Rushey Mead Manor Care and Nursing Home

Rushey Mead Manor Care and Nursing Home is a residential home providing personal care for up to 50 people, including those living with dementia related needs, physical disabilities or end of life care. The home is multicultural, where Asian languages are spoken as well as English. At the time of the inspection there were 26 people using the service.

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

People felt safe because staff were trained and understood their responsibility to protect people from abuse and harm. People were confident staff would take action if they raised any concerns. Records showed safeguarding processes were followed.

Risks to people had been assessed and kept under review. Care plans were person centred and provided guidance for staff to follow to minimise risk and to promote people’s safety, dignity and independence, as practicable.

People received their medicines as prescribed. When we identified risks the registered manager took immediate action to address this to ensure medicines were managed safely.

People were provided with a choice of food to encourage healthy and balanced diet. Individual food preferences, cultural and dietary requirements were met to maintain good health.

The service employed a nurse, who provided advice and support to staff when people’s health was of concern. People were supported with their oral hygiene needs. The service worked in partnership with health care professionals. People were supported to access community health care services as and when required.

Staff recruitment processes promoted safety. New staff were inducted. Staff were fully trained and competent in their roles. There were enough staff employed to meet people's needs. Staff received feedback on their performance through regular supervisions.

Staff followed infection control procedures to keep people and visitors safe from the risk of contagious diseases.

Incidents and accidents were clearly recorded and actions were taken to learn from these and to reduce the risk of reoccurrence. Systems were in place to ensure the premises and equipment used in the delivery of care were serviced and maintained. People, relatives and staff spoke positively about the environmental improvements and decoration.

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 received person centred care, and staff promoted and respected their preferences, cultural and diverse needs. Information was provided in forms people could understand. Staff were able to speak with people in their preferred language which was not English.

People had opportunities to follow their interests and hobbies and maintain relationships with their family and friends. Staff spent meaningful time with people who were cared for in bed to reduce the risk of isolation.

People and relatives knew how to complain. The complaints process was managed effectively in line with the complaints procedure.

People received compassionate and dignified end of life care in line with their wishes documented in their care plans.

The service was well managed. There were systems in place to monitor the quality of the service and improvements were made when required. Staff felt well supported and said the registered manager, care manager and provider were open and approachable. The service worked in partnership with outside agencies.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 September 2021) and there were 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 and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Safe, Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rushey Mead Manor Care and Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People were supported by staff to keep in touch with those important to them. Relatives and friends visiting the home were required to complete a COVID-19 test, had their temperature check and wore Personal Protective Equipment (PPE).

We saw PPE was accessible within the home and staff used it in accordance with the most up to date guidance. Information about the correct use of PPE and handwashing guidance was displayed throughout the home. Staff had undertaken training on infection prevention and the correct use of PPE.

People and their family members had been involved in decisions in all matters related to COVID-19, which included regular testing and vaccination. Individualised approaches to supporting people during the pandemic had been made in recognition of people’s needs.

Staff and essential care givers engaged with a programme of regular testing according to government guidance. Staff and visiting professionals were asked to provide evidence of their vaccination status against COVID-19 prior to entering the home.

The provider had an ongoing refurbishment programme in place, which considered infection prevention measures.

Cleaning schedules and recording documents had been designed specifically for each area of the home and were reviewed weekly. Information about good practice in infection control was displayed.

The service comprised of three floors. The upper floor was undergoing extensive refurbishment and was not being used at the time of our visit. At the time of our inspection there were 26 people using the service. Two people were in hospital at the time of our visit.

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

The management of people’s medicines needed to be strengthened to ensure people received their medication safely. We found some areas of medication administration did not follow best practice.

Further improvements were needed to the risk assessments and care plans to make sure they contained detailed guidance for staff to follow. We were informed that these were being transferred onto a new electronic system and so not all of them had been reviewed and improved.

Although staff rotas showed there were sufficient staff on duty, we found people were left unsupervised for long periods and they often had to wait before staff attended to their needs in a timely manner.

We have made a recommendation about safe staffing levels.

Although staff wore appropriate Personal Protective Equipment (PPE) we found that PPE was not always well managed, and some areas of the environment required improvement to ensure they were easy to clean and to keep people safe from the spread of infection.

We found that systems in place to ensure people’s oral healthcare needs were met needed to be strengthened.

