Archived: New Forest Nursing Home

New Forest Nursing Home is a residential care home providing personal and nursing care to 37 people at the time of the inspection. The service can support up to 48 people.

New Forest Nursing Home provides accommodation and nursing care for up to 48 people, some of whom may be living with dementia or have a physical disability. The home is in a rural location in Fritham, near Lyndhurst. Accommodation is split over two floors. There is access to landscaped gardens and grounds.

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

People were safe and supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We saw evidence of people’s and their relative’s involvement in care assessments.

Risks to people were recorded in their care plans and staff demonstrated they had a good knowledge of people. People mostly received their medicines safely.

People and their relatives were very positive about the food. People were encouraged to maintain a healthy, balanced diet, based on their individual needs and had access to food and drink whenever they wanted.

The home had a consistent staff team who understood the needs of people well. We saw staff upheld and promoted people’s rights relating to equality and diversity. People and their relatives were positive about the quality of care and support people received.

Staff identified what was important to people and endeavoured to provide meaningful experiences and lasting happy memories. New Forest Nursing Home offered bespoke care and support for people at end stage of life (EOL) and to their families.

People and their relatives told us that they thought the home was well led and spoke positively about the registered manager, nominated individual and provider. The registered manager, nominated individual and provider carried out numerous audits to ensure the service was effective.

The manager was proactive in ensuring they had a visible presence within the home and operated an open-door policy ensuring that any low-level concerns were dealt with promptly preventing escalation. The service was well-led by a management team whose passion and drive to deliver a good service, leading by example, was evident.

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 18 January 2017).

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.

At this inspection we found improvements had been made in these areas and the service was compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

New Forest Nursing Home provides accommodation and nursing care for up to 48 people, some of whom may be living with dementia or have a physical disability. The home is in a rural location in Fritham, near Lyndhurst. Accommodation is split over two floors with 38 single occupancy rooms and five double rooms. There is access to landscaped gardens and grounds.

New Forest Nursing Home has a registered manager in post. People spoke highly of her and she demonstrated a good understanding of the needs of people living 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection nearly all people and their relatives told us they were happy with the provision of care, treatment and support provided. We found the service provided safe, effective and responsive care and treatment which was well managed.

The challenge to the service was to recruit and maintain staff. Senior staff were actively recruiting permanent staff and as a result of a recent successful recruitment drive the were employing less agency staff. Thorough processes were in place which helped to ensure only suitable staff were recruited. Staff received a good induction and were provided with relevant training to help to ensure they had the necessary skills and knowledge to carry out their roles competently.

people were happy about how their health care needs were being met and there was good communication between the service and external health care professionals. Staff were kind and caring and respected people's privacy and dignity. They spoke knowledgably about the treatment care and support people needed. There were a range of activities available although this had reduced temporarily as the additional activity coordinator was temporarily absent.

There were robust quality assurance processes in place to ensure the service continued to deliver consistently a good quality care and to drive improvements where necessary.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led

This is a summary of what we found.

Is the service safe?

We found that not all aspects of the service were safe. People were cared for by staff who were knowledgeable about their needs and had the skills to provide the support people required. However, we found there was not always enough staff available to meet people's needs. Everyone we spoke with said they were happy with the way their care needs were met but raised concerns about the timing of their care.

Staff did not always respond quickly when they were needed. We saw that each person had access to a call bell to alert staff when they needed them or in an emergency. During our inspection we found there were frequent occasions when call bell alerts were not always responded to quickly with some responses taking longer than seven minutes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having sufficient staffing to respond quickly when needed.

People were cared for in a clean and hygienic environment. They were protected from the risk of infection because there were appropriate systems in place to identify and manage those risks.

There was not an effective policy in place for the administration and management of medicines. Medication was not always stored appropriately and in compliance with the National Institute of Clinical Excellence (NICE) guidance. The arrangements in place in relation to the recording and administration of medicine were not always followed by staff. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management and administration of medication.

The staff we spoke with were clear about their role and responsibilities in respect of providing care and meeting people's needs.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). Relevant staff had received training to enable them to understand when an application should be made. At the time of our inspection there were six people in the home who were subject to DoLs. We looked at the records for these and saw they had been completed correctly.

