Archived: Rushyfields Residential and Nursing Home

This inspection took place on 23 August 2018 and was unannounced.

At our last inspection in August 2017 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. The home was meeting the requirements of the fundamental standards.

People, relatives and staff felt the service was a safe place. People were protected from the risk of abuse because staff understood how to identify and report it.

There were sufficient staff on duty to meet people’s needs. We received positive feedback about staff always being available when people needed them and staff were visible throughout our visit.

People received their medicine safely and were supported to access the support of health care professionals when needed.

Where risks were identified to people who used the service or to the environment these were assessed and plans put in place to reduce them. Accidents and incidents were analysed to identify trends and reduce risks.

People’s needs had been assessed both before and after their admission to identify their care needs.

Staff were well supported and received the training they needed.

People received a varied and nutritional diet that met their preferences and dietary needs. The service provided home-made food and drinks which were adapted for different diets.

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.

People told us they thought the service was caring. We received some examples of the service being very caring in the way it supported people and their relatives.

People told us, and we observed, that care was delivered with dignity and respect and people were supported to be as independent as possible.

Care plans were detailed and reflected people’s needs and preferences. Care plans were evaluated regularly and included meaningful information about people’s needs.

People were actively engaged in a range of activities and had opportunities to access the wider community.

People told us they did not have any concerns about the service but knew how to raise a complaint if needed. Feedback on the service was encouraged in a range of ways and was positive.

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

Further information is in the detailed findings below.

At the last inspection in March 2017 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The breaches were:-

Regulation 12 Safe care and treatment

Regulation 14 Nutrition

Regulation 17 Good governance

Regulation 18 Staffing

We also found at that time the provider was in breach of Regulation 18, Care Quality Commission (Registration) Regulations 2009, namely Notification of other incidents.

Following our last inspection we asked the provider to take action to make improvements. During this inspection we found improvements had been made and there were no continued or new breaches of regulations.

There was not a registered manager 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 2008 and associated regulations about how the service is run. Since the last inspection the registered manager had left the service. A peripatetic manager had been managing the service. They told us a new manager had been appointed and was due to start working at the service in September 2017. A handover period had been agreed by the provider to ensure continuity of service.

Pre-employment checks were carried out on staff to ensure they were of suitable character and had the necessary skills to care for vulnerable people. Staff and relatives felt the new staff recruited by the manager were genuinely caring. We saw staff were kind and respectful towards people. They maintained people’s dignity and privacy.

A programme of checks was in place to ensure people were protected from living in an unsafe environment. These included, for example, fire safety and water temperature checks.

We checked people’s medicines and found they were administered by staff who had been trained to do this. Medicines were stored securely and there were regular audits to ensure medicine counts were correct. A system had been introduced by the provider to ensure the nurse on duty had oversight of the application of people’s topical medicines (creams or ointments applied to the skin).

People had care plan documents which were accurate, up to date and regularly reviewed. We found these described people’s individual needs. Where risks to people had been identified, for example, falls risks, actions had been put in place to mitigate these risks. Each person had a day allocated to them. The day involved staff with different roles in the home contributing to that person’s needs on the day. For example, housekeeping staff in the home deep cleaned their room, checks were carried out by maintenance staff and care staff reviewed the person’s care records.

The building had been adapted to support people with dementia related conditions. We found the walls had been decorated using brightly coloured pictures. Corridors were distinctive with themed areas. Signage was in place to assist people to orientate themselves around their environment, for example towards bathrooms and toilets. We found the home to be clean and tidy throughout.

There were enough staff on duty. The manager reviewed the staffing levels on a monthly basis and had listened to the staff about the times in the service where there was the greatest need. They had put in place a twilight shift so there was an extra pair of hands to support people to bed.

People had a positive meal time experience supported by staff who gave them choices and promptly responded to their requests. Staff completed food and fluid charts for people to monitor their food and fluid intake and nutritional needs. These were given to the manager who reviewed the charts to ensure that people needing interventions in their care were supported correctly.

The staff had made referrals to other health care professionals when they assessed people required addition support. We saw referrals had been made to dieticians, speech and language therapy team (SALT), GP’s community nurses and community psychiatric services.

Relatives were involved in the service. They had been asked for their views and told us the manager had listened to them. They had also given information about their family member to enable staff to provide appropriate care.

Staff new to the service received an induction which supported them to get to know the home and people who used the service. Supervision, appraisals and training were also given to staff to help support them in their duties.

People had the opportunity to be engaged in activities which prevented them from becoming socially isolated. This included arts and crafts and entertainment.

Systems and processes were in place to monitor and improve the quality of the service. This included audits and a monthly visit by the regional manager who carried out a review of the service. Surveys were in place and we found relatives had made many positive comments about the care delivered and the home itself.

Rushyfield Care Centre provides accommodation for up to 41 people who require nursing and personal care. The home is split into two units. Upstairs is known as the Usher Moor unit and downstairs is the Langley Moor unit. At the time of our inspection 19 people were living upstairs and 18 people were living on the ground floor.

At the last inspection in October and November 2015, we asked the registered provider to take action to make improvements to the administration of topical medicines (creams applied to the skin). We found the home had failed to make improvements.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

Visitors expressed concerns to us about the levels of staff on duty and the availability of staff to keep people safe. During this inspection we visited the home on a nightshift and found where staff were required to attend to one person this left the remainder of people unattended on the floor.

