This inspection took place on 5 and 6 July 2018 and was unannounced. This was the service’s first inspection under the current registered provider, Lilian Faithfull Homes. We rated the service as ‘Good’ overall. Resthaven Nursing Home (known as Resthaven) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Resthaven can accommodate 42 people in one adapted building. It predominantly cares for older people. At the time of the inspection 33 people lived there and required support with their physical needs whilst some also lived with dementia. People lived on two floors, each floor having single occupancy bedrooms with washing facilities, lounge and dining areas, communal bathrooms and toilets. Outside there was an enclosed garden as well as an open front garden with ample car parking. Attached to the home was a small chapel which people and visitors could use.
The service is required to have a registered manager and one was 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 provider had identified areas that required improvement when they took over the home in March 2017and had since made significant improvements to the service.
There were many positive comments from people and relatives about how caring and kind the staff were and we observed many kind and caring interactions from the staff. The provider had forwarded specific examples of where staffs’ patience and kindness had improved people’s quality of life and wellbeing.
Personal care was delivered in private but staff sometimes forgot to respect people’s private spaces, for example, we observed staff entering people’s bedrooms without first knocking on the door and being invited in. Although the provider subsequently told us staff were trained to do this we have recommended that the training around this be reviewed so that practice can alter.
People’s preferences and their likes were explored with them and met. People’s diverse preferences were included in people’s care plans for staff information and to help staff meet these.
People had opportunities to take part in social activities which they enjoyed. On one of the days of this inspection the weather was unusually hot and this had an impact on what we observed in relation to activities on that day. People were sleepy and this had an impact on their ability to be engaged. On the second day of the inspection we observed people to be more involved and enjoying themselves. The registered manager told us this was far more representative of the activities at Resthaven. We were given examples of how support with meaningful activities had improved people’s self-worth, their confidence and quality of life. On-going improvements were being made to further support people’s overall wellbeing.
People were supported to take their medicines and medicines were stored securely; records were well maintained. During the warm weather staff had found it difficult to meet the medicine manufactures’ recommendations in relation to the temperatures medicines should be stored at. Action was being taken in response to this and the provider told us they planned to take further action to address this.
The provider continued to keep staffing levels and the deployment of staff under review. There were enough staff to keep people safe. Where needed agency staff were used to support this and successful staff recruitment had seen this usage reduced. Robust recruitment procedures were followed and helped to protect people from those who may not be suitable to care for them.
Systems and processes were in place to keep people safe and to ensure their health needs were met. Risks to people were identified and managed resulting in these being reduced or removed altogether. People told us they felt safe and well cared for and relatives told us they considered their relative to be well cared for. People had access to health care professionals to support their health needs. Some adaptions to the building and its grounds had been made to meet people’s needs.
A complaints process was in place and records showed that complaints were fully investigated and where necessary action had been taken to address these. Managers aimed to resolve complaints to the satisfaction of the complainant but in some cases, this had not been possible, despite great lengths having been taken to try and achieve this. There was evidence to show that the provider’s complaints procedures were adhered to and complaints were managed in a transparent manner. Where appropriate people were offered and explanation and an apology given. The registered manager used all complaints and other feedback as points for learning.
People’s relatives were made welcome and they were consulted with, where appropriate, about people’s health and care. People were afforded the right to have visitors in private if this was their wish.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People’s independent decisions were respected by the staff. The principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were adhered to in order to protect those who were unable to consent to live at Resthaven and received the care and treatment they required. Where people were unable to make independent decisions and where it had been necessary to make decisions on their behalf, these had been made in the person’s best interests.
People’s end of life wishes were explored with them. People were supported to remain comfortable at the end of their life. Those who mattered to people and who were important to them could stay with them at this time. Staff provided support to relatives and friends as and when they wanted this.
There were processes in place to monitor the quality of care provided to people and monitor the home’s overall performance. Where required actions were identified and completed which led to continuous improvement being made. The home’s continuous improvement plan showed what actions had already been completed and what further action was planned. For example, actions completed included the recruitment of further staff to support activities for people. On-going actions included those relating to people’s care records; staff were getting used to the provider’s new documents.
A change in the staff culture and how staff were expected to work had led to people receiving safer and more personalised care overall. Managers were managing these changes well. They were continuing to make improvements to the home’s senior staff structure, so that best practice could be fully promoted moving forward. These changes were also providing staff with the support and direction they needed. The provider had supported the registered manager to make these changes and they continued to provide additional support and guidance where needed.