Iffley Residential and Nursing Home

Iffley Residential and Nursing Home is a service providing accommodation, personal and nursing care for people aged 65 and over including people living with dementia. It can accommodate up to 76 people across three separate floors. There were 72 people living at the service at the time of our inspection.

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

People remained safe at the service. People benefitted from staff that understood how to protect them from harm. Risks to people had been assessed and recorded. There were enough suitably trained and skilled staff to keep people safe. People received their medicine safely and as prescribed.

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. People had support to access health care services if required. People were positive about the food and had their nutritional needs met.

People remained supported by staff that were caring, compassionate and respectful. Staff referred to the community at the home as a ‘family’. People and where appropriate relatives were involved in making decisions about the care people received. People's independence was promoted, and their confidentiality was protected. The team demonstrated commitment to celebrating people’s diverse needs.

People received care that met their needs. People had opportunities to take part in activities and outings of their choice. Staff explored people’s interests in order to create opportunities for people to continue pursuing their interests. People knew how to make a complaint and told us their concerns were acted upon promptly. Staff worked with professionals to ensure people received high quality end of life care.

The service remained well-led by an experienced registered manager who was supported by a team of committed staff. People and staff were listened to and able to provide their views in various ways. There were systems in place to monitor the quality of the service. The staff team worked well with a number of external local health and social professionals and promoted an open and transparent culture.

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 28 April 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 the last inspection, the service was rated Good. At this inspection we found the service remained Good. At the last inspection in July 2015, we asked the provider to take action to make improvements in relation to management of medicines, and this action has been completed.

People told us they were safe. Staff were knowledgeable how to recognise safeguarding concerns and what to do if they suspected abuse. There were systems in place to identify and manage risks to people.

There were enough staff on duty to keep people safe. People were assisted promptly and with no unnecessary delay. There was a recruitment system in place that helped the management make safer recruitment decisions when employing new staff.

People were cared for by staff who were knowledgeable about their roles and responsibilities and had the relevant skills and experience. Staff received regular appraisals and were well supported in their roles.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. 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 were supported to meet their nutritional needs. Staff supported people to eat their meals where they chose and provided individual support if required. External professionals were positive about the management of the home and told us people were referred appropriately when needed. Records showed people had access to a range of health professionals.

People’s needs were assessed prior to the admission to the service to ensure their needs could be met. People’s care plans were reviewed regularly and there was ongoing work in progress to keep them current.

Staff encouraged people to engage in activities. People benefitted from an environment designed to enable them to move freely around the service.

The registered manager worked to continually improve the service. Feedback was sought from people and their relatives and action taken when needed. Complaints policy was available to people and relatives. The registered manager had quality assurance systems in place and a good overview of the concerns they were working to address.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We found Iffley Residential and Nursing Home needed to take action to become a safe service.

There was guidance for staff on the safe handling of medicines. We found medication was stored and administered safely at the home. There were some gaps on the medication administration sheets where staff had not signed to show medicines had been given to people. This meant the medication administration records could not always be relied upon to provide an accurate account of whether people had been given their medicines as prescribed. Records showed one person was given an 'as required' medicine almost every night, rather than occasionally. The protocol for use of the medicine said it needed to be reviewed each month, but no reviews had taken place.

Staff recruitment files contained documents such as written references and evidence of checking for criminal convictions. There was high use of agency staff to cover vacant posts at the home. We looked at the information provided by agencies in respect of three workers supplied to the home. For two of these workers, there was no information about any checks that had been carried out and the workers' backgrounds. There was a written profile for the third person which provided a summary of checks and experience. We noted this did not contain a photograph so that the home could verify the person who first arrived at the home was the person supplied by the agency. This showed appropriate checks were not always undertaken before staff began working at the home.

We observed there were adequate staff to meet the needs of people living at the home. Call bells were attended to quickly and efficiently and people told us they generally did not have to wait long if they rang their call bell. Staff went about their role in an unhurried manner and took their time with people. Staff told us they felt there were enough staff working at the home. However, all the staff we spoke with told us the current high use of agency staff sometimes made things difficult. Several people told us agency staff did not understand and meet their needs as well as the permanent staff. This resulted in inconsistencies in how they received their care.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us no recent applications had needed to be submitted to deprive anyone of their liberty.

