Nazareth House - Cheltenham

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Systems were in place to protect people from abuse and harm. Any incidents or concerns were reported and investigated to help prevent further occurrences. However, we received mixed opinions from health care partners about the effectiveness of the systems in place to promptly address anydecline in people’s health needs. Care and risk management plans were in place to inform staff about the management of people’s individual risks and their preferences. The home was clean and well maintained. Staff followed good hygiene processes to minimise the risk and spread of infection. People received their medicines as prescribed from staff who were trained and competent to administer medicines. Safe recruitment practices were being used. Progress was being made to ensure staff were trained and competent to support people safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives were positive about the learning culture of the home. They told us they felt confident to raise any concerns or suggestions and they would be listened to. We received comments such as, " Yes. I can talk to the manager [name] about anything if I am worried. Absolutely fine, if I had any worries they would put it right. " and "I have been able to suggest activities to the activities coordinator with contact details and she has arranged this."

The registered manager explained they had enhanced the systems used to investigate incidents, to cascade information to staff to prevent further incidents and to embed good practices. One staff member spoke positively about the improved communications systems used with visiting professionals to ensure they had access to relevant information about people when they visited the home.

There was a culture of learning across the service. Any incidents, complaints and feedback from people and visiting professionals were investigated and discussed amongst the managers and staff team. Any actions required to prevent further incidents were taken to drive improvement.

People told us prior to admission, the home had assessed their needs and worked with key and relevant health care professionals to ensure physical and emotional needs would be met at Nazareth House.

The registered manager explained their admission process and told us they would only accept new people into the home if they could meet their needs. Senior staff were aware of the home's pre-admission process and the information they needed to understand people’s needs prior to and on admission. They worked with key and relevant partners, such as people's family members and GPs to gain relevant information about people’s needs which helped to ensure continuity of care for people. This information was reflected in their care plan and reviewed on a regular basis.

Some healthcare professionals told us staff at Nazareth House did not always work collaboratively with them to ensure people could register with a new GP in a timely way when they were admitted into the home from hospital or their own home. Commissioners of care found the staff at Nazareth House – Cheltenham worked flexibly with them to ensure people could be safely supported. This occasionally required the home to accommodate emergency admissions.

Admission processes were in place to assist the safe transfer of people into the home and to assist their continuity of care. Managers involved people, their relatives and other key representatives in the admission assessment and to maximize the control people had about the decision to move into the home.

People and their relatives were complimentary about the staff who supported them and told us they felt safe living at the home. We received comments such as: “Feels very safe. Carers and people here are very friendly and very welcoming"; "I do feel safe because they are there when you need them [carers]" and "She is happy and safe, really content there……I am really pleased."

The registered manager and staff were aware of the home's systems to report and escalate any safeguarding concerns to the relevant internal and external departments. They were clear about how they may recognise forms of abuse and changes in people's behaviours if they were unable to express their concerns. The registered manager told us they had worked closely with adult social care professionals from the local authority to improve the processes around the assessment and recording of people’s mental capacity.

We observed staff interacting well with people in an appropriate and respectful manner. Where people living with dementia became agitated or distressed, staff responded in a way which promoted the persons, and others safety and in a way which reduced people's anxieties or worries.

Systems were in place to safeguard people from risk of abuse and harm. The registered manager worked with staff to ensure all staff had completed their safeguarding training and they understood their role and responsibilities of reporting any forms of abuse. The registered manager had provided additional information such as safeguarding posters and held safeguarding discussions with staff during supervisions and meetings to reinforce their safeguarding knowledge.

People and relatives complimented the quality of care provided at the home. Relatives positively described their experiences and observations of the care people received as well as the staff being kind and attentive. Relatives said staff knew people well and quickly recognised any changes in people’s health or well-being which was escalated to the GP and communicated to them.

