Mary Seacole Nursing Home

We found the following examples of good practice.

The provider had a robust procedure for visitors in relation to infection control and prevention. Family members visiting people in the service had to arrange an appointment. Visiting times were staggered so as to avoid congestion at the main entrance and only one family member was nominated by people to be their regular visitor. Exceptions were made for visitors who required assistance from another family member or if the person in the home was receiving end of life care. In which case, more than one relative was permitted to visit them. Visitors had their temperature checked by staff at the entrance and this was recorded along with their contact details. There was clear and appropriate signage in place for staff, people and visitors.

The provider followed government guidelines regarding Covid-19 and adapted their procedures when guidelines changed. Changes were communicated to people, relatives and other regular visitors through letters, leaflets and emails to ensure they had up to date information.

Staff were provided full personal protective equipment (PPE) and there was a regular supply delivered to the service weekly. Additional PPE was in stock should it be required, for example face shields, surgical gowns, long sleeve overalls and goggles. Staff were encouraged and trained to use PPE effectively and safely. People in the service were supported to understand the need for staff to wear face masks. Hand sanitiser stations were conveniently located.

People were supported to self isolate should they test positive for Covid-19. Staff in each unit only worked in that unit to avoid any cross contamination. People and staff were tested regularly in line with government testing guidance for care homes.

There was a specialist isolation unit on the ground floor, which could be used as a designated setting. A designated setting is a separate accommodation unit for people who have tested positive for Covid-19 and have been discharged from hospital. They are cared for in the designated setting for the remainder of their isolation period before being moved on to their homes or other care settings. We saw that the isolation unit in the service was staffed separately from the rest of the nursing home. There were specific entrance and exit points for staff away from other areas of the building to avoid the risk of transmission of Covid-19 or other infections. There were robust procedures in place to ensure the risk of infection was minimised.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Mary Seacole Nursing Home is a residential nursing home providing personal and nursing care to 43 people aged 60 and over at the time of the inspection. The service can support up to 50 people.

Mary Seacole Nursing Home can accommodate 50 people across six separate units, each of which has separate facilities. One of the units specialises in providing rehabilitation to up to seven people in a separate unit and another accommodates people for respite care.

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

Staff recruitment checks were verified by the provider, however, we have made a recommendation in relation to the availability of recruitment records.

People and relatives told us they felt safe at the service. People were protected from the risk of abuse or harm because staff knew the action to take should they suspect or witness any abuse. Risks to people were assessed and appropriately managed to ensure people received safe care. Appropriate infection control practices were followed by staff. Learning from incidents was discussed and shared with staff.

People’s needs were assessed before joining the service. Staff felt supported and received training relevant to their role. People’s nutritional and hydration needs were met by the service and their likes and dislikes considered. People had access to healthcare professionals to meet their health needs.

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 were treated without discrimination and their cultural and religious needs respected. People and relatives told us staff treated them with dignity and respect and looked after them well. People were involved in their care and staff encouraged people to develop their independence as much as possible.

People received individualised care relevant to their needs. People’s communication needs were documented in their care plan. People and relatives said they felt able to make complaints. People’s end of life wishes were assessed and documented in their plan of care.

Systems for monitoring the quality of the service were in place and regular audits took place. Systems for analysing incidents/complaints and continuous learning took place to improve the quality of the service provided to people.

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 25 August 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.

Mary Seacole Nursing Home is a purpose built 50 bedded NHS care home with nursing, which provides accommodation for people who require permanent or respite nursing care. This includes care and support for people who are living with dementia and people with end of life care needs. The premises are arranged over three floors, with the second floor used for administrative areas. The ground floor and first floor provide single occupancy bedrooms with ensuite facilities, communal dining rooms, lounge areas, adapted bathrooms, an activity room, a relaxation room for people using the service and two passenger lifts. There is a seven bedded transitional neurological rehabilitation unit for people who have had a neurological injury or have been diagnosed with a long term neurological condition, which offers dedicated areas for people to develop and improve upon their independent living skills. Facilities include a laundry room, a therapeutic exercise room, a communal lounge and an adapted kitchen. There are landscaped gardens and a terrace at the rear of the premises for use by people on all of the units, and the building is within short walking distance of local shops, cafés and other amenities. At the time of the inspection 44 people were using the service; 38 people were receiving permanent or respite nursing and six people were using the transitional neurological rehabilitation unit.

