We carried out a review of the data available to us about Nazareth House - Hammersmith 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 Nazareth House - Hammersmith, you can give feedback on this 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.
The provider had implemented a programme of testing for people using the service and staff. At the time of our inspection, two staff members had tested positive for COVID- 19 and were self- isolating within their homes. The care home was therefore temporarily closed to visitors.
The provider had suitable systems to minimise the spread of infection across the service. Staff were restricted to the same area of the building to minimise the risk of spreading illness.
Measures were also in place to minimise the risk of visitors catching or spreading illness. The provider had a separate entrance for visitors, who were required to have their temperature checked, disinfect their hands and provide initial details about their infection risk, before they were able to visit people within the service’s garden area for a limited period of time under socially distanced conditions.
Face masks and other Personal Protective Equipment (PPE) available for visitors and staff. Communal areas within the home were arranged to accommodate social distancing and there were electronic tablets within the home for conducting virtual meetings.
The provider had full access to Personal Protective Equipment (PPE) and staff had received appropriate training in infection control procedures both internally and from external providers. The provider had explained the need for PPE to be worn by staff to people using the service.
Further information is in the detailed findings below.
People’s experience of using this service and what we found
The provider did not keep records to demonstrate lessons were being learned when things went wrong. Accidents and incidents were recorded, but there was no record kept of how lessons were being learned to mitigate against any future risks. There had been some safeguarding concerns raised which are being investigated by another authority. The provider was working with the local authority to resolve these issues. The provider did not always ensure there were enough staff deployed to meet people’s needs. Insufficient information was recorded in relation to people’s mental health needs which created a risk of them not receiving the care they may have needed. The building was not suitably adapted for people with dementia as the décor was sparse and there was a lack of reference points to prompt people.
The provider did not take appropriate action to mitigate people’s risk of social isolation as people’s involvement in activities were not monitored and there was a lack of activities provision for people with dementia. People’s relatives told us their complaints were listened to, but appropriate action was not always taken to rectify these. People’s relatives told us they were asked for details of their family member’s needs and preferences, but these were not being met in practise. The provider did not always ensure that information was provided to people in a format they understood.
The provider monitored the quality of people’s care, but some of the issues that had been identified during our inspection had not been identified by them prior to our inspection. People told us there had been a decline in the quality of the service and care workers told us the registered manager did not always engage with them. The registered manager understood his regulatory responsibilities, but notifications of significant events had not always been reported to the CQC as required.
The provider had risk management guidelines in place for areas of risk relating to people’s health and safety. Medicines were managed safely and the provider delivered care in a clean and hygienic way. Care was not always delivered in line with current legislation and standards as the provider was not always meeting the requirements of the Mental Capacity Act 2005 or ensuring that lessons were learned from accidents and incidents. Staff were given appropriate support to carry out their roles. People’s nutritional needs were met and they worked effectively with multi- disciplinary professionals. 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. The provider met people’s cultural and religious needs. People’s privacy and dignity was respected. The provider delivered end of life care in accordance with people’s needs and preferences. The provider sought feedback from people, their relatives and staff.
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 23 January 2017).
Why we inspected
inspection The first three days of our inspection were planned, based on the previous rating. We extended the inspection by a further day due to receiving concerns from the local authority.
Enforcement
We have identified six breaches in relation to safe care and treatment, person- centred care, consent, premises and equipment, good governance and a breach of the requirement to send notifications.
Please see the action we have told the provider to take at the end of this report.
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.
At the last inspection on 14 and 15 July 2014, we asked the provider to take action to make improvements in relation to consent and this action has been completed.
Nazareth House provides care and support for up to 95 people who require nursing and personal care. There were 85 people using the service when we visited. There are three floors within the building. The first and second floors are home to people with nursing needs and some people with palliative care needs. The third floor is a residential floor which is home to older people some of whom had early onset dementia.
There was a registered manager at the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
There were good systems in place for the safe management and administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.
Risk assessments and support plans contained clear information for staff. All records were reviewed every month or sooner if the person’s care needs had changed.
