Nova House

Nova House is a residential care home providing personal care for older people, some of whom were living with dementia. The service can support up to 36 people and at the time of the inspection there were 27 people living at the home.

People’s experience of using this service and what we found

The service had continued to deliver high quality support throughout challenging times. The atmosphere within the service was vibrant and fun, with laughter echoing down the corridors.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Comprehensive assessments and care plans provided the basis of personalised care and provided the foundations to ensure that staff supported people safely and in accordance with their needs and preferences. Risks to people were identified and managed in a way that balanced their safety with their right to freedom.

Staff were kind and compassionate and people had relationships with them that were fun and inclusive. People enjoyed their meals and were supported to eat a nutritious and varied diet. People received their medicines as prescribed and were supported to access external professionals to keep them healthy and comfortable.

The provider and management team had worked hard to maintain high standards of care and safety. Despite staffing shortages across the sector making recruitment of new staff difficult, existing staff felt valued and were motivated and committed to work had and go the extra mile for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 11 March 2020).

Why we inspected

We undertook this inspection as part of a random selection of services rated good and outstanding to test the reliability of our new monitoring approach.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

There had been an outbreak of Covid-19 at the beginning of the pandemic which resulted in people being supported to isolate in their bedrooms. At the time of the inspection the period of isolation had finished. The registered manager had followed the government guidelines on visiting throughout the pandemic.

Several people at the home were living with dementia. Staff spent time talking to people and reassuring them about the need for staff to wear personal protective equipment (PPE) and the need to socially distance as far as possible. Staff encouraged social distancing with extra space being put between seating in communal areas including dining table settings.

A vacant ground floor bedroom was used for relatives to visit. Relatives wore full PPE and sat at a safe distance from their loved ones. Throughout the pandemic relatives were able to keep in touch using video calls and facetime messaging.

The service had one cleaner and was in the process of recruiting two more. Staff helped with the cleaning routine to ensure seven day a week cover. A general cleaning regime was in place as well as a covid-19 specific regime. This ensured that all high reach areas and frequently touched areas for example, door handles and tabletops were cleaned several times every day.

Since the beginning of the pandemic all staff have undergone training and refresher training in PPE, infection prevention and control and specific training relating to Covid-19. The training has included online and some face to face sessions with some being provided internally and some by external bodies. Regular updates have been received from the local authority and Public Health England and these have been cascaded to all staff using a dedicated WhatsApp group with key points being reinforced during supervision meetings.

Staff had a dedicated point of entry to the home where they were able to change and put on PPE and have their temperatures taken before the start of each shift. We saw staff wearing PPE appropriately throughout the home and there were several locations where staff could dispose of used PPE, in foot-pedal operated bins, and put fresh PPE on. Any professionals visiting the home went through the same process of having temperatures taken and wearing full PPE.

Nova House is a residential care home providing personal care for older people, some of whom were living with dementia. The service can support up to 30 people and at the time of the inspection there were 29 people living at the home.

People’s experience of using this service and what we found

People were protected from harm and abuse and told us that they felt safe. Staff had completed safeguarding and risk assessment training and were able to tell us what action they would take if required. The service had a whistleblowing policy which staff were aware of and had confidence to use if needed. Accidents, incidents and near misses were recorded on a spread sheet and analysed for trends with any learning and improvements being taken forward. Safety checks and reviews had been completed on fire, gas and electricity equipment. People were supported with their medicines.

Staff training was recorded on a computer system that was accessible to all staff. Staff could therefore check and book training sessions when due. Oversight was maintained by the registered manager. Induction for new staff was followed with ongoing support through supervision meetings and appraisals. People could access health and social care professionals and some could make their own appointments.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Mental capacity assessments had been appropriately completed and best interest meetings and DoLS applications made when required.

Staff were kind to people and dignity and respect for people was apparent throughout the service. Staff knew people well and responded to their needs in a supportive way, always respecting people’s privacy and wishes. People were encouraged and supported to be independent both with day to day tasks and regarding their mobility around the service and beyond.

Care was person centred. People were provided with a range of activities both inside and outside of the service. Daily trips out were available to people and there was a six day a week activity program. People could choose what they wanted to join in with. A complaints policy was readily available to all and people and relatives knew what steps to take if they wanted to raise a complaint or an issue. Staff were trained in end of life care and were able to tell us the important aspects of care for people at that time.

There was a positive culture at the service displayed by all staff. The service was welcoming and staff were friendly. The registered manager maintained oversight of key areas of the service by regular auditing, identifying learning to be taken forward and embedded. People, relatives and staff were all provided opportunities to provide feedback about the service. The service was well established within the local community and strong relationships had been established with statutory partners and professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Good. (Report published 26 July 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nova House provides accommodation and support for up to 30 older people living with a dementia type illness. Some people are independent and need only need minimal assistance; others need support with personal care and moving around the home safely. There were 28 people living at the home during the inspection.

