The Chiswick Nursing Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were safeguarded from abuse and risk of harm. Staff and the provider had a good understanding of abuse and how to report it. People and relatives were involved in care planning and risk management. Risks identified were mitigated as much as possible. Staff were recruited to the service using safe recruitment practices. Some areas of the home needed updating and the provider had a plan in place. Staffing levels were reviewed regularly, however some people reported that there was not always enough staff on duty to meet their wider social needs. The management team were made aware of these concerns during our onsite and offsite assessment. The registered manager told us they had not received any complaints about staffing and the local authority had made a visit to the service and didn’t find any concerns. The registered manager told us they would carry out a satisfaction survey to find out people’s views on staffing.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe, one person said, “I feel safe. The staff are calm with me, and they are reassuring. For my condition I am in the right place.” Another person said, “The staff are very nice, and this reassures me that I will be well looked after. Also, there were security doors to keep us safe.". A relative told us, “Yes, [my relative] is definitely safe and that is because they are well trained, steady, consistent, reliable carers”. Everyone we spoke with told us the staff were good at their job and understood their role and responsibilities.

The provider had a clear safeguarding process in place. Safeguarding and whistleblowing procedures were in place. Staff had access to guidance about safeguarding and how to report abuse. Staff received training in safeguarding which meant they had knowledge and confidence in dealing with any safeguarding concerns. Staff had also received training in the principles of the Mental Capacity Act. This meant people who lacked capacity were supported to make decisions through a best interest decision making approach. The provider had in place the correct authorisations for depriving people of their liberty. The provider kept a log of safeguarding concerns and actions taken. This meant people could be assured the management team had a good oversight of this process. CQC and the local authority were kept informed of any safeguarding concerns.

Staff and leaders told us they understood how to protect people from abuse. Staff had a good understanding of abuse including the signs and symptoms. Staff said they would report any concerns to the managers and if this was not dealt with they would blow the whistle to external organisations such as the CQC or local authority according to the organisations whistle blowing policy.

People and their relatives told us they were involved in the care planning process. This also included managing risks. People were able to make decisions about their goals and what they wanted to achieve. The staff promoted and encouraged people to become more independent, for example, by providing additional equipment to aid their mobility.

Risk management plans were in place for people, plans gave clear guidance to staff to follow. Risk management plans were up to date and reflected the person’s current needs. Changes to their needs were regularly updated and communicated to staff through regular handovers. All accidents or incidents were analysed by the provider to look for any trends or patterns. This system helped the provider to seek out medical advice at regular intervals. Records we reviewed showed referrals had been made to health care professionals following an incident. This meant people could be confident that their health and well being was a priority. During our inspection we noted the home needed some updating. Some areas of the home were shabby and worn. The provider was aware of the need to replace furniture/flooring and there were plans for re-decoration. In addition, people and relatives had made some comments about the maintenance issues and in some cases the length of time it took for repairs to be done. We spoke to the registered manager about this, and they shared with us an extensive plan to replace furniture and flooring. There was also evidence of repairs being completed and recorded.

During our visit we observed people being supported in the home for example in some instances people were using walking aids, to mobilise. Staff were supportive and patient when walking with people. Staff were observed taking account of the environment for any hazards, encouraging and re-assuring people when moving from one area to another. People showed they were relaxed when being supported by staff, we observed people smiling and following staff guidance. However, we did also observe that some areas of the home had some objects in corridors which could potentially cause a safety incident, we brought this to the attention of the staff who acted in removing these items straight away.

Staff and leaders understood people’s care needs. They were able to describe any changes to people’s needs, including new identified risks to the person’s wellbeing. The service worked with health care professionals and care plans were regularly updated to reflect changes to people’s care needs. For example, following a fall the management team had referred a person to the falls prevention clinic, this meant the person would have a full assessment and additional measures could be put in place if needed.

During our inspection we noted the home needed some updating. Some areas of the home were shabby and worn. The provider was aware of the need to replace furniture/flooring and there were plans for re-decoration. In addition, people and relatives had made some comments about the maintenance issues and in some cases the length of time it took for repairs. We spoke to the registered manager about this, and they shared with us an extensive plan to replace furniture and flooring.

The provider had a process in place for recruiting staff safely. This meant people could be assured that staff had been fully vetted before starting in their role. Staff had a full and comprehensive induction. Staff also had training in a variety of areas which enabled them to build competence and confidence in their role. Staff records showed staff training was regularly reviewed and updated.

Most people we spoke with, and some relatives told us there was not enough staff on duty to meet all of their needs. One person said, “They must be short staffed, because they don’t always get me up in good time. It’s 11 o’clock now and I asked them at 9.30 to help me.” And another person said, “They are just run off their feet. Do you know, you are the only person I’ve a proper conversation with, all day long. I so wish they would come and have a proper chat with me, rather than doing what they have to and then leaving.” Some relatives also told us there was a lack of staffing, one relative said, “The staff are stretched at the best of times, and you notice that, particularly when there is training going on. They are attentive when helping someone, but they have no time for a meaningful dialogue or conversation, which is important for the elderly.” We spoke to the management team about this, and they informed us that prior to our visit this had not been raised with them as a concern, however following our feedback the registered manager told us the staffing levels would be reviewed and a questionnaire will be sent out to people to ask for their views. The service records we reviewed showed that staffing levels were regularly checked and kept under review.

Some staff told us they didn’t think there was enough staff on each shift. Other staff we spoke with told us staffing levels were adequate. All staff we spoke with told us they were well supported by their line managers. Service records showed staff had regular team meetings and supervisions. Staff said they had good training. Training records showed staff had attended a range of training to support them in their role.

During our visit to the service, staff were friendly and patient with people, call bells were answered in a timely manner. However, we also noted that the support being provided was task driven. This meant that there was little time for staff having a chat with people. Staff were very busy and at times were in a hurry to move onto the next task. This was noted by everyone on the inspection team. We also observed staff being supportive and caring towards people.

The provider had procedures and processes in place to prevent infections in the home. Staff had a good understanding of infection, prevention, and control. Staff used personal protective equipment, when supporting people. There was a cleaning schedule in place and regularly checked by the managers. We did detect some malodours in some areas of the home. The registered manager told us this was due to the old flooring which was due to be replaced as part of a refurbishment for the home.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.