Staff received an induction and ongoing training and support. Staff were knowledgeable about people’s health conditions.

People received a choice of meals and drinks and were assisted to eat and drink where required. People’s health care needs were assessed and monitored, and staff worked with external healthcare professionals in meeting people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Independence was encouraged and supported. Information about independent advocacy services was available. It was not clear how people were involved in opportunities to discuss and review how their care and treatment was provided.

Staff had information to support them to understand people’s needs, preferences and diverse needs. People received opportunities to participate in social activities. The provider’s complaint policy and procedure had been made available to people who used the service, relatives and visitors. People’s end of life wishes had been discussed and planned with them.

The systems, audits and checks on quality and safety had improved and the provider had an ongoing action plan to make further improvements. People received opportunities to feedback their experience of the service.

The service had a registered manager in place at the time of our inspection. 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.

Risks in relation to people developing a pressure ulcer or who had a wound were not always assessed or monitored appropriately. People’s needs were not always met in a timely way due to the way staff were deployed in the service.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions.

People were supported to maintain their nutrition and staff responded to people’s changing health and sought advice and guidance from health and social care professionals.

People were not always supported in a caring and compassionate way and their dignity was not always upheld. People who lived with a dementia related illness were supported by staff when they became distressed and staff respected people’s rights to privacy.

The systems in place to monitor the quality of the service were not always robust in identifying where improvements needed to be made. People were involved in giving their views on how the service was run. The management team were approachable and supportive.

Medicines were prescribed and given to people appropriately. We spoke with three people using the service about their prescribed medicines. They told us that staff gave them their medicine and they were given at the times prescribed by their doctor. We saw medication was stored and administered in line with safe practice.

There was enough equipment to promote the safety and comfort of people who use the service. We saw people had specialist equipment such as chairs to promote good skin integrity. People told us they had equipment they needed to make them comfortable.