Archived: Cale Green Nursing Home

At the time of our inspection the home was in the process of being sold and the new owner was in the process of applying to become the registered provider.

People’s experience of using this service:

People and their relatives told us they felt safe and protected from abuse in the home. People said they knew the care team well and that staff understood their needs.

People were not always kept safe from environmental risks. Some doors which should have been locked to prevent people becoming trapped in rooms, or to keep people safe from harmful chemicals were left propped open. Some hot water outlets were not monitored to check whether the temperature of the water posed a scalding risk to people. Fire drills were not being performed in the home.

People’s care records were being re-written to ensure the person received support that was personal to them. We found the care records that had been completed reflected people’s needs well.

Checks were done on people before they started work in the home however we found that sometimes not all the appropriate checks were completed.

People enjoyed the food in the home and were given choices of meals. Where people didn’t like the choices alternatives were offered.

People, their relatives and staff told us the home had improved under the new management and found the management team approachable, open and honest.

The manager did not always have a clear oversight of the quality monitoring and health and safety requirements in the home.

Rating at last inspection: Requires Improvement 12 July 2018

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We have asked the provider to let us know what action they will be taking to improve the service to at least ‘Good’. We will continue to monitor the service through information we receive and future inspections.

At the time of our inspection the home had voluntarily suspended placements from the local authority. The local authority quality team had been working with the service to address some quality concerns relating to the levels of care within the home, particularly pressure area care. We did not ask the provider to complete a Provider Information Return (PIR) prior to the inspection.

Cale Green Nursing Home is a nursing home for up to 50 people. It is located in the Cale Green area of Stockport. Cale Green Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At this inspection we found the provider was in breach of three regulations of the Health and Social Care Act 2014. You can see the action we have told the provider to take at the end of this report.

People told us they felt safe and there were policies and procedures in place to protect people from abuse. This meant staff working in the home knew how to raise any concerns they had regarding the people living there.

During our inspection issues relating to the safety within the home were identified. Portable Appliance Testing (PAT) had expired, a scalding risk from a shower was present and two rooms posed a potential entrapment risk.

Sufficient levels of staff were on duty. Staff told us they received a good induction which gave them the skills they needed to provide care for the people living in the home. Some care worker training had expired and additional training that had been requested had not been provided.

People’s medicines were managed safely meaning people received the correct medication at the right time. Staff received appropriate training to allow them to support people with their medication safely.

People’s personal and cultural choices and preferences were respected and were included in the way their care and support was planned.

Care and support staff told us they felt well supported and received appropriate training to allow them to support people living in the home. Some care worker’s training had expired meaning their practice may not have been in line with current guidance and may have put people at risk.

People told us they were given a choice of meals and enjoyed the food. Drinks were always available. Where people living in the home needed support to eat or drink, staff helped them with this in a patient and caring manner.

People living in the home told us they felt they were treated with kindness and compassion. Staff demonstrated they knew the people well and treated them as individuals and listened to them.

People were involved in planning and reviewing their care and encouraged to remain as independent as possible.

An activities coordinator provided a range of activities and encouraged people to take part in them. Where people were unable or chose not to join in communal activities, one to one activities were arranged.

People nearing the end of their life were treated with dignity and their needs were kept under review. Training for staff to enable them to use a syringe driver could allow people to have care from people they know and help prevent people having to go to hospital or having visits from district nurses to provide care.

At the time of our inspection the registered manager of the home was leaving. The management structure of the home was being changed to try to provide more management oversight.

People were encouraged to express their views about the service, and actions that had been taken as a result of feedback was clearly displayed. If people felt uncomfortable raising concerns directly with the service contact details for other bodies were displayed.

The ratings from the previous inspection by the CQC were on display within the home.

At the inspection carried out in October 2016 we found that overall rating for the service was 'Requires improvement', with the well-led domain being rated 'Inadequate'. We found that the service should remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any key domain over two consecutive comprehensive inspections. The purpose of special measures is to ensure the provider makes significant improvement to become compliant with the Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Cale Green Nursing Home is registered to provide 24 hour nursing care and support for up to 50 older people. The home is located in the Cale Green area of Stockport near Manchester.

At the time of our inspection, 21 people were living at Cale Green Nursing Home.

At the time of our inspection, 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection of the service in October 2016, two breaches of regulations were identified and action was required to address those breaches. The breaches related to poor management of medicines (Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Safe care and treatment, and, poor management of records (Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Good governance.

At this inspection we found that the service had improved and regulatory requirements previously breached at the inspection conducted in October 2016 had been satisfactorily addressed.

People living in the home told us they were happy with their care and felt safe when staff were supporting them with care.

Staff had been recruited safely and staffing levels were maintained at an appropriate level to meet people's changing needs.

Care plans were person centred and included risk assessments that provided staff with clear instructions to follow when supporting people with their care needs. Care records showed they were reviewed on a regular basis and any changes were recorded.

We found the building to be clean and well maintained although some areas, such as corridors and some bathrooms and bedrooms were showing signs of wear and tear.

