We carried out a review of the data available to us about Atholl House Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Atholl House Nursing Home, you can give feedback on this service.
The home is an adapted building with a purpose-built extension and accommodation is split into 5 communities over 2 floors.
People’s experience of using this service and what we found
People were supported to access healthcare services when required.
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 (published 26 March 2021).
Why we inspected
We undertook this targeted inspection to check on a specific concern we had about people being supported to access healthcare support. The overall rating for the service has not changed following this targeted inspection and remains good.
We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
The home had a designated unit which enabled people who were positive for COVID-19 to be safely admitted to the home without placing other people at the home at risk. The unit was self-contained and could be accessed independently from the rest of the home to reduce the risk of transmission of COVID-19. The unit had its own staff team.
Effective infection control systems were in place and these were understood and followed by staff. The home was clean and fresh and there was regular wiping down of touch points and equipment. Visiting arrangements followed current government guidance for routine visits and the use of essential care givers. Hand sanitiser and personal protective equipment (PPE) was readily available in the home and there were sufficient supplies of PPE. People, staff and essential care givers took part in the home's COVID-19 testing regime, which followed current government guidance. Appropriate processes were in place should anyone display any symptoms of COVID-19.
We found the following examples of good practice.
• People were supported on a designated unit that was self contained and could be accessed independently from the rest of the home to reduce the risk of transmission of COVID-19.
• People were supported by a staff cohort who were permitted to work only on the designated unit. Staff had their own staff room and changing facilities within the designated unit.
• People were supported by staff who were trained in infection prevention and control (IPC) and were aware of up to date guidance regarding Personal Protective Equipment (PPE).
• The premises looked clean, hygienic and uncluttered. Chlorine based products were used for cleaning in line with current guidance. Cleaning schedules were in place and were complied with.
• Staff risk assessments had been undertaken to identify staff who were at disproportionate risk of COVID-19. Where staff were at higher risk, measures were put in place to mitigate risk. Staff allocated to the proposed designated unit were required to have had a COVID-19 vaccination prior to working on the unit to reduce risk of transmission.
We were assured that this service met good infection prevention and control guidelines as a designated care setting.
Atholl House Nursing Home is a nursing home providing personal and nursing care to 48 people at the time of the inspection, across five units, some of whom were living with dementia. The service can support up to 84 people.
Peoples experience of using the service and what we found
People were cared for by staff in a way that kept them safe and protected them from avoidable harm. Enough staff were available to respond to people’s needs in a timely manner. , The management of people’s medicine had improved and people received their medicines when they needed them, and systems were in place to ensure that medicines were stored and administered safely and that adequate supplies were available. Accidents and Incidents were investigated, and measures were taken to prevent re-occurrences. The premises were clean, and staff knew and followed infection control principles.
The provider’s governance systems had improved since our last inspection, but these still needed time to show these has been successfully/effectively embedded. The registered manager and staff worked in partnership with other agencies to improve outcomes for people. The provider understood their duty of candour.
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 requires improvement (published 03 March 2021) there were multiple breaches of regulation. Following the last inspection, we issued a warning notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 outlining the improvements we needed to see.
Why we inspected
We carried out an unannounced focussed inspection of this service on 01 February 2021. Breaches of legal requirements were found. The provider was issued with a warning notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection the provider produced an action plan outlining how they would improve.
We undertook this focused inspection to check they had met the warning notice, followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Atholl House Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
We found the following examples of good practice.
• People were supported by staff who were trained in infection prevention and control (IPC) and wore Personal Protective Equipment (PPE) in line with current guidance.
• The premises looked clean, hygienic and uncluttered. Chlorine based products were used for cleaning in line with current guidance. Cleaning schedules were in place and were complied with.
• Staff were only permitted to work on the unit that had been proposed as a designated setting. Staff were required to access the unit via a separate entrance and had their own staff room and changing facilities.
• Staff risk assessments had been undertaken to identify staff who were at disproportionate risk of COVID-19. Where staff were at higher risk, measures were put in place to mitigate risk. Staff allocated to the proposed designated unit were required to have had a COVID-19 vaccination prior to working at the setting to reduce risk of transmission.
