The inspection visit was carried out on 03 December 2014 and was unannounced. The previous inspection was carried out in May 2014, when non-compliance had been found with three regulations. This inspection included following up the action taken by the service in response to the non-compliance. The inspection was brought forwards because of concerns raised to the Care Quality Commission (CQC) from an anonymous source, in regards to people’s general care and welfare.
The premises are an old detached building situated near to the seafront of Whitstable. The service provides nursing care and accommodation for up to 34 older people, some of whom may also be living with dementia. The accommodation is provided on two floors, with most bedrooms on the ground floor. On the day of the inspection, there were 27 people living in the home, with one admission during the day, taking the total to 28 people.
The service is run by a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some of the people in the home had been assessed as lacking mental capacity to make complex decisions about their care and welfare. There were clear records to show who their representatives were, in order to act on their behalf and in their best interests, if any difficult decisions needed to be made about their care and treatment.
All staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the manager or senior management. Senior managers visited the home on a regular basis, and three visited the home on the day of our inspection. Staff knew that the senior managers were accessible to them.
The service had suitable arrangements in place to protect people from assessed risks. These included risks of fire, and other risks such as trips and falls, legionella and use of equipment. Each person living in the home had individual risk assessments based on their own personal care and treatment. These included a Personal Evacuation Emergency Plan (PEEP) in the event of fire or other emergency. Other risk assessments were in places for people’s individual needs.
The manager had systems in place to determine the numbers of staff needed in relation to the dependency needs of people living in the home; and the overall numbers of people living in the home at any one time. She told us that she was able to increase staffing levels if people’s dependency needs rose significantly, and used bank staff who were known to the home for additional shifts. However, it was evident that care staff were very busy and appeared to be rushed, and people were left unattended in the lounges for periods of time, especially people living with dementia. The service could not demonstrate that sufficient numbers of staff were employed at all times to meet people’s assessed needs.
You can see what action we told the provider to take at the back of the full version of this report.
There were reliable recruitment practices in place to check that staff were suitable for their job roles. Staff showed kindness, empathy and patience with people during our inspection. People said that the staff “Looked after them well” and responded quickly when they called for assistance. Staff were supported through individual supervision meetings, group supervision, regular training, formal training qualifications, staff meetings, and yearly appraisals. All staff were trained in dementia care.
People’s medicines were administered by trained nurses. These were stored and managed in accordance with current guidelines and legislation.
People told us that they liked the food, and had plenty of choice. The menus provided a suitable range of foods to meet people’s different nutritional needs. The catering staff were familiar with different diets, such as fortified diets for people with low weight, and diabetic diets. Staff took time to assist people with eating and drinking where necessary.
People’s health care needs were assessed and managed by trained nurses, in association with other health care professionals. Referrals were made to GPs, and to other health care professionals as needed, such as dieticians, speech and language therapists, dentists, and the mental health care team. People’s care plan records contained detailed information about their health and personal care needs. People’s preferences were clearly recorded, and staff showed that they were familiar with these, such as calling people by their preferred name.
The premises were visibly clean. However, the premises did not provide an environment that facilitated the care of people with nursing needs and/or dementia. For example, the main lounge was long and narrow, which meant that chairs could only be placed around the room. The paintwork and walls were painted in light colours to increase the lightness in the property, but there was a lack of pictures or signage to aid and stimulate people with dementia; and a lack of activities to meet their assessed needs. An activities audit showed that this was in the process of being addressed.
We recommend that the staff follow the guidelines provided by the National Association for Providers of Activities for older people (NAPA); and the National Dementia Strategy for England (in association with Alzheimer’s Society), to support the staff in providing a suitable range of activities for people living with dementia to enjoy.
Staff were aware of people’s preferences to stay in their own rooms or to socialise with others. The activities co-ordinator carried out individual time with people during the mornings, which was enjoyable for the people concerned, but meant that other people were left without any activities or stimulation apart from watching television or having music playing. Group activities were carried out during most afternoons, but on the day of our visit some people said they were tired after lunch and did not wish to join in. Staff enabled people to go out of the home, and some had recently visited the town’s cenotaph to celebrate Remembrance Sunday.
People said that staff were friendly, and a relative said “The staff are pleasant and welcome me when I come in. They do their best.” One of the people told us “I am very settled being here”; and another said “I am as settled as I could possibly be with having had to leave my own home.” Personal care was given in the privacy of people’s own rooms or bathrooms; and suitable screening was available for people in shared rooms. Two people’s dignity was compromised during the day, as one person was wearing someone else’s clothing; and another person was weighed in the lounge in view of other people.
You can see what action we told the provider to take at the back of the full version of this report.
People told us that if they had any concerns they would talk to the nurse on duty, or the manager or her deputy. They were confident that if they raised any concerns they would be dealt with appropriately. Formal complaints had been responded to in a timely manner, and except for one complaint which was ongoing, had been satisfactorily resolved.
The manager had been in post for eighteen months, and staff told us that she had brought about positive changes in the home. This included more liaison with staff about bringing in changes, and allowing staff to take more part in discussing different ideas to improve the home. The company provided on-going support from senior management, which included a visit to the home at least once per month to monitor the quality of the service. However, auditing processes had not highlighted the need for people living with dementia to have more supervision and stimulation available. There were systems in place to obtain people’s views and ensure that their views were listened to and taken into account, so as to provide ongoing improvements. The manager was acting as the nurse on duty throughout the day of the inspection, and said she usually worked approximately one shift per week as the nurse. This helped her to maintain first hand knowledge of how care was being delivered.