Naseby Care Home

The inspection took place on the 6 and 7 January 2016. The inspection was unannounced on the first day and announced on the second. The inspection was carried out by two inspectors. At the last inspection in August 2014 the service was not meeting the regulatory requirements for care and welfare of people and records. We found during this inspection that improvements had been made and the service was now meeting these requirements.

Naseby Care Home is registered to provide accommodation and personal care for up to 21 people. At the time of our inspection there were 18 older people living at the service, some of whom were living with a dementia. Accommodation is provided over the ground and first floor. The managers’ office is located on the second floor. The first floor is accessed by a lift and stairs, the stairs continue up to the second floor. All of the bedrooms are single occupancy. Two rooms have an en-suite wash basin and toilet. Three rooms on the first floor are not accessible from the lift or suitable for a hoist. There are three shower rooms, two on the ground floor and one on the first floor. There is one bathroom. On the ground floor there is a lounge area which leads into a conservatory that is used as a dining room. There is a well equipped kitchen, laundry and sluice room. The service has a secure well maintained garden at the rear of the building which is accessed across a gravel parking area.

The service has 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 that the service was not always safe. We found that medicines were not always administered safely. We found that on the morning of the 16 December staff had signed to say that five separate medicines had been given to one person. We checked the medicine supply and found they were still in the pack and had not been given. We found three opened bottles of eye drops. Each stated that they expired 28 days after opening. None had a recorded date for when the bottles were opened. All three had prescription dates over 28 days old. We looked at records for one person who had a prescription for medicines that needed to be given as required. We checked the medicine and amounts given corresponded with the medicines remaining. A medicine administration record sheet is kept in bedrooms for creams with a body map that showed the areas any creams needed to be applied. We checked the charts for the week for one person and they had been completed correctly.

We found that the service did not review the amount of care workers needed to support people when they had to carry out additional domestic duties or were supporting people with increased care needs. On our arrival on the 6 January staffing consisted of the manager who was administering medicines and two care workers. People, their relatives and staff told us that at times it felt like there were not enough staff, particularly at weekends or if care staff were covering the laundry and kitchen. We asked how staffing levels are decided. The operations manager told us that the organisation has a management tool that when populated with people’s levels of dependency calculates how many staff hours are required to support people safely. The registered manager told us that they would familiarise themselves with the tool immediately and use it to support decisions about staffing levels. We observed staff responding quickly to call bells. One person was receiving care in bed and not able to use their call bell. Records did not evidence how often they were checked by staff during the day or how they would be able to call for assistance.

We were told that some people at the service were living with a dementia. We observed potential hazards in the service that had not been risk assessed. The staircase had restricted access down from the first floor. A key pad had been fitted which prevented people accessing the stairs to the ground floor without a member of staff assisting. People had free access to the stairs from the ground floor and from the first to second floor of the building. The kitchen door was open both days of our inspection. This meant that people had free access into the kitchen area. The cook works alone and on one occasion we saw the door open and the kitchen unattended. The manager told us that she would complete a risk assessment and would look at restrictions to accessing areas of the kitchen that may be hazardous. We were told that a bolt would be fitted to the door immediately so that the door could be locked whenever staff were not in the kitchen.

Health and safety audits were completed monthly. Records showed us that staff had health and safety training every two years. Staff had not reported hazards to the manager. The manager told us that they would include staff in future health and safety audits to ensure they were competent in identifying hazards that could harm people.

We spoke with two care workers who were not able to demonstrate an understanding of whistleblowing. This meant that staff did not know what action to take if their senior staff were not responding to concerns being raised about the safety of the service. Staff meeting minutes showed us that whistleblowing had been discussed at a staff meeting in October 2015. We spoke with the manager who told us they would discuss with each member of staff to assess their level of understanding. Staff had completed safeguarding training. They were able to tell us how they would recognise abuse and the actions they would take.

Staff received fire safety training. We spoke to one care worker who was not able to explain what action they would take in the event of a fire. We discussed this with the manager who told us they would review the care workers fire safety competencies. A signing in book was in the foyer but did not have any empty pages for visitors to complete. This meant that there was no record of who was in the building in the event of an emergency. Each person had a personal fire evacuation plan. The service had an emergency contingency plan which contained information on how the service would keep people safe in the event of a major incident which affected the running of the service.