We were not assured that this service met good infection prevention and control guidelines as a designated care setting as the service was currently rated ‘Requires Improvement’ with breaches of regulation and therefore did not meet the required rating criteria.
Atholl House Nursing Home is a nursing home providing personal and nursing care to 65 people at the time of the inspection, across five units, some of whom were living with dementia. The service can support up to 84 people.
People’s experience of using this service and what we found
People medicines records did not consistently contain clear guidance for staff to follow to ensure people received their medicines as prescribed. People did not always receive safe care in line with their needs. Staff were not always recruited safely. People were supported by staff who were trained in safeguarding. People were supported by staff who understood infection control guidelines and were following these.
People were not always supported to eat and drink safely. 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. People were supported by trained staff who knew them well. People had access to healthcare professionals where this was required.
People were not always supported to maintain their dignity. People were supported by staff they described as caring. People appeared comfortable with staff and staff knew people well. People were encouraged to be involved in their care planning. People were supported to maintain their independence.
People were supported to maintain relationships with those who were important to them. People were encouraged to engage in activities they enjoyed. People were supported to communicate in a means more comfortable the them.
Quality assurance tools had failed to identify improvements at the service in relation to medicines, care, records and recruitment. People felt able to raise concerns with the registered manager and that these would be taken seriously. People, their relatives and professionals gave positive feedback about the registered manager.
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 requires improvement (published 16 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.
Why we inspected
This was a planned inspection to review the previous inspection rating. 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 coronavirus and other infection outbreaks effectively.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to people’s safe care and treatment and the oversight of the service at this inspection.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service:
People told us there were occasions where they may have to wait for staff and sometimes staff only had time to cater for the physical side of their care, and they felt rushed. We saw care was task orientated at times, although we also saw some very warm, kind and caring interactions between staff and people.
People were satisfied with how they received their medicines. There was room for improvement, but we saw staff gave people their medicines in a safe way.
Risks, and how these could be minimised was captured in people’s records although risks presented by people’s behaviours when anxious or upset needed to be assessed in a more robustly. People’s needs were assessed and reviewed but there was scope to improve the accuracy of some care records and develop the electronic care records system to allow easier oversight.
We saw some areas in the home could have been safer, some of these issues were addressed during our inspection. There was no auditing of the provider’s systems for maintaining good infection control.
People were positive about staff and most told us they were competent and offered them appropriate support. We found the provider was providing ongoing training to staff although needed to ensure they were more familiar with the electronic records system.
People had mixed views about the food offered but said they could always choose alternatives. We were made aware the menus were to be reviewed to coincide with the appointment of a new cook. People’s diets were monitored when they were at risk of poor nutrition.
People said they accessed healthcare services according to their needs and agreement.
People were asked for their consent before providing care. Some people were very positive about their treatment by staff, although a few did raise matters they agreed we share with the registered manager. For example, one person said they were going to raise the issue but spoke with us first. People told us their privacy was respected and independence promoted. We heard from relatives that end of life care was sensitive and appropriate.
People’s needs were met but there was scope to continue making people’s care more person centred and ensure people’s involvement improved further. We saw improvements had been made to provide regular activities for people through development of the activity co-ordinators roles.
The consistency of management and leadership had improved with the appointment of a manager, who is now registered with CQC. There was still scope for improvements, many of these recognised by the provider which needed to be progressed to further develop the delivery of high-quality, person-centred care.
Rating at last inspection: The rating for the service at our last inspection was ‘requires improvement’ (Published on 14 April 2018). This service has been rated ‘requires Improvement’ for the two previous inspections. There were four breaches of regulation at our last inspection in January 2018 these related to safety, person centred care, dignity, and good governance which we found had been addressed at this latest inspection.
Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets.
Enforcement: We will be arranging a meeting with the provider to discuss how they will improve following a repeated ‘requires improvement’ rating.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
Atholl House Nursing Home 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. This service provides nursing and personal care for up to 84 people. At the time of this inspection 60 people were living there, some of whom were living with dementia.
