Ruislip Nursing Home

Ruislip Nursing Home is a care home providing personal and nursing care to up to 31 people. The service provides support to older people, including people living with the experience of dementia and people receiving care at the end of their life. At the time of our inspection there were 31 people using the service, one of whom was in hospital.

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

During the inspection we found risk assessments and risk mitigation plans were not always updated after an incident to reflect lessons learned and to include preventative measures.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective.

We made a recommendation the provider consider current guidance on infection prevention and control and take action to update their practice accordingly.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were followed and there were enough staff to meet people's needs. Medicines were managed safely.

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 26 August 2021) and there was a breach of regulation. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 20 May 2021. A breach of legal requirements was found regarding good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ruislip Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and governance.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Ruislip Nursing Home is a care home providing accommodation, personal and nursing care for up to 31 older people, including people living with the experience of dementia and people receiving care at the end of their life. At the time of the inspection, there were 29 people in the home and one in hospital.

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

The provider had quality assurance and audit systems but these were not always effective in identifying the shortfalls we identified during the inspection. Further improvements were needed to ensure that the systems were always effective for checking risks and mitigating any identified risks within the service.

Risks to people had been regularly assessed and reviewed to help ensure the best outcomes, however, we found further improvements needed to be made in relation to safety in the environment. During the inspection the provider addressed these areas immediately and risks were mitigated.

People told us they felt safe. People were supported by staff who were trained to identify and report safeguarding concerns.

Medicines were stored correctly, and people were supported to take their medicines as prescribed by staff who had been trained and competency assessed.

People were supported by staff who knew them well and staff deployment was sufficient to meet people’s needs safely.

People and their relatives were involved in their care planning and staff delivered care in line with people’s preferences. People’s needs were recorded during the pre-admission process and relatives told us there was ongoing involvement in reviews of people’s care. This information was recorded in their care plans. The home is accredited to the Gold Standard Framework (a nationally recognised approach to supporting people with end of life care) and people’s choices about the way they wished to be cared for at the end of their life had been discussed to ensure their preferences had been recorded and were known to staff.

During the inspection the registered manager informed the inspection team they had visiting restrictions in place in response to the COVID-19 pandemic. After the inspection the provider confirmed the updated government guidance in relation to visitors in a care home was now followed and visitors were permitted entry into people’s rooms. People were encouraged to engage in activities of their choice, and we saw a daily programme of activities available.

People and their relatives told us the service was well managed, and they were happy with the care delivered. Comments from relatives included, “I would recommend, they are really caring…” and “I would recommend. The staff seem engaged and there is a broad offering.”

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 11 March 2020).

Why we inspected

This was a planned focused inspection based on the previous rating.

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.

We have found evidence that the provider needs to make improvements. Please see all the safe and well-led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report.

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.

Ruislip Nursing Home is a care home providing accommodation, personal and nursing care for up to 24 older people, including people living with the experience of dementia and people receiving care at the end of their life. At the time of our inspection, 23 people were using the service. The home is in the process of finishing a renovation project which will increase the bed spaces to 31.

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

Family members told us their relatives were safe. There were procedures in place to protect people from abuse. Risk to people’s wellbeing had been assessed and planned for. People received their medicines in a safe way. There was enough staff employed to keep people safe. There was a clear process to identify learning from accidents, incidents and safeguarding concerns.

People’s needs were assessed prior to coming to the home, including healthcare needs and the provider had good links with healthcare professionals. People’s nutritional and hydrational needs were being met. Staff received an induction and shadowed more experienced staff before they supported people on their own.

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 home was undergoing an extensive programme of building works as they were building a new dining room and more rooms.

People had good relationships with staff, and it was clear staff knew people well. People were supported to maintain relationships which were important to them. Each day there was a programme of activities that people could engage in. People’s privacy and dignity was maintained, and staff supported people to remain independent.

People were encouraged to make choices about their care and support. Peoples communication needs were assessed and planned for. The home had a complaints policy and people and their relatives told us they knew how to make a complaint. People’s end of life wishes were respected. The provider was accredited in the Gold Standard Framework. This training specialises in end of life care. People had their care plans reviewed in line with the provider’s policy or if their needs changed.

People and their relatives felt the home was well managed. The home had a very experienced registered manager who understood people’s needs. Staff attended team meetings and they told us they found these meetings helpful. Staff had regular supervisions and appraisals in line with the provider’s policy. The provider used effective systems for monitoring and auditing the service which helped to improved people's experience of care.

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 04 August 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

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

At the last inspection, the service was rated 'Good' for Safe, Caring, Responsive and Well Led and 'Outstanding' for Effective. It was therefore rated 'Good' overall.

At this inspection we found the service remained Good overall.

People continued to receive care in ways which helped them to remain safe. Staff understood the risks to people’s safety and people were protected from the risk of harm. There was enough staff to provide support to people to meet their needs, the provider carried out checks on new staff before they started work and people received their prescribed medicines safely.

The care people received continued to be effective. People were supported to have maximum 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. Staff received training that enabled them to meet the needs of people who used the service. People made their own day to day decisions about their care. Staff checked people agreed to the care offered before assisting them. Staff supported people to stay well and access health care services. Healthcare professionals told us the service provided very good standards of end of life care and pressure ulcer prevention.

Staff had built caring relationships with people using the service and encouraged them to make their own choices and maintain their independence. Staff treated people with warmth, respect and dignity.

The provider listened to the views and suggestions of people using the service and their relatives. People’s care plans reflected their preferences and unique histories and there were opportunities for people to do fun and interesting things. The provider had systems in place to manage and respond to any complaints they received.

People, their relatives and staff were encouraged to make any suggestions to improve the care provided and develop the home further. The registered manager worked with people, their relatives and other organisations in an open way so people would enjoy the best well-being possible. Regular checks were in place to assess and monitor the quality of the service and action taken to drive through improvements for the benefit of people living at the home.

Further information is in the detailed findings below.