Is the service effective?

We found Iffley Residential and Nursing Home needed to take action to become an effective service.

People and relatives we spoke with told us the food was good at the home. One person said 'There have been a lot of issues with food but it's getting better.' The relatives we spoke with said food had improved since the new chef had started at the home. People were provided with a choice of suitable and nutritious food and drink. We observed lunch was served in a relaxed manner and people were given the choice of where they could eat. People's care plans showed they had been assessed by staff in relation to their eating and drinking needs. Where a risk had been identified, it was clear that actions had been taken to address these risks, such as referral to the GP or dietitian. However, we found food and fluid intake charts had not always been filled in accurately where people were at risk of malnutrition or dehydration.

Staff told us they had received an induction which included shadowing a more experienced care worker and undertaking training. We looked at four staff development files. These showed frequency of supervision varied from none to three meetings this year. This meant staff were not receiving regular supervision, at the frequency the provider expected.

Staff had not completed all the training the provider required. Records showed there were gaps to courses such as fire safety, moving and handling and safeguarding adults from abuse. The manager was not able to provide any assurance of when or how staff training would be brought up to date at the home. This meant people were supported by staff who may not have the skills and knowledge to support them safely and appropriately.

Is the service caring?

We found Iffley Residential and Nursing Home provided a caring service.

People we spoke with were positive about standards of care at the home. Comments included 'Generally the care is excellent,' 'The carers couldn't be nicer and we had plenty of involvement when admitted,' 'There's nowhere like your own home but they look after me well here,' and 'I'm quite happy here, I've got everything I need.' People told us their personal care was carried out with good regard for their privacy and dignity. We observed doors were closed whilst support was provided and there were curtains and screens in the communal bathrooms to protect people's privacy.

Is the service responsive?

We found Iffley Residential and Nursing Home provided a responsive service.

Care plans provided clear instructions for staff on how people liked to be treated and how they wanted their care provided. Risk assessments had been written for a range of activities and situations. For example, the likelihood of developing pressure damage. Records showed people had access to external healthcare professionals such as GPs, district nurses and Parkinson's Disease nurses. People received support and advice from community physiotherapists where there was a history of falls. This helped to ensure preventative measures were taken, wherever possible, to reduce the likelihood of further falls.

Activities were held in the home throughout the week. Outings had taken place to venues such as the local donkey sanctuary and garden centres; people had also been out for pub lunches. Around the home there were various items on display to remind people of things from their past. We saw one of the garden areas was decorated with artwork produced by residents. The home had a cinema room and a sensory room for people to enjoy. There were also quiet areas where people could sit with their visitors.

Is the service well-led?

We found Iffley Residential and Nursing Home needed to take action to become a well-led service.

Staff and relatives we spoke with told us the manager and deputy manager were very approachable. There were regular relatives' and residents' meetings at the home and an annual survey had been carried out this year to seek people's views.

We found although there were regular medication audits, these had not always identified all the issues at the home. For example, that one person's 'as required' medication was being given on a daily basis and had not been reviewed monthly, as required.

Audits of the quality of care had been carried out in February and June this year. We noted both audit reports highlighted areas of concern. We found some of these concerns were still not resolved from February 2014. For example, ensuring staff training was up to date and accurate maintenance of medication administration records. We could not be confident that enough was being done by the provider to check progress in meeting the actions and improving the service.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at five care plans and saw they contained appropriate risk assessments that were reviewed, dated and signed. The plans were person centred and held historical notes on the person including their likes, dislikes and preferences.

We spoke with five people and asked if they felt safe. One said 'I'm well looked after, I couldn't ask for more'. Another said 'oh yes, I am safe here'. One relative said 'it is good to know my brother is in safe hands, I have no concerns for his safety'.

We spoke with five care workers who felt that they were supported by the provider and had access to mandatory training, specific training and a structured supervision appraisal programme. One care worker told us 'If I need help I just ask, its good', while another care worker told us 'management is really good here, they take things onboard'.

The provider had conducted a residents and relatives meeting and the last meeting was held in March 2013. As the service had only just opened, the provider had not yet completed a quality survey.