At the time of this inspection there was no registered manager. A manager had recently been appointed and we confirmed with them that they were in the process of applying to be registered with the Care Quality Commission. 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 manager was present throughout this inspection.
At the time of our last inspection undertaken on 22 and 23 September 2016 we rated the service as Requires Improvement. We found shortfalls related to staffing, risk management and quality assurance, However; no breaches of regulations were identified. At that time these topic areas were included under the key questions of safe, responsive and well-led. We reviewed and refined our assessment framework and published the new assessment framework commencing from 1 November 2017. Under the new framework these topic areas are included under the key questions of safe, effective, responsive and well-led. Therefore, for this inspection, we have inspected these key questions and also the previous key question to make sure all areas are inspected to validate the ratings.
At this inspection we saw improvements had not been made in the areas identified at our last inspection. In addition we identified a number of other concerns including breaches of regulation. These breaches include: safe care and treatment, dignity and respect, person centred care and governance.
This has resulted in the overall location being rated as requires improvement.
The provider had systems in place to monitor the quality of support given and to make changes when needed. However, these systems were ineffective and did not identify the concerns or improvements required that we found at this inspection.
The provider did not have effective infection prevention and control procedures in place. Maintenance and repair processes were ineffective and did not keep people safe from the environment within which they lived. During this inspection, pieces of equipment were removed from use as they were ineffective in keeping people safe. People’s medicines were not safely stored.
People’s rights were not always protected by those supporting them and the management team did not always follow the principles of the Mental Capacity Act when making decisions that effected people.
People were not always treated with dignity and their privacy and confidentiality was not respected or protected. Interactions with staff members were task focused and did not value the person as an individual. People did not have sufficient opportunity to engage in activities that they found interesting and stimulating.
Although people received care from staff that had the skills and knowledge to meet their needs they were not always treated in a kind, caring and considerate manner by those supporting them. Physical adaptations to parts of the property had not been made to enable people to safely move around their home. People did not receive information in a way they could access. The management team were unaware of the accessible information standards and had failed to implement these at Atholl House.
People received care from staff members who knew their individual likes and dislikes. However, people were not consistently involved in the creation and development of their care plans. People did not have care and support plans that reflected best practice and people’s future wishes were not recorded.
People and their relatives were encouraged to raise any issues and the management team had systems in place to address such concerns or complaints. However, people did not always feel their concerns were adequately responded too. Staff members did not feel they received adequate support and guidance from the management team. Although staff felt supported by their colleagues they felt removed from decisions affecting their workplace and felt the management team did not always listen to them.
People had access to healthcare to maintain wellbeing. People were supported to eat and drink enough to maintain their health but monitoring was inaccurate and gave misleading information.
Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s needs was provided. People were kept safe from the potential harm of abuse or ill-treatment as staff knew how to recognise and respond to such concerns. The provider followed safe recruitment procedures when employing new staff members. Any incidents and accidents were investigated in order to minimise reoccurrence.
We last inspected the service on 29 January 2014 at that time the provider was meeting the requirements of the law we assessed them against.
People were not always supported by staff who understood their risks and how to manage them. People did not always receive care and support in a way that reflected the risk management plans in order to reduce risks. Staff were often very busy and people sometimes felt had to wait for support.
The registered manager had systems and processes in place to monitor and analyse the quality of the service, however we found the systems were not always effective in identifying issues. People and their relatives had limited opportunities to provide feedback and felt communication could be improved.
People were supported by a staff team who were able to recognise the signs of potential abuse and how to report it.
People received their medicines as prescribed and were given medicines by staff who were suitably trained. People’s medicines were stored safely.
People received care and support from staff who had been recruited safely and received suitable training and support.
People were supported to have sufficient to eat and drink. People were given a choice of what they ate and drank and specific dietary needs were catered for.
People were asked for their consent to care and support and the principles of the Mental Capacity Act 2005 were being applied. Assessments of people’s capacity were completed where people lacked capacity.