We have made a recommendation about the management of people's oral health care needs.

Systems in place to meet people’s nutritional and hydration needs were not adequate to ensure people’s dietary needs were met. We found a lack of choice, poor staff knowledge about people’s dietary needs and inadequate nutritional screening.

Staff training records showed there were some gaps in staff training. They showed that training in areas necessary for a staff member’s role had not always been undertaken. For example, the staff rota showed there were two ‘nutritional assistants’ employed but the training records showed they had not completed training in relation to nutrition and hydration. The provider had put plans in place to make improvements to staff training.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

We found there was a lack of choice in relation to people’s meals and activities. We observed staff taking people from one area of the home to another without asking them if that was what they wanted.

There was a wide range of quality checks in place to monitor the quality of the service. However, these needed to be strengthened to ensure they identified areas where improvement was needed.

People and their relatives felt that Rushey Mead Manor Care and Nursing Home was a safe place to live. Staff we spoke with had an understanding about how to recognise abuse and the steps they needed to take to report any concerns.

Staff received an induction when they first commenced work at the service. Most staff felt well supported by the management team, and in particular the registered manager.

The registered manager and the provider had identified that further development was needed and had implemented numerous improvements. They were in the process of developing an action plan detailing their priorities to bring about change.

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

Rating at last inspection

The last rating for this service was Good (published 22 October 2020).

Why we inspected

The inspection was prompted due to whistle-blowing concerns received about poor staffing levels, a lack of choice, and the management and leadership of the service. A decision was made for us to inspect and examine these risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rushey Mead Manor Care and Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified three breaches in relation to the safe administration of medicines, risk management and infection control, meeting peoples nutritional and hydration needs and good governance.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Rushey Mead Manor Care and Nursing Home is a care home that provides accommodation for persons who require nursing or personal care including those with dementia related needs, physical disabilities or end of life care. The home is multicultural and Asian languages are spoken as well as English. The home can accommodate and care for up to 50 people.

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

Care plans required more person-centred information to ensure people received care in line with their likes, dislikes and preferences. The registered manager told us written information could be provided in different languages or made available in large print on request. However, we were not able to find any information recorded about whether people had been asked if they would like information to be provided in their first language.

People and their relatives felt that Rushy Mead Manor Care and Nursing Home was a safe place to live. Staff we spoke with had completed training in safeguarding vulnerable people from abuse and understood how to recognise abuse. Risks to people's safety were assessed and strategies were put in place to reduce any risks. There were sufficient numbers of staff who had been safely recruited to meet people's needs.

People’s medicines were safely managed, and systems were in place to control and prevent the spread of infection.

People's care needs were assessed before they went to live at the service. At the time of our inspection the staff were not undertaking home or hospital visits to complete assessments of needs. The local authority were providing these to the service.

Staff received an induction when they first commenced work at the service and ongoing training that enabled them to have the skills and knowledge to provide effective care. Staff felt well supported by the registered manager and new registered provider. They received regular supervision and said they could contact the registered manager if they needed support.

People’s cultural and dietary needs were well met with English and Indian meals being available, both vegetarian and meat based. People were supported to follow the correct cultural etiquette when eating and were supported to eat and drink enough to maintain their health and well-being. Staff placed a strong emphasis on the dining experience to ensure it was enjoyed by all.

Staff supported people to live healthier lives and access healthcare services.

The new registered provider took over the service in March 2020. They had addressed areas of immediate safety such as installing a new call bell system and replacing broken fire doors and emergency lighting. They had commenced extensive refurbishment work at the time of our visit.

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.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service and understood their cultural needs well. People and relatives, where appropriate, were involved in the planning of their care and support. People's privacy and dignity was always maintained.

There was a complaints procedure in place and systems to deal with complaints effectively. The service provided appropriate end of life care to people when required.

People, relatives and staff were positive about the improvements already made at the service. Systems in place to monitor the quality of the service had been enhanced and actions were taken, and improvements made when required.

Staff felt well supported by the registered manager and the new registered provider. They described them as approachable and responsive. The service worked in partnership with outside agencies.

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

Rating at last inspection

This service was registered with us on 18/03/2020 and has not been inspected.

The last rating for this service was requires improvement (published 24 August 2019). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about people’s care and support needs, infection control practices, the environment and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the registered provider needs to make some improvements. Please see the responsive section of this full report.

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.