Archived: Revitalise Netley Waterside House

Revitalise Netley Waterside House had been identified for use by the Local Authority as a designated care setting in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status with 19 beds available. During this inspection we only looked at the identified designated setting. At the time of inspection there was no one staying in the designated care setting.

Revitalise Netley Waterside House 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.

We found the following examples of good practice.

• Information was easily accessible on arrival, or before visits, to ensure visitors followed guidance, procedures and protocols to ensure compliance with infection prevention control. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home, alongside having their temperatures taken. There was no routine visiting, however, by exception arrangements were in place for people on end of life care to receive visitors.

• All members of staff worked in only the designated care setting, this included part-time and agency staff.

• Staff were trained and knew how to immediately instigate full infection control measures to care for people with Covid-19..

• Arrangements were in place so staff could appropriately socially distance during breaks, handovers and meetings.

• Cleaning staff had cleaning schedules, which they were required to complete which included evidence that high touch areas were regularly cleaned. For example, light switches, TV remotes and door handles.

• The service had appointed a dedicated lead to deal with all hospital discharges and ensure people were received safely into the service in accordance with national guidance.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Revitalise Netley Waterside House is one of three centres provided by Revitalise Respite Holidays, a national charity providing respite care and short breaks in a holiday setting for guest’s living with either a physical disability, learning disability, sensory impairment or dementia. The service provides 24-hour nursing care for those that need this. People staying at the service were referred to as guests and their informal carers as companions so throughout the remainder of the report we have used the same terminology. The service can accommodate up to 39 guests, although at the time of our inspection there were 21 guests and nine companions staying. The theme of the week was ‘Historic Hampshire’. One guest lived at the centre permanently.

The registered manager had recently left the service. A new manager had been appointed and was due to start at the service in July 2018. In the interim the service was being supported by the operations team. 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.

Improvements had been made to ensure that risks to guest’s health and wellbeing were assessed and planned for.

Guests’ needs were assessed, however, some of the holiday care plans needed to be more detailed. The care guests received did not always reflect the needs identified in the assessment.

The design of the premises was suitable for the guests, although some aspects of the fixtures and fittings were tired and worn and needed repair or decoration. A programme of renovation was underway.

Staff sought guest’s consent before providing care however, we have made some recommendations about the need for documentation regarding consent to be reviewed.

Infection control risks were effectively managed.

There were systems in place to manage medicines safely.

There were sufficient numbers of staff deployed.

Staff had received training in safeguarding adults, and understood the types of abuse and neglect.

Staff had the skills and knowledge to support guests appropriately.

Guests were supported to eat and drink according to their preferences.

Technology was used to support the effective delivery of care and support.

Guests were cared for by staff who were kind and caring and were treated with dignity and respect.

Despite the short-term nature of guests’ stay within the service, the staff we spoke with were knowledgeable about the guests and could explain to us their individual needs and requirements.

Overall, guests received person centred care that was responsive to their needs.

Guests took part in a suitable range of excursions and activities.

Information on how to make a complaint was readily available within the service.

Staff felt well supported and reported a positive culture and improved communication.

There were effective quality monitoring systems to monitor the quality of the care guests received.

Revitalise Netley Waterside House is one of three centres provided by Revitalise Respite Holidays, a national charity providing respite care in a holiday setting for guest’s living with either a physical disability, learning disability, sensory impairment or dementia. The service provides 24 hour nursing care for those that need this. The service can accommodate up to 39 guest’s, although at the time of our inspection there were 21 guests and one companion staying. The theme of the week was ‘Youth Week’. Two guest’s lived at the centre permanently. Most guest’s booked to come to the service for a week’s break and would either come alone or with their main carer. The aim was that during the break, the carer also had respite from their role and was able to take a relaxing break. People staying at the service were referred to as guests and their carers as companions so throughout the remainder of the report we have used the same terminology. The provider operates a large residential volunteering programme and so in addition to permanent staff; guests were also cared for by a number of long and short term volunteers.

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 2008 and associated Regulations about how the service is run.

We found a breach of the legal requirements regarding safe care and treatment. Risks to guest’s health and wellbeing were not being adequately assessed and planned for. The provider’s checks had not effectively identified these and other areas for improvement.

Environmental and infection control risks were effectively managed and improvements had been made to the management of medicines.

Staff sought guest’s consent before providing care and guests were encouraged and supported to make decisions about their care and support.

Staff received training, supervision and an induction which ensured they had the skills and knowledge to support guests appropriately.

Guests were positive about the food and were provided with support to ensure they were able to have enough to eat and drink.

There were sufficient numbers of staff to meet guest’s needs and guests told us they felt safe and that the staff were kind and caring. We observed a number of positive and warm interactions between guests and staff. Staff demonstrated a good understanding of the meaning of dignity and how this encompassed all of the care provided to each guest.

