Archived: Nuffield Care Centre

Updated 6 August 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.

The first day of this inspection took place on 31 May 2016 and was unannounced. On this day the inspection team consisted of three inspectors and a specialist nurse advisor. The specialist nurse advisor had experience in providing nursing care for people in a clinical and adult social care setting. The second day of this inspection took place on 08 July 2016 and was announced. We gave 24 hours’ notice as we needed to ensure the registered manager would be present. They had been on leave on the first day of our inspection.

Before the inspection we reviewed all the information we held about the provider. This included information sent to us by the provider in the form of notifications and safeguarding referrals made to the local authority. Notifications are information about important events which the provider is required to send us by law. We did not ask the provider to complete a Provider Information Return (PIR) before the inspection. The PIR is a form that asks the provider to give some information about the service, what the service does well and improvements they plan to make. This was because we were undertaking this inspection six months following the previous inspection to follow up on improvements we had asked the provider to make.

We used a number of different methods to help us understand the experiences of people who lived at the home. On the first day of inspection we spoke with 10 people, seven members of staff, the deputy manager, a general manager, three relatives and three health care professionals. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

On the second day of inspection we spoke with seven people, two relatives, four care staff, a chef, two nurses, the deputy manager, the registered manager and a general manager.

During both days of inspection we spent time observing the care and support provided to people. We also observed lunchtime in the main dining room. We read 11 people’s care records and six medicine administration records, and DoLS applications made to the local authority. We also read other records which related to the management of the service such as training records, policies and procedures and quality auditing systems.

The last inspection of this service was 5 November 2015 where we found five breaches of the Health and Social Care Act 2008 (Regulated activities) 2014, and rated the service inadequate. We placed the service in special measures.

Updated 6 August 2016

Nuffield Care Centre provides accommodation and nursing care for up to 35 older people some of whom may be living with dementia. The home also offers respite care. This is temporary care for people who need support, providing relief for their usual care networks such as relatives and friends. On the first day of our inspection there were 22 people living at the home and on the second day there were 20 living there. There was nobody receiving respite care on either day of our inspection.

The service had a registered manager. 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 registered manager was not present on the first day of our inspection and was present for the second day.

We previously carried out a comprehensive inspection of this home on 5 November 2015. At that inspection five requirement actions were set for breaches of regulations 9 (Personalised care), 10 (Dignity and respect), 12 (Safe care and treatment), 17 (Good governance) and 18 (Staffing). The home was awarded an overall rating of ‘Inadequate’ and placed into special measures. The provider sent us an action plan telling us how they were going to drive improvement to ensure the service would meet the requirements of the regulations.

At this inspection we found that aspects of the service had improved and that the risks to people’s safety and wellbeing had reduced. However, further work was required to ensure improvements continued, were sustained and embedded.

The registered manager did not have a comprehensive oversight of the service and systems for monitoring service delivery. Audits and checks had not identified the issues we found at this inspection. Records relating to care and treatment of people were not always accurate or up to date. Feedback from relatives and staff was not used to make positive changes to the home. Immediate action was taken by the provider as a result of the feedback given during our inspection. Although this is positive, changes need to take place to ensure a proactive service is provided rather than a reactive one. Despite this people said that the culture within the home was starting to improve.

We took enforcement action against the registered persons and served Warning Notices in response to the above concerns.

Further work was required to ensure risks to people were appropriately assessed, managed and reviewed. For example, the use of bedrails, care and nursing needs and infection control. You can see what action we told the provider to take at the back of the full version of the report.

People’s legal rights to consent were not upheld. DoLS applications had not always been made when restrictions were placed on people’s liberty and they did not have the capacity to consent to this. Information within DoLS applications and other records indicated that two people were potentially being unlawfully deprived of their liberty as they had the mental capacity to make their own decisions. You can see what action we told the provider to take at the back of the full version of the report.

Care plans were not personalised and focused mainly on the clinical care people needed. People were not provided with a range of meaningful activities to prevent them from becoming board and socially isolated. They did not have opportunities to go out into the local community unless this was arranged by their relatives. You can see what action we told the provider to take at the back of the full version of the report.

People’s views on staff varied. There were inconsistencies with how people were treated. There were times when staff were kind and considerate. At times, some staff were task orientated and did not spend time talking to people. Dignity and privacy was not always promoted. You can see what action we told the provider to take at the back of the full version of the report.

Improvements had been made to the numbers and deployment of staff in the home. Where possible, the same agency staff were being used to help ensure continuity in care. Staff were now receiving supervision and guidance that helped them fulfil their roles and responsibilities. However, some staff did not communicate or understand how to interact with people who lived with dementia. We have made a recommendation about this in the main body of our report.

Formal processes were not consistently used to involve people in making decisions about their care. We have made a recommendation about this in the main body of our report.

People had mixed feelings regarding the food. Improvements had been made to the management of people’s dietary needs. Referrals had been made to external specialists and the majority of their recommendations acted upon. Improvements to the dining experiences of people who live with dementia should take place. We have made a recommendation about this in the main body of our report.

Improvements had also been made in the management of medicines. Medicines were stored, administered and recorded safely.

People were protected from abuse. Staff had a good understanding of what abuse meant and the correct procedures to follow should abuse be identified.

There was a complaints procedure in place and people were provided with a copy of this. A comments box was located at the entrance of the home that people could use to raise concerns either formally or anonymously if they wished.