We saw staff were supported to carry out their duties through induction, supervision and training. However we found there were a number of incidents where people had not been protected and staff had not given due regard to people’s well-being.

Regular checks were carried out on the building included fire-fighting equipment, fire alarms and fire drills. Water temperatures and window restrictors were also checked to make sure people were safe in their environment.

We found concerns about three people not having in place equipment to keep people safe and the maintenance of that equipment including sensor mats. During the inspection we asked the registered manager to conduct a review of everyone with equipment to ensure people were safe. The registered manager provided us with a list of 16 people for whom the service used bed or floor sensor mats, seat sensors, door sensors, crash mats and bed rails. With the exception of one person whose bed sensor was on order the registered manager gave us assurances the equipment was in place and in working order.

We also found processes to review and analyse people’s accidents in the home to be ineffective in looking at people’s personal safety.

Food and fluid charts were not completed appropriately in the home. There were no target fluid levels in place so staff were not aware how much people needed to drink to remain hydrated, and we found records to indicate people had drinks after 4.30pm were not in place. The charts failed to reflect adequate food intake for people.

People and their relatives were involved in assessments of people prior to their admission to the home. Care plans have guidance to staff on how to meet people’s care needs, however we found some of these care plans were missing. A resident of the day was chosen which meant their care was to be reviewed that day. We found these were incomplete and their care plans had not been reviewed. Staff were unable to provide us with audits on people’s plans to ensure they were up to date and accurate.

Relatives told us about their mixed experiences of making a complaint. We saw staff had documented complaints raised by relatives but these had not been documented with outcomes by the registered manager

Activities were provided in the home by two recently employed activities coordinators. The registered manager explained the coordinators were finding out what works in the home and as yet there was no current activities programme in place.

Staff had learned the best ways to distract people at times when they became distressed. We found they engaged people in activities including singing. Staff welcomed visitors into the home.

We found staff were respectful of people and protected their privacy and dignity. People spoke to us about staff closing their curtains and doors to ensure their personal care was given in private.

The regional manager carried out monthly visits to the home and to carry out an audit on behalf of the registered provider. Over a six monthly period we found the regional manager repeatedly made the same recommendations each month to improve the service. This meant that despite the registered provider having in place a system in place to carry out monthly monitoring visits the registered manager had failed to embed the recommendations and make the required improvements.

Registered persons are required by law to notify CQC of particular incidents which occur in services. These include serious injuries to people. We found there were four notifications about serious injuries not made to CQC. Following the inspection we contacted the local safeguarding team and found further safeguarding notifications had also not been made to CQC. This meant the service had not fulfilled their registration requirements.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Details of any enforcement action taken by CQC will be detailed once appeals and representation processes have been completed.

During our inspection we asked the provider, staff and people who used the service specific questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

Is the service caring?

During out inspection we saw people were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were treated with dignity and were supported to make choices and remain independent. A relative told us she felt her parent was much better cared for now and always appeared clean and tidy. She attributed the better care to having a new manager in post.

Is the service responsive?

We found a daily reporting system in place from the night staff to the manager to allow the manager to quickly address issues.

People using the service, their relatives, friends and other professionals involved with the service completed a satisfaction survey. Where shortfalls or concerns were raised, we saw these had been addressed by the provider.

Relatives told us the staff had responded to their needs in helping them to care for their family members

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that as far as possible anyone who was unsafe to work with people was not offered employment.

The service was safe, clean and hygienic. Equipment was regularly checked to make ensure people were not put at unnecessary risk.

People told us they felt their relatives were safely cared for at Rushyfield

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw these had been followed correctly.

Is the service effective?

People's health and care needs were assessed with them, and their representatives. Specialist dietary, social, mobility, equipment and dementia needs had been identified in care plans where required.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments.

People completed a range of activities in and outside the service regularly.

Is the service well led?

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People told us the service had improved since the new manager came into post.

Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service.

Some people living at the home had complex needs and were not able to verbally communicate their views and experiences to us however we were able to speak with two people who told us, 'I've lived in the village all my life so I know a lot of the carers, which is lovely. Everyone is so kind and helpful here,' and 'I really like the place; it's cosy and friendly and I have some good friends for company.'

We spoke with a visiting relative who said, 'I cannot speak highly enough about this home. The staff are amazing. They are so caring with Dad. They spend time with him and engage with him. On every possible level this place is first class.'

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with a visiting relative who said, 'I am aware of safeguarding from my own job and I can tell you the staff are fully aware of safeguarding. I also know for a fact Dad feels safe here; it shows in his body language.'

We found medicines were managed in a safe way.

We saw the manager undertook audits of the services provided. There were also arrangements in place to gain additional feedback about the services provided from survey data.

During this inspection visit we focused on these two areas.

We found the provider had introduced a comprehensive statement of purpose which clearly set out the aims and objectives of the service, the kinds of services it provided and a broad range of additional information.

We saw the provider had begun to modify the facilities within the home to provide an improved environment for people with dementia conditions. We also found the provider had introduced a wide range of audits to scrutinise all aspects of care from facilities management through to individual care and support of people.

In addition we found the manager had improved communication with people who use the service and their relatives.