People were supported to access healthcare services when required and maintain their health.
People were supported by a staff team who treated them with kindness. People were supported to make decisions about how their care and support was provided and how they spent their leisure time. People were treated with dignity and respect and were encouraged to maintain their independence. People were supported to maintain relationships that were important to them.
People and their relatives were involved in the planning and review of care and were supported by staff who provided care and support in a way that respected people’s preferences. People were supported to engage in activities which they enjoyed and were encouraged to engage in personal interests and hobbies.
People and their relatives knew how to make a complaint and felt confident that complaints would be effectively managed. We looked at complaint records and saw complaints were logged and investigated and actions taken to improve practices had been documented.
People and their relatives knew who the registered manager was and staff felt supported by the registered manager. Staff felt concerns and suggestions were listened to and acted on and the registered manager had a good understanding of their responsibilities.
We found that people were supported in making day to day decisions about the care they received. One person told us, "I am kept well informed'. People's dignity was respected by staff.
The care people received was reflected in their care plans. Care was regularly reviewed to ensure it met people's needs. However, we found that records relating to how one person's skin was supported to be healthy was not properly completed
Staff used equipment correctly and followed guidance to limit the risk of the spread of infection.
We found that staff were recruited in a way which determined they were appropriate people to deliver care and checks were carried out to ensure their suitability. One person told us, 'Staff are excellent'.
The service had a clear complaints procedure. We found that complaints were appropriately recorded and progressed.
We looked at three care plans that provided sufficient information to support staff's understanding about people's assessed needs and how to care for them. 'One person who used the service said, 'They couldn't look after me any better even if I was the queen.'
We found that appropriate systems were in place to ensure people were protected from potential abuse.
We looked at systems and practices for the management of people's prescribed medicines and found them to be robust and ensured people were supported to take their medicines safely.
The staff training programme showed that staff were provided with relevant training to ensure they had the skills and competence to care for people.
The provider had an effective quality assurance monitoring system in place, to ensure people were protected from unsafe care and treatment. We spoke with a person who lived there who said, 'I have lived in three other care homes and this is the best.'
This review was carried out to look at all the information we had received since we told the provider where they needed to improve. We visited the service to check the improvements.
We spoke with people that used the service and a relative of a person that lived at Atholl House.
One person told us that that the care was 'very good and they can't do enough for you'.
People told us that staff were very friendly and that people living there were supported in the right way.
One relative told us that the care was 'excellent, is the best home in Wolverhampton' and that the care was 'first class, very good, relative well looked after'.
One visiting relative said, 'The care here is brilliant.'
One person who uses the service said, 'The staff assist me to have a wash and get dress and they do this well.'
People who use the service cannot be entirely confident that all staff will have the skills to protect them from potential abuse.
One person who uses the service said, 'The staff are polite and talk to me nicely.'
A visiting relative said the care was fantastic and staff always take the time to talk to them.
The management of prescribed medicines remain unsafe and this could compromise people's treatment.
Efforts had been made to improve systems in monitoring the quality of the service delivery. However, we identified a number of shortfalls that could have a negative impact on the care and support people receive.
Another person told us, 'I'm happy living here.'
A person who uses the service told us, 'The service is cheerfully provided.'
People made some positive comments about the care they receive. However, we found some shortcomings in how care is planned and provided which could place people at risk.
'The staff know me that well they don't have to ask me how I need to be cared for.' 'I thank the people who look after me.'
The care plans we looked at did not contain any evidence to show people's involvement in their care planning; we did not see people's comments or their signatures.
Three staff spoken with demonstrated a reasonable understanding of safeguarding people from potential abuse.
One person who uses the service said, 'The staff are respectful and polite.'
Another person who lives there said, 'The staff are very good.'
The staff training records we looked at showed that staff do not receive sufficient training to ensure they have the skills to provide an effective service.
We observed staff attending to people in a caring manner.
"When I buzz (nurse call alarm) they come quickly.'
Another person said, 'There are always staff around when you need them.'
We found that the quality assurance systems in operation were ineffective to ensure people receive a good service.