Archived: Birdsgrove Nursing Home

Birdsgrove Nursing Home is a care home with nursing. It is registered to provide accommodation and nursing care for up to 87 people. The Care Quality Commission (CQC) has placed a restriction on admissions to the service and at the time of this inspection 15 people were living at Birdsgrove Nursing Home. Following the last inspection the service was rated as Inadequate and placed into special measures. This inspection found there had been insufficient improvement to take the service out of special measures. CQC is now considering the appropriate regulatory response.

Some of the people using the service are living with dementia while others require assistance due to age or frailty. The service is arranged in three units. At the present time the unit in the oldest part of the service is not used by people living at the service. However, staff access this part of the premises for maintenance and storage purposes.

The service is required to have a registered manager. 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 the time of the inspection the service did not have a registered manager.

The service had been without a registered manager since September 2015. Since then there had been staff appointed to manage the service but they had not registered with CQC. The current manager was appointed to the service in November 2015 and had submitted their application to register with CQC in July 2016. The current manager was present and assisted during the inspection.

We last inspected the service on 30 November and 1, 2 and 4 December 2015. At that inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found some improvements have been made however, a number of concerns remained evident.

A number of fire safety issues were identified which led to a referral to the fire safety officer. These included a fire risk assessment which made no reference to how less able people or people using wheelchairs would be managed safely if the premises need to be fully evacuated. Emergency lights did not always work or were dimly lit resulting in poor levels of lighting and a potential risk to those people with visual impairment or dementia. Final fire exit doors with energised magnets installed did not release when the fire alarms were activated and staff were not aware of how to override this to operate the doors manually. In addition, staff were not clear on the actions expected of them in a fire emergency or who the fire marshals were.

Other issues relating to the safety of the premises were identified and included the lack of a detailed risk assessment relating to the control of infection. It was therefore unclear how issues relating to storage, equipment cleaning, floor cleaning, utility areas and clinical hand washing facilities were managed and monitored. Areas of the service were found to be unclean with a build-up of dust, grease and grime. Mould was found growing across carpets and on tiles and bath sealant. Appropriate hand washing facilities and equipment were not always available and we could not be sure that staff understood the colour coding systems of cleaning equipment for preventing the spread of infection. Unlabelled substances and out of date supplies presented further risks to people using the service and staff.

Staff had identified a toilet leak and reported it to the manager and maintenance worker. However, the manager’s health and safety checks had failed to identify this as a potential slips/falls risk to people using the affected bathroom. It was not until inspectors indicated the risk of someone slipping and falling that action was taken to put the area out of use.

People’s personal information was not always kept confidential or secure. There was a risk personal records may be accessed by unauthorised personnel.

Staff were aware of their responsibilities with regard to safeguarding people. However, they were not all aware of the whistleblowing policy and who to contact outside the organisation if they needed to.

Medicines were ordered, administered and disposed of safely. Most storage was in line with guidelines. However, we found some creams stored in a cupboard where the temperature was not monitored, resulting in a risk of them becoming inactive or dangerous for use.

There were sufficient staff with appropriate skills to meet people’s needs. Staff had been recruited using effective recruitment procedures.

People’s right to make decisions was protected. When people could not make decisions for themselves appropriate best interests meeting were held. Staff sought consent from people before assisting them.

Staff received support in the form of meetings, appraisals and training which they considered sufficient to do their job effectively. People’s nutrition was monitored when necessary and people had sufficient to eat and drink. Their healthcare needs were met.

Some adaptations such as the use of memory boxes and coloured toilet seats had been made to the premises to meet the needs of people living with dementia, however, these were limited. Parts of the premises were in poor condition and needed attention.

Staff treated people with kindness, compassion and respect. They knew people well and provided privacy and dignity. People had the opportunity to plan the care they would like at the end of their lives.

Care plans reflected people’s needs and were regularly reviewed and updated. Staff were responsive to people’s needs and care was provided mostly in a person centred way. However, there were some examples of practice we could not be sure promoted people’s personal choice.

Activities were under review by the new activity co-ordinator who planned to include more personalised activities into the programme.

Audits were carried out but did not always identify areas where action was needed. We found the provider was reactive to issues raised but not proactive in identifying concerns and taking action to ensure the service was a safe place for people to live in and for staff to work in.

People, relatives and staff spoke highly of the manager who they felt was approachable and supportive. The manager had created an open culture in the service which had led to good team working and a positive attitude in the staff team.

Improvements had been made to staff training so that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff told us they felt there had been improvements in the team spirit at the home and were enthusiastic when describing how the staff team had worked together on making improvements since our last inspection.

Systems had been put in place to improve record keeping and record auditing. This meant people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We found the provider had met the outcomes we inspected and had put systems in place to monitor their ongoing compliance.

We spent time with eight of the people living at the home, and one visiting relative, completing questionnaire forms. We also spoke to people on the different wings as they had their lunch.

Lunch was served hot and people told us they were enjoying the food. They said enough staff were available to provide the support they needed at meal times. One person commented "Oh yes, definitely". Another person mentioned they sometimes had to wait if staff were helping other people, but added the staff were "all very good, they don't rush me, they are very kind."

People said meals were nice and portions were the right size, not too much, not too little. They confirmed they were offered choices at meal times and that staff asked them what they liked to eat. One person said "they ask me all the time!"

We found most people were provided with suitable and nutritious food and drink to meet their needs. However, staff had not always identified when people were at risk of inadequate nutrition or dehydration and had not always taken appropriate action where such a risk had been identified. Staff had not received training that enabled them to protect people from the risks of inadequate nutrition and dehydration or that enabled them to support people with swallowing difficulties to eat and drink more safely.

Records relating to the management of the home were kept securely and were located promptly. However, people were not protected against the risk of unsafe or inappropriate care arising from a lack of proper information about them.

People told us about some of the recent activities out into the community and about community activities taking place inside the home. They said they had found the days interesting and confirmed that more community involvement had been taking place.

We found people had been enabled to participate in making decisions relating to their care. The provider had improved opportunities and support to people living at the home in relation to promoting their community involvement.