We observed care staff accessing and wearing protective equipment such as disposable gloves and aprons when supporting people with care related tasks. This helps to minimise the risk of cross infections.

Medicines were safely managed and were administered to people by nurses and trained care staff.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).Staff understood how to support and help people to make day-to-day decisions and were also aware of their own responsibilities under the Mental Capacity Act (2005) and DoLS.

We saw that staff were receiving training appropriate to the jobs they are employed to carry out.

People's nutritional needs were assessed and appropriate support had been provided.

During our visit we saw people looked well cared for and we observed staff supporting and speaking with people in a caring and respectful manner. Staff demonstrated they knew people’s individual likes, dislikes and their preferences around their individual daily routines for example, what time they liked to get up and go to bed.

End of life care was provided by care staff in a sensitive and compassionate way.

People who used the service and their relatives knew how to raise a concern or make a complaint.

The registered manager and senior management team had developed and utilised a variety of methods to assess and monitor the quality of the service. This included regular audits of the service and meetings held to seek the views of people using the service, their relatives and the staff team.

At the last inspection in October 2016 we rated the well-led domain as 'Inadequate' as we found the management of the service was not, at that time, well-led and staff lacked clear management leadership. At this inspection we found the provider had taken action and was now meeting regulatory requirements. Although we saw improvements had been made, we have not rated this key question as 'good', to improve the rating to 'good' would require a longer term track record of sustainable good practice.

The service was previously inspected on 12 and 13 January 2016, when breaches of legal requirements were found, at that time; we found the service was not meeting the regulations relating to mental capacity, medicine management, governance, staff recruitment, infection control, people’s dietary requirements and communication. We rated the service as inadequate and placed it into special measures. We asked the provider to submit an action plan to show how they intended to make the necessary improvements. On this inspection we found the provider was still in breach of two of the regulations. The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

We have made a recommendation to the provider in the report which included. We recommended to the provider completes morning and evening audits of care to ensure people receive their choices in relation to their care plans around getting up and going to bed.

When we visited the service there was no registered manager in place. The owner told us they had started the recruitment process to appoint a new manager to 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Cale Green Nursing Home is registered to provide 24 hour nursing care and support for up to 50 older people. The home is located in the Cale Green area of Stockport near Manchester.

At the time of our inspection there were 32 people living at Cale Green Nursing Home.

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated they knew people’s individual characters, likes and dislikes.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). The service was meeting the requirements of the Mental Capacity Act 2005. Staff understood how to help people make day-to-day decisions and were aware of their responsibilities under the Mental Capacity Act (2005) and DoLS.

Appropriate arrangements were in place for the ordering, storage and disposal of medicines. We did find discrepancies in medicine management at the time of inspection. Medicines were administered to people by nursing and trained care staff at the time of inspection. However the home was still undergoing training for some nursing staff which was on going within the home. We spoke to the provider who showed us an action plan stating when these would be completed by all staff. The home was receiving support and guidance from an independent pharmacy to support improvements in relation to medicines management.

We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found this was consistent with the guidance within the safeguarding policy and procedure in place at the home.

We spoke to some staff who had not received regular supervisions. The provider had completed an audit on staff files and completed an action plan to ensure all staff receive supervisions in line with the policy.

People told us the food at the home was good and they had enough to eat and drink. We observed lunch being served to people and saw people were given sufficient amounts of food to meet their nutritional needs. However, we did not feel people received a social experience around meal times. We spoke to the registered provider about this who was already in the process of renovating a room to become a bistro for people and their relatives to use.

We observed activities carried out by the activity co-ordinator on the day of inspection which were play your cards right, singing and 1-1 shopping in the community. We spoke to the provider who was already looking into additional support for the activity co-ordinator so more 1-1 activities could be put in place for people who wanted this. Staff told us, “We do our best some people do not want to join in any activities they like their own company.”

Whilst care plans contained generic risk assessments to guard against poor nutritional, mobility and tissue viability our examination of care plans evidenced risk assessments were also highly specific to people’s individual needs.

We looked at the recruitment records of six members of staff. The DBS is an organisation which holds information about people who may be barred from working with vulnerable people. Checks made with the DBS help employers make. We found these were not always safe.

The registered provider told us a new external organisation was due to begin supporting the home with their audit processes over the next few months. There were a number of blank audit documents ready for utilisation as well as specific audits which had already been implemented by the service.

A complaints policy was in place at the service and staff, people and relatives were aware of how to complain.

During this inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Is the service safe?

People living at Cale Green Nursing Home had an individual care file that included risk assessments and a care plan that described how to meet people's individual care needs.

A visiting relative told us that they were pleased with the care their relative received. They also told us they had never seen or heard anything that would cause them concern. One relative said 'I think [her relative] is well looked after and seems happy and settled.'

The provider had infection control policies and procedures in place with specific guidelines for staff to follow. We found that the provider had effective systems in place to maintain appropriate cleanliness levels within the home and restrict the spread of infection.

Since the last inspection visit on 6 March 2014 we found that improvements had been made to address the shortfalls associated with insufficient staffing levels. We noted the staffing levels recorded on the rota matched the number of staff on duty seen during our visit.

