Background to this inspection
Updated
26 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.
Our inspection was unannounced and took place on 14 and 15 January 2016. The inspection was carried out by four inspectors and a nurse specialist advisor. The specialist advisor provided specialist nursing advice and input into our inspection processes. Our inspection team also included a two 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. Our experts by experience had personal experience of supporting an elderly relative.
We reviewed the information we held about the service. Providers are required by law to notify us about events and incidents that occur; we refer to these as 'notifications'. We looked at the notifications the provider had sent to us. We used the information we had gathered to plan what areas we were going to focus on during our inspection.
We spoke with 33 people who lived at the home, 10 relatives, nine care staff, three nurses, three unit managers, the clinical lead, registered manager and area manager. We also spoke with two health care professionals and an advocate. We viewed care files for 14 people, medicine records for 18 people, recruitment records for six staff and staff training records. We looked at complaints systems, completed provider feedback forms, and the processes the provider had in place to monitor the quality of the service.
Some people were unable to verbally tell us their experiences of living at the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the needs of people who could not talk with us. In addition we observed staff administering people's medicines, carrying out activities and supporting people during their lunchtime meal.
Updated
26 May 2016
Our inspection was unannounced and took place on 14 and 15 January 2016.
Netherton Green Residential and Nursing Home is registered to provide accommodation and support for 120 people. The home is a purpose built building and consists of four separate single storey buildings each accommodating up to 30 older people. The four units are called Saltwell, Darby House, Windmill House and Primrose. On Windmill House, nursing care was provided to people who lived with dementia and 28 people were in occupancy. Primrose provided care for people who lived with dementia and 29 people were in occupancy. On Darby House palliative nursing care was provided and 25 people were in occupancy. Saltwell provided intermediate/rehabilitation nursing care and 30 people were in occupancy. This is a step down support unit for people discharged from hospital who were not ready to return to their own homes.
At our last inspection of July 2014 the provider was not meeting two regulations that we assessed relating infection control standards and staffing levels within Primrose unit. Improvements were also required regarding the caring approach towards people and the level of interaction from staff with people who lived with dementia, on Primrose. Following our inspection the provider sent us an action plan which highlighted the action they would take to improve. Our inspection findings confirmed that improvements had been made. However we found other areas of practice that required improvement at this inspection.
There was a registered manager in post at the home. 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 were kept safe from harm or potential abuse by staff who had been trained and knew how to recognise and report concerns. Information about the risks to people’s safety were communicated and equipment was in place to meet their needs safely.
There were enough staff across the different units but staff were not always effectively deployed to consistently meet people's needs.
People were cared for by staff who had been recruited safely and who had received induction and training. Additional training was needed and had been planned to ensure they met people's needs
and kept them safe. Staff felt that they were well supported.
People's rights were met under the Mental Capacity Act 2005 (MCA), and the Deprivation of
Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority. Assessments of people’s capacity and advanced decisions made by them were known.
Most people enjoyed the meals offered. Some people were not proactively given a choice because information about meals was not provided in a way they could understand. Some people did not receive the support they needed to eat and drink sufficient amounts.
People were complimentary about the staff and described them as kind and patient. However some people’s support was not sufficiently personalised to meet their needs and preferences. People’s dignity was at times compromised because staff did not always promote choice or anticipate the needs of people whose communication was limited.
People told us that they felt that activities at the service were limited. We saw the provider was taking action to improve this.
People were given information on how to make a complaint and systems were in place to manage complaints. People felt the home was well led. There was a new management structure in place. We saw quality assurance systems had improved and had picked up a number of shortfalls which the registered manager had plans to address. However we found additional areas that required improvement which demonstrate care practices and processes are not consistently embedded to ensure people receive person-centred, quality care.