Hurst Nursing Home provides nursing care and accommodation for up to 22 older people. At the time of this inspection, there were 18 people living at the home, all of whom required nursing care and nine were living with different stages of dementia.
A registered manager was in post when we visited. 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.
All of the people and relatives we spoke with during the inspection said they felt safe in the home. One person told us, “I absolutely feel safe; there is no funny stuff going on in here”.
We saw staff deliver care with compassion and understanding. They took time to listen to people to ensure they understood them. Staff were seen to be positively and meaningfully interacting with people. There appeared to be a good rapport between staff, people and their relatives.
Staff we spoke with knew how to keep people safe; they were able to identify signs of possible abuse and knew what to do if they witnessed them. However, not all staff had received up to date training in this area.
Staffing levels provided were sufficient to meet the needs of people accommodated.
People and their relatives said that the food at the home was good and choices had been provided. Where necessary, people were given help to eat their meal safely and with dignity.
Care records indicated risk assessments had been carried out, for example with regard to skin integrity, nutrition and hydration. However, records of nursing care and treatment provided were not up to date or complete. This meant that identified risks to people may not be effectively managed to reduce the likelihood of occurrence or recurrence.
Care plans were in place for all but one person who had recently been admitted. However, people, or their relatives, had not been consulted with regard to their needs and wishes to ensure the care provided was person centred. Information had not been kept up to date to ensure it reflected people’s current needs. Care plans were not effective in making sure people’s needs had been met.
A limited programme of activities had been provided. However, it was not clear how they provided for the needs of people who stayed in their rooms. This meant that they were at risk of isolation and withdrawal.
Not all staff had received supervision and appraisals at regular intervals to ensure they had the necessary skills and knowledge required to carry out their work. Staff training records indicated training had not been kept up to date and some staff had received no training at all in some essential areas, such as understanding dementia and diabetes.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). It is the responsibility of the Commission to monitor how the MCA and DoLS are applied in health and care services it has registered.
Despite having some training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the registered manager and staff demonstrated a limited understanding of their role and responsibilities in this. Where people did not have the capacity to make decisions about their care, the registered manager was unable to demonstrate how this was assessed and how decisions would be made. DoLS applications had been made on behalf of seven people even though there was no evidence to demonstrate they lacked capacity.
People and their relatives had been asked for their views of the quality of the service. However, the registered manager was unable to demonstrate how comments and suggestions received had been considered and, where appropriate, action implemented to improve the service.
A quality assurance system was in place to monitor how the service had been provided and to identify shortfalls. This did not include monitoring complaints, accidents, incidents or safeguarding referrals so that lessons could be learned and action taken to reduce the likelihood of recurrence. There was no evidence to demonstrate, where shortfalls had been identified, action had been taken to make improvements to the service.
We have identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.