Background to this inspection
Updated
13 January 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by 3 inspectors, 1 pharmacist inspector and 1 specialist advisor nurse. The inspection was also supported by 4 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. 2 Experts by Experience spoke with people and relatives during the inspection and 2 Experts by Experience contacted people's relatives and friends by telephone to request their feedback.
Service and service type
Nazareth House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Nazareth House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. A new manager had been in post for just over 2 months and was in the process of submitting an application for registration.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We reviewed the action plan the provider had submitted following the last inspection and all subsequent updates. We also looked at notifications that the service had sent to the CQC. Notifications are information that registered persons are required to tell us about by law that may affect people's health and wellbeing. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 14 people who used the service and 4 relatives of people who used the service about their experience of the care provided. We spoke with the regional manager, the manager, the unit lead, 3 senior care workers, 5 care staff, 1 activities co-ordinator, the catering manager and a visiting healthcare professional. We undertook observations of people receiving care to help us understand their experiences, especially for those people who could not talk with us.
We reviewed a range of records. This included 15 people's care records and 7 people's medication records. We looked at 6 staff files in relation to recruitment. A variety of records relating to the management of the service, including quality assurance, complaints and health and safety were also reviewed.
The 2 Experts by Experience contacted relatives of people living at the home to gather their feedback on the quality of care peop
Updated
13 January 2023
About the service
Nazareth House is a residential care home providing accommodation and personal care to people aged 65 and over, some of whom were living with dementia. The service is registered to support up to 84 people. At the time of the inspection there were 59 people living at the home.
The home is a large adapted residential house which has living space and bedrooms over two floors.
People’s experience of using this service and what we found
The management and the staff team had made significant improvements overall in the management of the home and the quality of care people received since the last inspection. This was reflected in the feedback we received from relatives, staff and health care professionals.
We observed people to be safe and were supported by care staff who knew them well and responded to their needs accordingly. Staff understood safeguarding and how to keep people safe from abuse.
Care plans were person centred and were reflective of people’s current care needs. Individualised risk associated with people’s health and care needs had been assessed and documented with clear guidance for staff on how to minimise the identified risk and keep people safe.
People received their medicines safely and as prescribed. We did identify some issues around assessing risks associated with people who had been prescribed high risk medicines and evidencing multi-disciplinary discussions and decision on the administration of covert medicines.
Processes in place supported the recruitment of staff who had been assessed as safe to work with vulnerable adults. There were enough staff available to ensure the safety of people. Staff received the required training and support and applied learning effectively in line with best practice.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were seen to eat and drink well and were supported to maintain a healthy and balanced diet. People were supported to maintain healthy lives and had access to health and social care professionals where required.
Staff were caring and kind and relatives confirmed this. We observed staff responding to people's needs with dignity and respect. However, we did receive some feedback from people and relatives that certain staff did not always respect people’s privacy and dignity.
People overall received care and support that was person centred and responsive to their needs and requirements. Relatives had been involved in the care planning process. However, people did not always have access to appropriate activities which would provide interaction and stimulation and support their mental well-being. Not all staff took a responsibility to ensure there was varied programme activities planned and delivered in the absence of the activities coordinator.
People and relatives knew who to speak with if they had any concerns or complaints to raise.
The management team had reviewed and implemented several audits and checks to monitor the overall quality of care people received. Issues identified were clearly linked into an evolving action plan which was reviewed and updated regularly. The provider was working closely with the local authority to implement and sustain improvements.
We have made 3 recommendations to the provider and the management team about sustaining the improvements and embedding all learning and developments going forward and ensuring people's privacy and dignity is respected at all times.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and updates
The last rating for this service was inadequate (published 17 June 2022) and there were multiple breaches of regulation. We took enforcement action due to the significant concerns found. A Warning Notice for the breach of regulation 12 and 17 was issued to the provider following the inspection. 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 and the provider was no longer in breach of those regulations and had met the requirements of the Warning Notice. However, we did identify a new breach of regulation 9, person centred care.
You can see what action we have asked the provider to take at the end of this full report.
This service has been in Special Measures since 17 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 7 and 8 December 2022 to check that the provider had followed their action plan, to confirm they now met legal requirements and to check if the provider had met the requirements of the warning notice we previously served. Whilst improvements have been noted under each of the key questions looked at, the overall rating for the service has remained as requires improvement.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will meet with the provider following this report being published to discuss how they will work towards ensuring they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.