Is the service effective?

We found the service was effective. There was enough equipment to promote the independence and comfort of people who use the service. Care plans contained information about the equipment people required and appropriate risk assessments. This included moving and handling equipment and pressure relieving mattresses. We saw equipment identified in the care plans was available in people's bedrooms. Care records showed people had access to appropriate medical care, including GPs, dentists and chiropodists.

Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills necessary to care for people. Staff told us about the care they were providing for specific people which matched information in the person's care plan. The people we spoke with were complimentary about the care they or their relative received.

People were provided with a choice of suitable and nutritious food and drink and were supported by staff who were aware of individual people's dietary needs and preferences.

Is the service caring?

People were supported by kind and attentive staff. People said they had no concerns over how they were treated and they felt their privacy and dignity were respected. The records we looked at showed the staff took account of people's individual wishes and these were respected, when providing care. For example, one person's care plan stated 'I don't like baths'.

People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed part of the lunch time meal and saw that staff were organised and able to provide the individual support people required at a pace suitable for them. We saw people were supported to sit in suitable chairs or sit upright in bed to reduce the risks of eating in an unsafe position.

People's wellbeing was enhanced through the availability of individual and group activities focussed on people's preferences, interests and diverse needs.

Is the service responsive?

People's care plans were reviewed regularly and updated to meet people's changing needs. One visitor told us they were kept informed about any changes to their relative's care plan.

There were arrangements in place to respond to short term staff absences, which were managed through the use of overtime and agency staff. The provider told us they always used the same agency and tried to get staff who had previously worked in the home.

Staff received specific training to meet the needs of people living at the home. This included Mental Capacity Act training, pressure sore management and understanding the needs of the service user. Discussions with staff showed they were aware of how to use the training they had received for the benefit of people.

We saw there was an effective compliments and complaints policy in place, which was published in the service users' guide. The manager showed us their complaints file and told us they had not received any formal complaints during the last year. The people and visitors we spoke with told us they knew how to complain but had not needed to do so.

Is the service well-led?

There was a clear management structure. There were also procedures in place to monitor the quality of service provided with audits. These included, care planning documentation audits, accident and incident analysis, infection control audits and medication audits. However, the quality assurance process currently in place was not robust enough to identify all areas of concern, such as those found during our inspection. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having an effective quality assurance system in place.

An annual survey questionnaire was sent out to people, their friends and families seeking their views on the service provided. We saw the results of the latest survey, which provided a balanced mixture of both positive and negative comments. An action plan had been created as a result of the feedback provided.

Staff attended regular supervision meetings in line with the home's staff supervision and appraisal policy. Each supervision meeting provided the opportunity for staff to raise and discuss any concerns and to feedback on observed behaviour.

We spoke with three members of staff and confirmed that they had received appropriate induction training and had the skills necessary to carry out their duties. Staff received regular supervision that addressed work performance and training needs as well as the support of people that used the service.

Staff had received safeguarding training and were able to say what action they would take if concerns were raised or observed. The people we spoke with during the visit said they felt safe in the home and were confident that if they had any concerns, these would be addressed promptly by the matron.

The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. We saw that the service had arrangements in place to deal with foreseeable emergencies, ensuring that people were cared for safely should the service not function as it should be.

People who used the service were very positive and were unanimous that they were treated with respect and given choices. Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes. One person said ‘’they always knock and tell us what. Nothing is done blind.’’ We observed bells were answered quickly and this was confirmed by people using the service.

Most people told us they had a pre admission assessment and were involved in their care planning. Many people were seen participating in activities in the dining room and lounge including those unable to physically take part. Two others were sitting quietly watching television. Others were resting in their rooms.

People made positive comments about staff and told us they knew most of them. One person said ‘’all the staff are pleasant.’’ Staff were observed to be respectful and caring towards people. People told us they felt unhurried when receiving care but that there may not be enough staff on duty at the weekends.

The home was clean and free from odours. People were very satisfied with the standard of hygiene and cleanliness. One person told us that ‘’cleanliness is incredible.’’

Records showed that equipment was serviced regularly and was replaced without undue delays as required.