From the day and night rota that we looked at we saw there was enough staff to meet the needs of people who lived at the home. We saw that safe staffing levels were managed on a daily basis and consideration was given to people's level of dependency in the home.

These improvements helped to make sure people were safe and their health and safety needs were met by sufficient numbers of appropriate staff.

Is the service effective?

Staff told us told us that the staff team all worked well together and provided a high standard of care.

Since the last inspection visit we saw that a part time activity coordinator had been employed. They were able to describe the activities that were being provided in consultation with the people living at Cale Green Nursing Home. Some activities included trips out to the park and local shops, reminisce groups, board games and quizzes, birthday and a 50th wedding anniversary party. We saw that a clothing sale party had been arranged for later in August 2014 and we were told that exercise activities were due to start the week following this inspection visit.

During this inspection we spoke with a visiting health care professional who told us they didn't have any concerns regarding the care delivered by staff. They said that the staff were helpful and knowledgeable about the needs of people living at Cale Green Nursing Home.

We saw the manager had introduced a new recording system and staff had received additional training in the recording of falls and accidents. This meant the service learned from incidents and responded effectively.

Is the service caring?

The atmosphere in the home felt relaxed and friendly. From our observations we saw that care staff had a good understanding of people's individual needs and personalities. We saw that staff were kind and sensitive in their approach to people.

We observed that people looked well cared for and were appropriately dressed. One gentleman did not look like he had had a shave but when we spoke with him he told us that he hadn't wanted one.

All of the people we spoke with who were living at the home indicated that they were happy and had everything they needed. Comments included: 'Its home from home here, you can do whatever you want,' 'The food is very nice and there is always a choice' and 'They [the staff] are very very good, in fact they are excellent".

Is the service responsive?

We saw that where appropriate the service had accessed advice and care from other health care professionals. For example we saw evidence of visits from the GP, the speech and language therapist and the district nurse. This meant the provider sought relevant professional advice and guidance appropriately.

People were made aware of the complaints system. A copy of the complaints policy was displayed in the home and was presented to people in a format they would understand. Records of complaints we saw had been effectively resolved in a timely way.

Is the service well-led?

Since the last inspection on 6 March the provider had recruited a new home manager and regional manager to help make sure those systems and procedures would be followed by the staff team.

The provider had clear objectives for both managers who had a lead role with regard to planned service developments, workforce changes, staff training, planned absences and changes in legislation.

The registered manager was described by staff as approachable and supportive. One member of staff told us 'The staff are all coming together now and the atmosphere is much better.' Another member of staff 'It's very good here, it's like a big family, everybody is very nice.'

We saw customer surveys were sent out every six months to people who used the service and their representative. The survey was in a format that people could understand. We reviewed responses from the latest survey. Comments included, "I am happy with my care' and 'I like the comfort, safety and companionship at the home.'

We spoke with four people who used the service and two relatives. We spoke with the provider, the general manager, one registered nurse, two care workers and one domestic worker.

The home manager told us that 21 people were currently being cared for in bed due to their physical condition and 23 people were receiving nursing care.

We saw that some care plans had not been reviewed and updated as needed on a regular basis.

We looked at health and safety records and noted there were potential infection control risks.

We saw that people's dependency levels had been calculated inaccurately and did not correspond with peoples identified needs as recorded in their care plans.

We looked at the staffing needs analysis which did not clearly show that there were enough nurses for people to expect a consistency of care.

We saw that some records required to be kept to protect people's safety and wellbeing were not properly maintained and fit for purpose.

We looked at the care plans of six people who used the service. We noted that the care plans had been updated to include more detail about their needs.

We found four people who had mental health needs were being supported by staff who had not received mental health awareness training.

Five people spoken with told us they were provided with enough food and drinks throughout the day and night. However we had some concerns that people were not receiving the correct consistency of food when they had been assessed as having a swallowing impairment. This meant that people were at risk of unsafe care due to aspiration or choking.

We looked around the building and found there were still shortfalls in relation to the maintenance of the premises. However we found the provider had made significant improvements to some of the equipment used at the home.

We saw improvements had been made to care records and new auditing systems had been implemented to ensure these records were accurately maintained.

People we spoke with told us that they were happy and had no complaints. Some of the comments we received were: 'The food is good, can't grumble,' 'I can't really complain about anything,' 'I am very happy here' and 'I am happy with the way they (the staff) treat me.'

We spoke with three visitors to the home all of whom were complimentary about the care their relative received. We were told that the level of care was good and the staff were: 'Very nice and respectful.' One person said: 'They have been a Godsend, they really look after him well.'

During this inspection we did have some concerns about the lack of detail in people's care plans. This meant that people living at the home might not be protected from receiving unsafe or inappropriate care.

We had concerns about the safety and availability of some of the equipment. This meant that some people may not benefit from equipment that meets their needs.

Staff told us that training was good at Cale Green Nursing Home. However, a number of staff told us that morale was: 'Very low and they did not feel valued.' We were told that the staff provided a high standard of care but they did not feel they received any acknowledgment for the work they do.