Staff demonstrated a good knowledge of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed as needed and we saw these in people’s care files. Where staff felt it was in a person’s best interests to deprive them of their liberty, applications were sent to the local authority for Deprivation of Liberty authorisations to ensure this was lawful.
Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.
People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.
Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.
People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met. Although Nazareth House is a Catholic care home, there were people using the service from other denominations of the Christian faith and people were welcomed and respected from other faiths and with other beliefs.
People were supported to maintain a balanced, nutritious diet. People at risk of malnutrition had appropriate assessments conducted and were referred to the community dietitian as appropriate. Advice was implemented by care staff and the kitchen staff who were also aware of people’s dietary needs. People were supported effectively with their other healthcare needs and were supported to access a range of healthcare professionals.
People using the service felt able to speak with the registered manager and provide feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Care staff gave excellent feedback about the registered manager and gave us examples of improvements that had been implemented and sustained.
People were encouraged to participate in activities they enjoyed and people’s participation in activities was monitored. People’s feedback was obtained to determine whether they found activities or events enjoyable or useful and these were used to further develop the activities programme on offer. The activities programme covered five days a week and included a mixture of one to one sessions and group activities. There was limited provision for activities over the weekend, but special weekend activities were arranged every month.
The organisation had good systems in place to monitor the quality of the service. Feedback was obtained from people through monthly residents and relatives meetings as well as annual questionnaires and we saw feedback was actioned as appropriate. There was evidence of auditing in many areas of care provided as well as significant monitoring from senior staff members within the organisation.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
We undertook an unannounced inspection of Nazareth House on 14 and 15 July 2014. Nazareth House provides care and support for up to 95 people who require nursing and personal care. There were 82 people using the service when we visited.
At our last inspection on 6 November 2013 the service met the regulations inspected.
The service had a registered manager who had been in post since October 2013. 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 and associated Regulations about how the service is run.
We found a breach with regard to consent arrangements. Managers and staff had received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). However, the manager and other senior staff confirmed that mental capacity assessments were not consistently completed when required. This meant that there was a risk that decisions were being made without people’s valid consent. This was a breach or Regulation 18 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
Managers and staff had received training on safeguarding adults. Safeguarding adults from abuse procedures were robust and staff understood how to safeguard the people they supported.
People and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place which reflected their assessed needs.
Recruitment procedures ensured that only people who were deemed suitable worked within the service. There was an induction programme for new staff which prepared them to perform their role. Staff were provided with a range of training to help them carry out their duties. Staff received regular supervision and appraisals to support them to meet the needs of people. There were enough staff employed in the service to meet people’s needs.
Staff assisted people to eat and drink appropriately. People were supported effectively with their health needs and were involved in making decisions about what kind of support they wanted.
Staff, people who used the service and relatives felt able to speak with the manager and provided feedback on the service. They knew how to make complaints and there was an effective complaints system in place.
The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified action plans were put in place to rectify these.
People's medication was safely managed and only administered by staff that could demonstrate their competence. People who use the service had their medicines administered as prescribed.
People's care and treatment was delivered by staff that were safely recruited and had the right skills, experience and training for the post they held.
One person told us 'they [staff] are so kind to us all.' Staff received training and regular supervision to do their job and reported to us that they felt well supported to do a good job.
The provider had in place an accessible and robust process for handling complaints received by the service and we saw that efforts were made to resolve matters to people's satisfaction.
We looked at 15 care plans and saw that people's preferences had been documented. Furthermore, we saw that if a person lacked capacity, the provider had acted in accordance with legal requirements. People were assessed regularly by staff to ensure that all their care needs were being met. This included assessing their nutritional status on a monthly basis. People were supported to eat and drink sufficient amounts to meet their needs.
There were systems in place to monitor the quality of service provided and to obtain feedback from people. Monthly audits were carried out and quality monitoring visits were conducted by staff from one of the provider's other services. However, people were not protected from the risk of infection. We saw that some areas, including commodes were visibly unclean at the time of the inspection. There was a lack of guidance for staff on how to clean equipment and staff we spoke with were unsure of the procedure.