Nazareth House - Plymouth

Updated 9 February 2019

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 inspection took place on 07 and 10 January 2019 and was unannounced. The inspection was carried out by two adult social care inspectors.

Before the inspection we contacted Healthwatch Plymouth and the local authority for their feedback about the service. Where this was given, it can be found throughout the report.

Prior to the inspection we reviewed records held about the service. This included the Provider Information Return (PIR) which is a form that we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed previous inspection reports and notifications. Notifications are specific events registered people have to tell us about by law. In addition, we reviewed information that had been shared with us, such as complaints, and compliments.

During the inspection we spoke with eight people and one relative. We also spoke with a number of staff. This included a chef, five care staff, the registered manager, the deputy manager, the head of care, the activities co-ordinator, the receptionist and the administrator.

We reviewed six people's care plans, and medicine administration records (MARs). Other records we reviewed included the records held within the service to show how the registered manager and provider reviewed the quality of the service. This included a range of audits, questionnaires to people who live at the service, minutes of meetings and policies and procedures.

After our inspection, we contacted a GP, a visual sensory advisor, and the local hospice for their feedback about the service. Where this was given, it can be found throughout the report.

Updated 9 February 2019

The inspection took place on 07 and 10 January 2019 and was unannounced.

Nazareth House – Plymouth 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.

CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The service provides care and accommodation for up to 46 people. On the days of the inspection 43 people were staying at the service. Some people were living with dementia and some people had both physical and mental health needs.

The service is owned and operated by Nazareth Care Charitable Trust. They also own 19 other care homes across England, providing residential and nursing care to older people.

The service had a registered manager 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good, with the caring key question improving to outstanding.

Why the service is rated good.

The care home, and people who lived in it, formed part of the community. People lived in a service which had been adapted to meet their individual needs. People’s health and social care was co-ordinated with external professionals to help ensure they got the support they needed.

People lived in a service that truly respected and valued people as individuals, and they were empowered in their care.

People were cared and supported in a service which had a strong, visible and person-centred culture. People’s privacy and dignity was at the heart of the service’s culture and values.

People were empowered to be in charge of their own care and had their views listened to and respected. People’s religious needs were known.

Staff, were incredibly respectful of everyone’s individual beliefs, as well as those living at the service. People were supported at the end of their life with compassion. There were good links with the local GP practices and the local palliative care team.

People were protected from abuse, because staff received safeguarding training and knew what action to take if they suspected someone was being abused, mistreated or neglected.

People told us they felt safe living at the service. People did not face discrimination or harassment and their individual equality and diversity was respected.

People were supported to stay safe whilst still respecting their freedom. People lived in a building that was assessed for safety. Overall, people who had risks associated with their care had them assessed and managed to help ensure that they were supported safely. But whilst documentation was not in place, risks to people were low because knew how to support people safely, and those living with diabetes were managing their own health, because they had the mental capacity to do so.

People received their medicines safely and people were encouraged to manage their own medicines where possible.

People were supported by sufficient numbers of staff. However, whilst staff were recruited safely, gaps in people’s employment history had not always been fully scrutinised. Immediate action to rectify this was taken at the time of our inspection.

People were protected by the spread of infection. The service smelt fresh and clean, and was free from any odours.

People and their relatives told us they felt staff had the skills and experience to look after then effectively. People’s needs were assessed prior to them moving into the service. Personalised care plans were created to help ensure people’s needs were met in line with their wishes and preferences.

People told us the food was lovely. People had nutritional care plans in place and were encouraged to enjoy a nutritious and balanced diet. People were encouraged to live healthy lives and to keep mentally and physically well.

Overall, 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 also supported these practices.

People’s communication needs were known by staff. Overall, the Accessible Information Standard (AIS) was known and had been considered. The AIS aims to make sure that people who have a disability, impairment or sensory loss get information that they can access and understand. However, further improvements were needed to ensure that all documents, were in a suitable formats for everyone.

People could access a variety of social entertainment, which was either organised by the activities co-ordinator or by external entertainers.

People told us they did not have any complaints, but knew who to complain to if they had any concerns. People told us they were confident that action would be taken.

Whilst the service is predominately linked to the Catholic faith, we were told by people and staff that everyone was welcome at the service, regardless of their religious beliefs. However, the provider’s website, Statement of Purpose and service user guide did not reflect this inclusiveness.

People and relatives spoke positively about the leadership of the service. Staff were complimentary about the registered manager. There was a strong management team in place. Staff felt valued.

The provider’s values were at the heart of the service, and were used to shape the provider’s governance arrangements. There were processes in place to monitor and assess the safety and quality of the service, which also involved people who lived at the service. However, despite a variety of audits being in place, they had failed to identify areas requiring improvement. The registered manager was responsive to our inspection feedback and had already started to take immediate action to make changes, before the end of the inspection.

The registered manager and the management team kept their knowledge up to date by working in conjunction with external professionals, attending external conferences, and training courses.

The service worked positively with external agencies in order to help continuously learn and improve. The provider learnt when things went wrong, and had notified the Commission appropriately in line with their legal duties. The registered manager and management team displayed openness and transparency throughout the inspection process, thus demonstrating the main principles of the Duty of Candour (Doc). The Duty of Candour is a legal requirement that providers must be open and honest with people and apologise when things go wrong.

We recommend the provider considers national guidance about supporting people to access and understand information. In addition, we recommend that the provider reviews their website, statement of purpose and service users guide in line with national guidance about equality, and action is taken to strengthen their overall governance framework.

Further information is in the detailed findings below.