Guests were supported to take part in a range of activities both within and outside of the home.

Information on how to make a complaint was readily available within the service.

The manager had cultivated positive relationships with guests and the staff team and the organisation was committed to actively seeking the engagement and involvement of guests and staff in developing the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Revitalise Netley Waterside House is one of three centres provided by Revitalise Respite Holidays, a national charity providing respite care in a holiday setting for people living with either a physical disability, learning disability, sensory impairment or dementia. The service provides 24 hour nursing care for those that need this. The service can accommodate up to 39 people, although at the time of our inspection there were 35 people staying. Thirteen of these were companions and therefore not receiving care. Two people lived at the centre permanently. Most people booked to come to the service for a week’s break and would either come alone or with their main carer. The aim was that during the break, the carer also had respite from their role and was able to take a relaxing break. People staying at the service were referred to as guests and their carers as companions so throughout the remainder of the report we have used the same terminology. The provider operates a large residential volunteering programme and so in addition to permanent staff; guests were also cared for by a number of long and short term volunteers.

The guests staying during our inspection had all booked to attend a specialist stroke week which was being provided in conjunction with The Stroke Association. This was the first time that this particular specialist week had been run at the centre. Additional one day training had been provided for all staff on caring for stroke survivors, including communication techniques.

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 2008 and associated Regulations about how the service is run. Throughout this report the registered manager is referred to as the ‘manager’.

Improvements were needed to ensure that all of the risks to guest’s health and wellbeing were adequately assessed and planned for. Risk assessments were not routinely used to provide additional guidance for staff about how they should manage guest’s particular needs.

Risks at service level were not always managed safely. Harmful substances were not always stored securely and we found a fire door wedged open. Parts of the environment or equipment used by guests were not always clean and well maintained.

Guest’s medicines were not always managed safely. Most medicines were safely stored. However, we were not assured that medicines were always stored within their recommended temperature ranges. We were also concerned that medicines were secondary dispensed by staff when some guests went on excursions. Information to support the administration of medicines was variable, for example, allergy information was recorded. However, additional information about ‘how I take my medicine’, ‘if required’, and ‘variable doses’ was not available. A care plan was not available to support one guest whose health could rapidly deteriorate.

We could not be assured that staff were receiving regular supervision and staff did not have all of the training relevant to their role.

The provider was not complying with their responsibilities in relation the Mental Capacity Act (MCA) 2005. There was a reliance upon asking the guests companion to consent to the care plan or make decisions on behalf of the guest. This is not in keeping with the principles of the MCA 2005.

Improvements were needed to ensure that the admissions and care planning process incorporated a consideration of whether a guest had capacity to consent to the stay, and whether any aspects of the care being provided might amount to a deprivation of that guest’s liberty. There was a risk that when guests were admitted, staff would not have a sufficient understanding of their individual needs and how these should be met.

Complaints were not always responded to in a timely manner. The provider was already making improvements to address this.

We could not therefore be assured that the systems in place for identifying and driving improvements were effective and the provider had not ensured that staff had access to policies and procedures which provided appropriate and up to date instruction to staff.

People were positive about the food provided and there was information available about the guests likes and dislikes, which enabled staff to plan to menu around guests needs and wishes.

There were sufficient numbers of staff to meet people’s needs and guests told us they felt safe and that the staff were kind and caring. We observed a number of positive and warm interactions between guests and staff. Staff demonstrated a good understanding of the meaning of dignity and how this encompassed all of the care provided to each guest.

Guests were supported to take part in a range of activities both within and outside of the home.

The manager had cultivated positive relationships with guests and the staff team and the organisation was committed to actively seeking the engagement and involvement of guests and staff in developing the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found people's care and support were based on detailed plans and effective assessments of their needs. However, staff did not always record the care delivered in sufficient detail. The provider had processes in place to ensure there were sufficient staff to meet the needs of a population which changed each week. The provider made the necessary checks before staff and volunteers started work.

We observed the care and support given to people in the communal areas of the home. We saw that staff and volunteers were friendly and caring, aware of people's needs and preferences, and responsive to them.

We spoke with eight members of staff, the registered manager and the operations director. We reviewed records related to people's care. We found people's care needs were assessed and their care plans reflected their needs. Care and support were planned and delivered with people's consent. Arrangements were in place for people who were not able to consent to their support and treatment. People's medication was stored and administered properly. The provider had effective recruitment procedures and made the necessary checks before staff and volunteers started work. Staff told us they felt supported to provide the care required.

We found that people's views and experiences had been taken into account in the way the service was provided and delivered in relation to their care. Their privacy, dignity and independence were respected. The care plans and assessments were thorough and ensured that people's needs were identified and appropriately met. Staff showed that they could identify possible abuse and report and work with professionals to provide safe ongoing care for people. There were enough qualified, skilled and experienced staff to meet people's needs. With staff supported by appropriately trained volunteers. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.