Background to this inspection
Updated
18 May 2016
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 inspection took place on 30 March 2016 and was unannounced. The inspection team consisted of two inspectors and an expert by experience in care of people living with dementia. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection we reviewed the information we held about the service and the service provider. The registered manager completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We received feedback from four healthcare professionals who regularly visited people living in the home. These professionals included a GP, a falls specialist, a specialist in adult psychiatry and social worker. This was to obtain their views on the quality of the service provided to people and how the home was being managed.
We spoke with 16 people and four relatives. We looked at six people’s care records including medicine administration records (MAR). During the inspection we spent time with people. We looked around the home and observed the way staff interacted with people. We used the Short Observational Framework for Inspection (SOFI). SOFI is a means of understanding the experiences of people who could not speak with us verbally. We spoke with the registered manager, the business manager and nine staff which included nursing, caring, housekeeping and catering staff. We reviewed a range of records relating to the management of the home. These included seven staff files, quality assurance audits, minutes of meetings with people and staff, incident reports, complaints and compliments. We reviewed feedback from people who had used the service and their relatives.
Updated
18 May 2016
We inspected this service on 30 March 2016. This was an unannounced inspection. Green Pastures Christian nursing home is registered to provide accommodation for up to 30 older people some of whom may have a form of dementia who require nursing or personal care. At the time of the inspection there were 29 people living at the service. The home was set on two floors which comprised of 3 separate units namely Galilee dementia unit downstairs as well as Jordan and Bethany units upstairs.
There was a registered manager in post. 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. The registered manager worked closely with the business manager and a senior nurse.
People who were supported by the service felt safe. The staff had a clear understanding on how to safeguard the people and protect their health and well-being. There were systems in place to manage safe administration and storage of medicines administered through monitored dosage systems. However, there was no system to monitor the stock of people’s prescribed medicines which were stored in boxes. Medication administration records (MAR) were not always completed to show when medication had been given or, if not taken the reason why. Thickening agents were not always stored safely.
There were enough suitably qualified and experienced staff to meet people’s needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.
The registered manager had a good understanding of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. However, staff had a mixed understanding of their responsibilities relating to the MCA.
Staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be restricted of their liberty for their safety. However, the registered manager did not have a clear understanding of their responsibilities in relation to the application of DoLS.
The registered manager informed us of all notifiable incidents. The provider had quality assurances in place. However, these quality assurance systems were not always effective. The provider’s policies needed updating. There was no whistleblowing policy in place.
There were sufficient staff to meet people’s needs. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.
The provider had an infection control policy in place. Staff knew how to protect people from the potential risk of infection.
People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively.
People were supported to have their nutritional needs met. However, we saw the dining experience for people varied. In the downstairs dining room, staff looked rushed to complete lunch tasks in time for the church service.
People felt supported by competent staff. Staff benefitted from supervisions (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.
There was a calm, warm and friendly atmosphere at the service. Staff we spoke with were motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.
People had access to activities and stimulation from staff in the home. Activities were structured to people's interests. We observed people engaged in reminiscing and one to one activities.
Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.
The registered manager had a clear plan to develop and improve the home. Staff spoke positively about the management and direction they had from the manager. The service had systems to enable people to provide feedback on the support they received.
We identified one breach of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we have required the provider to take at the end of this report.