Staff told us they were provided with information which helped them to support people to remain safe. Staff confirmed they attended staff handover meetings, at the beginning of each shift. These updated them with any changes to how people’s risks should be managed and about new emerging risks they needed to be aware of. A member of staff told us how risks to people living with dementia, could increase during the late afternoon and early evening due to ‘sundowning’ (behavioral changes that people who live with dementia may experience in the late afternoon or early evening). They told us this meant they needed to ensure their staff team were more aware of potential risks, such as falls and altercations between people, which arose from people’s increased confusion at that time of the day. The registered manager described the communication systems that were used to effectively share important information regarding changes in people’s care requirements, as well as any potential emerging risks and the necessary measures to mitigate them.

We observed people being supported by staff who knew them well and provided the support required to manage their risks. On the dementia unit, we saw staff supervising people from a distance and intervening if needed, to help prevent people harming themselves or others. Staff were responsive to people’s request for assistance and took prompt action and sought support from their colleagues and medical services as required.

Systems were in place to manage and monitor people’s risks. However, we found the management oversight of people's risks required further development to ensure appropriate actions had been taken when there were changes in people's needs. The registered manager was responsive to our feedback and introduced a more robust clinical oversight meeting and staff competency assessments in key safety areas. The registered managers actions contributed to an effective approach in managing and overseeing people's risks.

People and their relatives raised no concerns about the home's environment and felt the home was generally clean and well maintained. People said they were provided with appropriate equipment which was maintained and met their needs.

The registered manager explained they had implemented stronger communications systems with the maintenance and housekeeping teams and had enhanced their oversight of the cleaning and health and safety audits. This enabled them to monitor the safety and cleanliness of the home and take prompt action to address any issues.

We observed the environment being cleaned in a safe and effective way. We saw equipment being used safely to help reduce risks to people and to support safe ways of working, for example, use of hoists to transfer people safely and crash mats on the floor to prevent injury from falls off a bed. The registered manager had reviewed the layout of the care home and had moved their office into the dementia care unit. This move meant the registered manager was more visible within the building, but it also afforded better oversight of people using the lounge on this unit including the unit’s entrance door. This meant they could support or organise support more easily when people needed help to keep themselves or others safe from harm. We observed people being supported to use the outside spaces which were designed for easy and safe use.

The provider had systems in place to check the safety of the home's environment and the equipment used to support people. The maintenance person was responsible for checking all the health and safety aspects of the home including the home's fire systems. The required compliance checks had been completed and shared with the registered manager and regional maintenance manager for their review and any required follow-up actions. We found no negative impact; however, the completed health and safety audits were not always detailed and did not explicitly document the actions taken in response to their findings. Therefore, it was unclear whether the maintenance team had addressed any identified health and safety concerns; although the registered manager provided assurances actions had been taken. Equipment used to support people were regularly checked to ensure they were safe and functional such as bed rails, air mattresses and window restrictors. The required safety position for people’s bed rails was documented in their care plans. However, personalised air mattress settings and the required gaps for window restrictors were not recorded. This meant staff did not have guidance to accurately implement and check the control measures to help mitigate risk. The registered manager immediately addressed our concerns and implemented clear guidance to ensure staff had the information they needed when checking the environment and people’s equipment.

People and their relatives were generally pleased about the staffing levels of the home and the skills of the staff who supported them. People told us they were supported by regular carers who supported them in a timely manner. People said comments such as: “Very busy sometimes but come along when they have finished with somebody else” and “There are enough staff for me but others with more difficult mobility problems not as many…… Not as many staff at the weekends.”

The registered manager was aware that not all staff had completed their mandatory online training. This was being addressed with staff through individual supervision and staff meetings. Staff told us they were provided with training which was a mixture of online and face to face training. A member of staff commented they did not think it was sufficient training for staff who had no prior experience in care, but there were always more experienced staff who could support them. Two other staff told us they had been provided with links to the online training which they knew they had to complete. The registered manager explained most staff had been recruited from abroad and brought with them a lot of skills and experience from their previous health and social care roles which had benefited the home. The registered manager felt the skills and knowledge of these staff had reduced the impact on people while staff were undertaking the provider’s mandatory training.

