Archived: Retired Nurses National Home

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.

There was no registered manager at the home at the time of the inspection, the previous manager ceased their employment at the home on 18 December 2015 before they completed their registration. 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. A new acting manager had been recruited and had started work at the home the week before the inspection. The acting manager was to apply to become registered manager of the home.

The home had also undergone another major change in that Friends of the Elderly took over the control of the Retired National Nurses Home as an organisation in September 2015. As the Retired National Nurses Home remains a separate entity in its own right, both as a company and a registered charity, a new registration was not required.

The Retired Nurses National Home is registered to provide accommodation and personal care for up to 52 people. The home also has eight independent living flats and people who live in those are able to participate in activities in the home and have meals. Nursing care is not provided. At the time of the inspection there were 30 people living at the home.

Improvements were required to make sure the service provided to people was as safe as possible, such as the reviewing of risk assessments to identify actions that could lead to safer outcomes for people.

Staff had been trained in safeguarding adults and were knowledgeable about how to refer any concerns of abuse.

Risks to people’s health concerning the physical environment, had been assessed to make sure that the home provided a safe environment for people.

Accidents and incidents were monitored and audited to see if there were any trends that could make systems and care delivery safer.

The home employed sufficient staff to meet people’s needs.

Robust recruitment procedures were followed to make sure competent and suitable staff were employed to work at the home. The acting manager reviewed staffing files to make sure that all required records were in place and checks completed.

Medicines were managed safely in the home.

The staff team were well-trained and there were systems in place to make sure staff received update training when required.

The home was not meeting the requirements of the Mental Capacity Act 2005 as mental capacity assessments had not all been completed for people living with dementia. Appropriate applications made to the local authority for people at risk of being deprived of their liberty.

People’s consent, where people were able to give this, was gained for how they were cared for and supported.

Staff were not supported through one to one supervision and annual appraisals. In the transition period this level of support to staff had not been provided to the frequency of the home’s policy.

People were provided with a good standard of food and their nutritional needs met.

People were positive about the staff team and the good standards of care provided in the home. People felt their privacy and dignity were respected.

Care planning was in need of improvement. Some care plans did not reflect people’s needs and were not personalised.

The home provided a programme of activities to keep people meaningfully occupied. At the time of inspection there was a vacancy for the post of activities coordinator.

The home had a well-publicised complaints policy and when a complaint was made, these were logged and responded to.

There were systems in place to monitor the quality of service provided to people.

The home was undergoing a period of transition with a new organisation taking over the management of the home in September 2015 and the appointment of a new manager. Staff morale had been affected by the changes and many new staff had been recruited to work at the home.

There were systems in place to monitor the quality of service provided to people.

You can see what action we told the provider to take at the back of the full version of the report.

We looked at three care plans and spoke with five people that live in the home and four members of staff.

We found that people's privacy and dignity was not consistently respected and they were not fully involved in the assessment and care planning process.

We found that the provider had not taken appropriate steps to ensure that people were protected against the risks of receiving care or treatment that is inappropriate or unsafe. Assessments of need had been carried out and care plans were drawn up, but the information contained in these did not evidence what support people needed and how this should be delivered. There was no evidence that individuals had been involved in the care planning process and their wishes taken into consideration.

People we spoke with considered that staff were 'kind and caring'' and they received the appropriate care and support to meet their needs.

The provider was developing systems to assess and monitor the quality of service provision. We found that people were able to comment on service provision, but action was not always taken to address concerns.