People had risk assessments in place. We spoke with care workers who had a good understanding of people’s risk and what they needed to do to minimise risk and support the person.

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 and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working within the principles of the MCA. People had mental capacity assessments completed. Where it was identified that they were unable to consent to a restriction on their freedoms a best interest decision was recorded and a DoLs application sent to the local authority to request authorisation. We observed staff asking people for their consent.

New care staff completed the Care Certificate induction course over their first three days of employment. The Care Certificate is a national induction for people working in health and social care who have not already had relevant training. Staff had received regular training to enable them to carry out their role. Training records were kept with review dates noted where required. Staff files contained certificates for completed courses.

We observed the manager and senior staff working alongside care workers when providing care and support to people.

People told us they enjoyed the food. We spoke with the cook who demonstrated a good knowledge of people’s dietary needs and their allergies. One person required a specialist diet. . Staff had a good understanding of how to support the person effectively. Where necessary, people had charts to ensure that were eating and drinking enough. We found that staff were aware of who had charts and had completed them accurately.

People had good access to healthcare. Files evidenced that people had access to GP’s, specialist health services, chiropodists, dentists, opticians and district nurses.

We found that the service was caring. People and their families told us the staff were caring, easy to talk with and listened to what they had to say. The manager and care workers had a detailed knowledge of each person. We observed interactions between staff and people. Staff patiently supported people and offered reassurance. They enabled people to maintain some control and independence whilst ensuring their safety. People felt their privacy and dignity were respected. People and their families were involved in decisions about their care. People had not been told about advocacy services that would be able to speak up on their behalf. We raised this with the manager who agreed to source this information and share it with people.

The service was responsive. Information had been gathered prior to a person moving to the service. Assessments had been carried out which included the person, their family and other professionals. This information had been used to identify risks and create an initial care plan. Care records were individual and included assessments and detailed support plans explaining how a person liked to receive their care. The plans gave clear guidance on how to ensure a person’s dignity and independence. Plans included communication, mental wellbeing and the physical aspects of a persons’ care and support needs. However people on short stay placements had limited care plans and if a risk had been identified a detailed care plan had not been produced that told staff what they needed to do to minimise risk and ensure consistent care. Plans were reviewed and updated regularly. People and their families did not always continue to be included. Staff identified and responded quickly to changes in people’s care and health needs.

People’s files contained information about social activities people enjoyed. We saw an activity folder which contained a record for each person and activities they had been offered each day. This included the group activities, family and friends visiting and one to one time with staff. People did not have individual activity plans. The manager told us that these will be introduced this year.

People were supported to maintain relationships with their families and friends. There were no restrictions on times people visited the service. The service did not provide opportunities for people to access the community. A secure fenced garden had been provided for people. The garden was not visible from most areas in the home and was accessed over a gravel parking area which reduced some people’s opportunities to freely access the area.

People and their families felt they could raise concerns with staff. The service had a complaints process that included a concerns log. The complaints records showed us that complaints were investigated, actioned and outcomes reported back to the complainant. People were given information on how to appeal against outcomes.

The service was well-led. . Staff felt happy in their work and felt part of a team. They had a positive view of the service. People and their relatives told us the manager was effective and proactive. The manager felt supported by the organisation.

Staff felt included in decisions about the service and that they could share their ideas and concerns with the manager. The service had introduced a carer of the year award. In December three staff were nominated. The award demonstrated achievements in good care practice. The home had a small staff team and we saw the manager worked alongside staff throughout our inspection. Staff had a relaxed but respectful relationship with the manager. The manager demonstrated a good knowledge of people, their families and the staff team.

The manager completed regular audits to monitor the services performance. Actions from audits were completed and shared with staff.

The Manager had a good understanding of their responsibilities for sharing information with CQC and our records told us this was done in a timely manner.

A quality assurance survey had been completed in August 2015. Forms had been sent to people, their families, staff and other professionals. The results had been analysed by the manager. The overall results were positive. The outcome of the survey was shared on the organisations web site but not within the service. The manager told us that they would arrange for the outcome of the survey to be shared with people, their families and staff.