We observed people being supported in a person-centred way. Staff used the skills and knowledge they had acquired from their training and their previous health and social care roles to effectively, reduce the risk to people and to promote their wellbeing. On the dementia care unit, staff had been deployed to supervise people in the communal rooms. However, we observed it was difficult for staff to always attend to people’s individual needs when people’s confusion increased, such as during the late afternoon. We fed this back to the registered manager, who agreed to review the staffing numbers for this time of the day.

The provider's monitoring systems had found gaps in staff training which put people at risk of not receiving safe and person-centred care. This was discussed with the registered manager who explained the steps being taken to rectify gaps in staff development. For example, progress was being made to upskill some senior staff to become in-house trainers in key subjects such as safeguarding and for some staff to become leads such as specialist dementia workers. The registered manager explained in addition to the on-line training, they had sought advice and support from the local authority to arrange and schedule additional in-person training sessions on topics such as identifying early signs of deteriorating health in individuals. In addition, the registered manager was developing and implementing competency assessments to ensure staff training was fully embedded in their practices. Whilst progress was being made in staff development, further time was needed to embed the new measures. Safe recruitment practices were mainly being used to employ staff to ensure their previous work and criminal backgrounds were vetted and new staff were of good conduct to fulfil their role. However, the registered manager would benefit from increased oversight of staff recruitment process to ensure thorough checks of staff with prior experience in health and social care have been completed and take additional measures if they had not been able to gain assurances from previous employers.

People and their relatives complimented the cleanliness of the home. We received comments such as: "Oh very nice and clean everywhere" and "Clean, absolutely spotless everywhere." Some people commented the home was tired in places, however most people said they enjoyed living at Nazareth House and had no concerns about the cleanliness and maintenance of the home.

Staff told us they had access to appropriate cleaning products and personal protective equipment (PPE) and were aware of the provider’s infection control protocols such as disposing of bodily fluids and waste. The registered manager was prompting staff to complete their infection control training and told us they were working with the staff team and external infection control teams to improve the infection control practices across the home.

We saw the environment was kept clean. We observed staff had easy access to PPE which we saw staff wearing when they supported people with their personal care. We observed staff washing their hands in between attending to people. People were supported to wipe their hands with hand wipes before eating their meal.

Progress was being made to improve staff awareness and training in good infection control practices with all staff members. Improved communication and infection control audits were being developed with key staff members. However, we found staff were not fully aware of the home's infection outbreak procedures and the actions they should take to manage any outbreaks and how to support people who may have possible or confirmed infections. The registered manager was working with the local authority infection control teams to ensure safe infection control systems were being used and understood by staff. Since our assessment, an infection control competency assessment had been implemented to assess staff's understanding of the provider's infection control and outbreak policy.

People told us they received their medicines as prescribed and in a safe and caring way. The appropriate level of support and people's preferences were taken into consideration. Relatives told us staff and management knew people well and were able to respond to their clinical needs appropriately. One relative said, "No concerns at all, she will have a pain killer as and when needed. We are always updated on changes of medication."

Staff were knowledgeable and confident about how to support people with their medicines and were aware of the home's medicines management systems and protocols. Staff had received training and supervision and felt supported to manage people's medicines. They recorded the administration of people’s medicines effectively on individual Electronic Medicines Administration Records (EMAR).

There was an appropriate medicines policy in place to guide staff in safe administration and management of people's medicines. Medication administration training competencies were completed and records to evidence this were seen. Medication audits were completed weekly. There was an established process for dealing with drug safety alerts. Controlled drug registers were largely completed correct, and stock levels checked daily. Medicines incidents were investigated, however the quality and the detail of the investigation reports varied. Some incidents revealed a communication failure internally and externally and a lack of training in relation to agency staff. The fridge used to store medicines was not consistently checked and recorded to ensure medicines which were required to be stored in cool temperatures were being stored in line with manufactures guidelines. There were no protocols to manage out-of-range temperatures. Protocols were not in place for all medicines which were prescribed to be administered when required. However, the registered manager promptly addressed our feedback and implemented the required improvements to enhance their medicine management systems.