Patcham Nursing Home

Patcham Nursing Home is a residential care home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 30 people. Patcham Nursing Home is comprised of two floors, with a lounge, a conservatory and a dining area. There is a garden to the front of the home.

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

We saw safe staffing levels on the day of the inspection. However, we received mixed feedback from people and staff about staffing levels. Staff and people told us that mornings were busy and needed more staff to support people with getting ready for the day. People were kept safe from the risk of abuse by well trained staff. Infection risks at the home were minimised by the use of cleaners and good hygiene techniques by staff.

Staff told us they would like more supervision time, and more face to face training although they felt training was adequate. People felt the staff were well trained and that staff were caring. A person told us, “I have only been here two weeks and I feel surrounded by good people who want to keep me safe and well.” The home was clean and tidy and people were able to access the lounge, dining room and conservatory as they wished. Food was provided by a trained chef and people said they enjoyed the meals.

Staff knew people well and treated them kindly. People were supported by staff to be involved in decisions about their care and changes in the home. People had access to healthcare outside the home if they needed it and staff could accompany people to appointments. People were treated with dignity by staff that understood the importance of people retaining their independence and privacy wherever possible.

People had person centred care. Staff knew people and what they preferred to do during the day. The activities coordinator was undergoing extra training to better understand dementia and to expand the activities on offer at the home. People were able to feedback to the registered manager if they had comments about the service and the service had a clear complaints policy.

The service had a new registered manager who was passionate about the care of older people. Staff said that the new management had improved the morale at the home and created better teamwork. People told us they had noticed a change in the attitudes of staff and that staff were happier and helped each other with tasks. People and relatives were more involved in changes to the service, regular surveys enabled the registered manager and the provider to focus change on the areas that mattered to people.

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 details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 October 2018) and there was a breach of Regulation 17(2)(e) HSCA RA Regulations 2014 Good governance. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow Up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A registered manager was in post. 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.

The culture and values of the provider were not embedded into every day care practice. Although some staff spoke positively of the culture and how they all worked together as a team, feedback from other staff was mixed and indicated that there was a lack of cohesion and a negative culture in the service. Some staff did not have a good understanding of equality, diversity and human rights. We have identified this as an area of practice that requires improvement.

On the day of our inspection, staffing levels were appropriate. However, we received mixed feedback from people and staff in relation to staffing levels. Documentation showed that on several occasions, shifts had gone ahead with less staff than had been assessed needed. We have identified this as an area of practice that needs improvement.

We have made a recommendation in respect to equality, diversity and human rights.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people at the end of their life. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. The service was clean and procedures in relation to infection control were robust.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people, massage and manicures, and themed events, such as reminiscence sessions and visits from external entertainers People were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. People’s end of life care was discussed and planned and their wishes had been respected.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made the required improvements. We found improvements had been made. However, we identified further areas that needed improvement. The overall rating for Patcham Nursing Home has changed from ‘Good’ to ‘Requires improvement’.

Patcham Nursing Home provides personal care, accommodation and nursing care for up to 30 people. On the day of our inspection there were 25 older people at the service, some of whom were living with dementia and chronic health conditions. The service is spread over two floors with a communal lounge/dining room, a further sun lounge and a garden.

There was a manager in post, who had applied to become the registered manager. However, at the time of our inspection, they were not registered with the CQC. 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.

People’s medicines were stored safely and in line with legal regulations and people received their medication on time. However, safe procedures for the administration of the medication were not routinely being followed, which placed people at potential risk of receiving their medicines incorrectly. We have identified this as an area of practice that needs improvement.

We have made a recommendation about the management of medicines.

Staff had received essential training and there had been opportunities for additional training specific to the needs of people. However, we saw that several members of staff had not received essential updated ‘refresher’ training in a timely manner. This is an area of practice that needs improvement.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People and relatives told us they felt the service was safe. They remained protected from the risk of abuse because staff understood how to identify and report it.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. They supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs continued to be met and people reported that they had a good choice of food and drink.

People remained encouraged to express their views. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People and relatives also said they felt listened to and any concerns or issues they raised were addressed. They enjoyed taking part in meaningful activities both in the service and the community.

Staff felt fully supported by management to undertake their roles. People, staff and relatives found the management team approachable and professional.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team and this was observed throughout the inspection.

People who used the service told us they liked living at the home, they were happy with the care and treatment they received and the service met their needs. They told us that staff were 'Kind and caring' and there was always someone around to provide help and support. One person who used the service told us, "I'm very happy here and have no complaints".

Individual care plans provided structure and guidance for care workers, to ensure that the assessed care and support needs of people using the service could be met consistently and safely.

People were protected against risks associated with medication because the provider had appropriate arrangements in place to manage medicines.

The service had effective systems in place to deal with people's concerns and complaints.

Staff told us that they had received regular training and supervision. They said they felt valued and were supported to carry out their roles and meet the needs of people who used the service.

We found that nurses and care workers had developed awareness and a sound understanding of each person's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

During our visit we spoke with five people who were using the service, five members of staff and one visiting relative. People who used the service and their relatives told us that they liked the home and that the service met their needs. People told us that staff were kind and caring and that everyone was very nice. One person told us " it is an extra special home, the food is amazing."

People were offered choices as to what they wanted to eat or what activities they wanted to take part in during the day. We saw people being addressed in a respectful manner. We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitored the quality of care that people received. People said they would speak to the staff or the manager if they had any concerns.

Staff had received regular and varied training and felt supported to carry out their roles and meet the needs of people who used the service.