Nazareth House - Hammersmith

Updated 8 September 2022

Inspection team

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by three inspectors, an Expert by Experience and a specialist professional advisor. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The specialist professional advisor worked as a nurse in the care of older people.

Service and service type

Nazareth House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also reviewed the information we held about the service and obtained feedback from a member of the local authority.

We used all of this information to plan our inspection.

During the inspection

Inspection activity started on 29 June 2022 and ended on 12 July 2022. We visited the service location on 29 June, 8 July and 12 July 2022. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 8 September 2022

About the service

Nazareth House is a residential care home providing personal care to up to 95 people. The service provides support to older people with nursing needs and those with dementia. At the time of our inspection there were 90 people using the service.

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

People and their relatives gave positive feedback about the staff and told us they were kind and caring. We observed positive interactions between people and staff throughout the inspection.

People's care plans and risk assessments included clear guidelines for staff in how to mitigate risks to people’s safety in areas of known risk. However, we found that where people had conditions that were controlled with medication and had not shown symptoms for many years, relapse indicators were not in place. Furthermore, although we found people were appropriately supported with their pressure ulcer wound care needs, care plans did not detail how often people needed to be turned and turning charts were not completed consistently.

The provider supported people to participate in activities and made attempts to provide activities people enjoyed. However, people complained about not enjoying the activities on offer.

We were assured that this service met good infection prevention and control guidelines. The provider facilitated safe visiting arrangements, had systems in place to ensure the building was clean and had systems in place to prevent the spread of infection. We found mask wearing was not consistently complied with on the first day of our inspection, but this improved significantly on the second and third days.

There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training and were clear about their responsibilities.

The provider carried out appropriate pre- employment checks before hiring staff. There was an induction programme for new staff, which prepared them for their role. Staff were provided with enough training and supervisions to help them carry out their duties. There were enough staff employed to meet people’s needs.

Staff gave good feedback about the registered manager as well as their colleagues. The management team had a visible presence and staff said they made themselves available when needed.

The provider monitored the quality of people’s care, but did not pick up on issues relating to people’s turning charts or their specific medical needs.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published November 2019).

At our last inspection we found breaches of the regulations in relation to the provision of person- centred care, ensuring they delivered care in line with people’s valid consent, safe care and treatment, the premises and equipment and good governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting these regulations.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last 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.

Recommendations

We have made recommendations in relation to drafting risk management guidelines, making contemporaneous records, meeting people’s needs in relation to activities provision and conducting comprehensive audits. We will check if the provider has acted on any recommendations at our next comprehensive inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.