Archived: Retired Nurses National Home

Updated 9 June 2017

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 comprehensive inspection took place on 18 and 21 April 2017. The first day was unannounced. The inspection was undertaken by two inspectors and an expert-by-experience on the first day, with the lead inspector returning on the second day. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed information we held about the service, including notifications we had received from the service since the last inspection. Notifications are information about significant events that the service is required to send us by law. We also obtained feedback from the local authority social services contract monitoring team.

During the inspection we spoke with 19 people and three relatives about their experiences of the service. We made observations around the home, including observing care and support in communal areas. We also spoke with the registered manager, two care staff, two other staff and a visiting healthcare professional. We reviewed records including five people’s care records and medicines records, four staff files and other records relating to the management of the service.

Updated 9 June 2017

This comprehensive inspection took place on 18 and 21 April 2017. The first day was unannounced.

At the last inspection in January 2016, we told the provider to take action to improve care planning and to comply with the requirements of the Mental Capacity Act 2005. This action has been completed in order to meet the regulations, although improvement is ongoing.

The Retired Nurses National Home is a care home for up to 52 older people. Nursing care is not provided. There were 28 people living there or staying there short term when we inspected. Some people were living with mild or moderate dementia. The service was located in a 1930s purpose-built building. People had individual bedrooms on the ground and first floors, the first floor being accessed by two lifts and three staircases. Communal facilities, such as a lounge, dining room and chapel were located downstairs. There were neatly kept open garden areas to the front and rear of the building, and car parking spaces at the front.

There are eight independent living flats on site and people who live in those are able to participate in activities in the home and have meals. These flats did not form part of our inspection as the service does not provide personal care to people living in them.

As required by the conditions of its registration, the service had a registered manager, who had started in post around the time of the last 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.

People received care and support that met their individual needs. Their independence was promoted. People, and where appropriate their relatives, were involved in decisions about their care.

Staff treated people with compassion and respect, upholding their dignity.

People consented to their care, unless they did not have the mental capacity to give consent. Where they lacked mental capacity in relation to aspects of their care, a best interests decision was made. This took into account the person’s known preferences and there was consultation with the appropriate people, such as relatives and healthcare professionals.

Medicines were managed safely.

People’s nutritional needs were met. There was a choice of meals and snacks were available around the clock. Specialist advice was sought from healthcare professionals where there were concerns about weight loss or swallowing difficulties.

The service had an activities coordinator, who organised a range of group and individual activities for people to take part in if they chose. They had found out about people’s hobbies and interests in order to design the activities programme.

People were protected against the risk of potential abuse because staff understood their responsibility for safeguarding adults.

The premises were regularly maintained, and key checks were undertaken. However, we identified some environmental hazards, which we drew to the attention of the registered manager. Where able to, they took immediate action. Following the inspection the registered manager confirmed that remedial works had been authorised and were being arranged.

People involved in accidents and incidents were supported to remain safe. There were arrangements in place to keep people safe in an emergency. We have made a recommendation regarding the system for identifying treads and patterns in accidents and incidents.

Safe recruitment practices were followed before new staff were employed to work with people. People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. However, a few people said they thought call bells could be answered more quickly, whereas others were satisfied with the response.

People were positive about staff ability to provide the care and support they needed. Staff were supported through supervision and training.

People and staff were confident to raise any concerns with the management team.

There were regular meetings for people and relatives, and for staff, to discuss what was happening at the service and to contribute to improvements.

People’s experience of care was monitored through annual quality assurance surveys to people, relatives and other stakeholders. Information was gathered by an external organisation to be fed back to people and actioned as necessary.

The service worked in partnership with community organisations to improve the experiences of people living at the home.

There were regular internal audits to monitor the quality of the service being delivered. The regional director also visited most months.

Learning from safeguarding investigations and from internal audits had led to changes in practice. The provider had linked with a national organisation that promotes good, evidence-based practice in social care, to provide a dedicated safeguarding telephone line. The provider had also piloted a project to promote dignity in care.