Background to this inspection
Updated
6 May 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 inspection took place on 7 and 8 February 2017 and was unannounced. The inspection team consisted of an inspector, a specialist nursing advisor with experience of dementia care and an Expert 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.
Before the inspection, we asked the provider to complete 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 reviewed other information we held about the home, which included notifications they had sent us. A notification is information about important events which the provider is required to send us by law. We also contacted the commissioners of the service and Healthwatch Nottinghamshire to obtain their views about the care provided in the home.
During the inspection we observed care and spoke with six people who used the service, three relatives, a domestic staff member, a laundry staff member, two cooks, the maintenance person, two care staff, two nurses, the manager and a representative of the provider. We looked at the relevant parts of the care records of five people, two staff files and other records relating to the management of the home.
We asked the manager to send us an updated training matrix after our visit. The manager did this.
Updated
6 May 2017
This inspection took place on 7 and 8 February 2017 and was unannounced.
The provider is registered to provide accommodation for up to 26 older people living with or without dementia in the home over two floors. There were 11 people using the service at the time of our inspection. The home provides nursing care for older people.
At our last inspection on 20 and 21 September 2016, we served warning notices on the provider in the areas of medicines and good governance. We also asked the provider to take action to make improvements in the areas of person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, and staffing. We received an action plan setting out when the provider would be compliant with the regulations. At this inspection we found that the concerns in the areas of safeguarding service users from abuse and improper treatment and premises and equipment had been fully addressed. However, while improvements had been made, more work was required in all other areas.
The registered manager was no longer working at the home. They had left in September 2016 and a new manager was in place. The new manager had started the process to be registered with the CQC at the time of our inspection. They were available during the 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.
Staff did not always safely manage identified risks to people. Sufficient numbers of staff were not always on duty to meet people’s needs. The management of medicines required improvement.
Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Staff were recruited through safe recruitment processes. Safe infection control practices were followed.
People were not effectively supported by staff to have sufficient to eat and drink. Staff received appropriate induction and training but supervision and appraisal required improvement.
People’s rights were protected under the Mental Capacity Act 2005. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.
Most staff were kind and permanent staff knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People received care that respected their privacy and dignity and promoted their independence.
People did not always receive personalised care that was responsive to their needs. Activities required improvement. Care plans required improvement to ensure that they contained sufficient information to guide staff to provide personalised care for people. A complaints process was in place and staff knew how to respond to complaints.
The provider was not fully meeting their regulatory requirements. Some systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective. People and their relatives were involved or had opportunities to be involved in the development of the service.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.