Nairn House Care Home

Updated 21 February 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 2 inspectors, 1 CQC nurse specialist advisor, a CQC pharmacist and 2 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. The Experts by Experience supported the inspection by contacting relatives to gain their feedback on the care provided to their loved ones.

Service and service type

Nairn 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. Nairn House is a care home with 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 one month and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection and formal notifications that the service had sent to CQC. Notifications are information that registered persons are required to tell us about by law that may affect people’s health and wellbeing. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection. We also gained feedback from the local authority.

During the inspection

We spoke with the manager, regional support manager, 3 nurses, 6 care staff, 10 relatives and 2 people living at the home. We looked at 9 people’s care and support plans and risk assessments, 10 people’s medicines records, 6 staff recruitment records. A variety of records relating to the management of the service, including quality assurance and health and safety, were also reviewed.

Updated 21 February 2023

About the service

Nairn House is a residential care home providing personal and nursing care to up to 61 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 45 people using the service.

The home is a large detached building over three floors. People had access to en-suite facilities and adapted bathrooms.

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

We received positive feedback from relatives about the quality of care provided to people living at Nairn House. Relatives told us they felt staff were kind and caring. During the inspection we observed people being treated with respect and dignity.

We identified concerns around people’s risks relating to skin integrity and falls not always being assessed correctly. For people placed at the home for a period of rehabilitation, there was insufficient information in their care records to show how they should be supported.

There had been an unstable management structure with several managers overseeing the home. We found that whilst there was an activities coordinator and activities timetable in place, there was a lack of interaction or stimulation for people who remained in their rooms. Audits had not identified the concerns found during the inspection.

Staff had received training on safeguarding and understood how to report any concerns. People received their medicines safely and on time. There was good oversight of medicines management. The home recognised how important visitors were to people’s wellbeing. There were no restrictions on visiting and we observed relatives and friends visiting throughout the inspection. 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 recruitment was safe and all relevant background checks were completed before they started work. There were some difficulties around staffing and the home had multiple vacancies. At the time of the inspection the home was using agency staff to cover this. Following the inspection, we were told five new nurses and some care staff had been recruited.

Staff told us they felt supported in their role and were able to discuss any concerns with the manager. There were regular staff meetings. There were various mechanisms for people, relatives and healthcare professionals to give feedback.

The provider was responsive to feedback given at the time of the inspection and quickly responded to any issues raised. The home also worked closely with the local authority to help improve the quality of care.

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 2 March 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve the service. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider followed guidance on safe management of medicines. We also made a recommendation that the provider ensured people’s risks were consistently and appropriately assessed. At this inspection we found the provider had addressed previous concerns around medicines. However, we continued to find concerns around how people’s risks were documented and managed.

Why we inspected

We received concerns in relation to people’s nursing care needs, assessing of people’s risk and rehabilitation following fracture and overall management oversight of the home. As a result, we undertook a focused inspection to review the key questions of safe 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 have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nairn House on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches of regulation in relation to assessing and managing risk and management oversight of the home. This was a breach of regulation 12 (Safe care and treatment) and regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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