The home is a converted older building that has been extended and includes a bungalow to the rear. The bedrooms are on three floors, there is a passenger lift and a chair lift to enable people to access all parts of the home and there is a secure garden to the side and rear of the building.

The registered manager was present during the inspection. 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.

This inspection took place on the 1 June 2017 and was unannounced.

The provider had effective systems in place to assess and monitor the services provided. The registered manager said they audited all aspects of the care provided and the facilities to identify if any improvements were needed. People, relatives and staff were encouraged to be involved in developing the service and they said the registered manager was always available to talk to.

People and relatives said the staff were very good and they provided the care people wanted, whilst supporting them to be independent and make choices. Staff had a good understanding of people’s needs and they followed the guidance in the individualised risk assessments so that people were safe.

There were enough staff working in the home to support people. Effective recruitment procedures ensured only suitable staff worked at Nova House and relevant training was provided to ensure that staff were aware of their roles and responsibilities. Staff had attended safeguarding training and demonstrated a good understanding of how to protect people from abuse and what action they would take if they had any concerns.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and DoLS and were aware of current guidance to ensure people were protected. People had been supported through best interests meetings and referrals for DoLS had been made to the local authority to ensure people were safe.

A range of group and one to one activities were provided for people to participate in if they wished; these were flexible and depended on what people wanted to do each day. People said the food was good, choices were available and staff assisted people as required.

People had access to health professionals as and when needed. Visits and appointments were recorded in the care plans with details of any changes and relevant guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed near the entrance to the building, and given to people and relatives, when they moved into the home. People and relatives said they knew how to complain and had no concerns.

The home is a converted older building that has been extended in the past to include a bungalow to the rear. Bedrooms are on three floors, there was a passenger lift and a chair lift to enable people to access all parts of the home and a secure garden to the side and rear of the building.

The registered manager was present during the inspection. 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.

This inspection took place on the 13 and 20 April 2016 and was unannounced.

The quality and monitoring system was not effective in all areas and had not identified some issues, such as the improvements needed in the management of medicines. The registered manager started to address these during the inspection and audits had been completed for other areas.

There were enough staff working in the home to meet people’s needs and appropriate recruitment procedures were in place to ensure only suitable people worked at the home. However, the allocation of staff did not ensure people were safe at all times.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected.

People were assessed before they moved into the home to ensure staff could meet their needs, and care plans, including risk assessments to ensure their safety, were developed from this information. Care plans were reviewed and people and their relatives were involved in discussions about the care and support provided. Staff showed they understood people’s needs and provided the support and care people wanted.

People said they felt safe and relatives told us the staff ensured their family members were safe and well looked after. Staff had attended safeguarding training and demonstrated a good understanding of how to protect people from abuse and what action they would take if they had any concerns.

People told us the food was good. Choices were available and staff asked people what they wanted to eat and assisted them with their meals if required.

People had access to health professionals as and when they required it. The visits were recorded in the care plans with details of any changes to support provided as guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People, relatives and visitors said they knew how to complain, but they did not have anything to complain about.

There were are range of activities for people to participate in if they wished, these were very flexible and depended on what people wanted to do each day. Some people had their preferences, one person liked doing jigsaws, and other people preferred not to take part in group activities and remained in their rooms.

Feedback was sought from people, their relatives and other visitors to the home through satisfaction questionnaires. People, relatives and staff said they management were very approachable and were available at any time to discuss the support and care provided.

During this inspection we spoke with the registered manager and the deputy manager. We also looked and a range of documentation, including staff recruitment records, four care plans and medication administration records (MAR).

We found that improvements regarding outcome 21 had been made and identified shortfalls in the quality of record keeping had been addressed.

One person told us. 'They give me the help I need without any query at all. They are wonderful; I cannot speak highly enough of them. I need quite a lot of help at the moment washing and dressing and they help me to do that and encourage me to do as much as I can for myself'.

A visitor told us 'I have no concerns about the care here; it's a very good home'.

People had been cared for in an environment that was clean and hygienic.

People we spoke with told us they felt there were enough staff on duty and call bells were answered without delay. A member of the management team was available on call in case of emergencies.

The home's equipment was safe and met the needs of the people living in the home.

Whilst records had been stored securely not all records seen were up to date and accurate. Staff personnel records did not contain all the required information, medication administration records were not fully complete and care plans did not always accurately reflect current care needs.