There was a registered manager in post, who has managed the service for several years. 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 previous inspection in April 2016 the service was rated as ‘Requires Improvement’. There were no breaches of Regulations; however we had made three recommendations to the provider. We had recommended that improvements were made to address the storage temperature for medicines and address the lack of clinical guidance for staff to assess people’s pain. It was recommended that the provider implemented a supplementary system to enable staff to quickly access Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) information and that the provider sought guidance from a reputable source about how to put in place person centred care planning that reflected people’s wishes and interests. At this inspection we found that the provider had taken appropriate actions to fully address all three recommendations.

There were sufficient staff deployed to provide people with the care and support they needed. Clear systems were in place to make sure that staff were recruited in a safe way.

Assessments were in place to identify potential and actual risks that could harm people, restrict their independence and impact on their safety and wellbeing. Information about how to manage these risks was contained in people’s care plans.

Staff had received safeguarding training and knew what actions to take to protect people from the risk of abuse. This included a good understanding of the provider’s whistleblowing policy in regards to raising any concerns about the conduct of the service.

Training, supervision and support was provided so that staff could confidently undertake their roles and responsibilities. There had been a positive focus on training to understand and meet the needs of people living with dementia and this training was highly regarded by staff for its usefulness .

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is necessary to restrict their freedom in some way, to protect themselves or others. The provider understood its responsibilities and ensured that people’s rights were protected.

People were provided with a healthy diet that met their medical needs and particular cultural needs. Staff provided sensitively delivered support at mealtimes and chatted pleasantly with people to enhance their enjoyment of communal dining.

Care plans showed that people’s health care needs were properly assessed and suitable guidance was in place to support people to meet their needs. People were supported to access a wide range of health care professionals and the referral process worked efficiently as staff were part of the same NHS trust.

The provider had implemented an easily recognisable system so that staff had written information and an easily accessible second indicator in regards to whether people were subject to Do Not Attempt Cardio Pulmonary Resuscitation. People using the service and their relatives where applicable had been asked for their views for how they wished to be supported for urgent care and end of life care.

People and relatives told us staff were considerate, conscientious and friendly. We observed positive interactions between people and staff throughout the inspection.

People’s privacy during personal care was maintained, although we have discussed the use of ‘Do Not Disturb’ signs for specific circumstances when people are being supported with their hygiene care in bathrooms designated for communal use.

The provider made sure that people and their representatives were issued with useful information about how the service operated, which included information about how to make a complaint and receive independent support during the process.

Actions had been taken to improve how the service assessed people’s social care needs and gathered relevant information about their interests, hobbies and aspirations. However, this work was in progress at the time of the inspection. The standard of support for people to engage in fulfilling activities had significantly improved and we saw how people were now able to access different musical and creative entertainments and pastimes.

The provider had suitable systems for investigating complaints and where necessary, learning from complaints had taken place. People’s views about the quality of the service and how to make improvements were sought through a variety of methods, which included surveys, questionnaires, meetings, and informal chats with the registered manager and other senior nurses.

People using the service and their relatives informed us that they liked how the service was managed. The registered manager provided a visible and approachable style of leadership and he monitored the quality of the service during his time spent on the units. Additional quality monitoring was undertaken through clinical audits and monitoring visits by the senior management team based at the Homerton University Hospital NHS Foundation Trust.

The unit lead for the transitional neurological rehabilitation unit demonstrated a ‘hands-on’ managerial style, with a good emphasis on working with people, their families, the staff team and other health and social care professionals. The unit had defined clinical and other quality assurance systems to evaluate its performance and gather people’s feedback.

Mary Seacole Nursing Home is a purpose built 50 bedded NHS care home with nursing, which provides accommodation for people who require permanent or respite nursing care. This includes care and support for people who are living with dementia. The premises are arranged over three floors, with the second floor used for administrative areas. The ground floor and first floor provide single occupancy bedrooms with ensuite facilities, communal dining rooms, lounge areas, adapted bathrooms, an activity room and two passenger lifts. There is a seven bedded transitional neurological rehabilitation unit for people who have had a neurological injury or have been diagnosed with a long term neurological condition, which offers dedicated areas for people to develop and improve upon their independent living skills, including a laundry room, a therapeutic exercise room and a kitchen. There are landscaped gardens and a terrace at the rear for use by people on all of the units and the premises is within short walking distance of local shops, cafés and other amenities. At the time of the inspection 45 people were using the service; 43 people were receiving permanent or respite nursing and two people were using the neurological rehabilitation unit.

There was a registered manager in post, who has managed the service for several years. 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 previous inspection in September 2015 we found three breaches of regulation and made one recommendation in relation to improvements the provider needed to implement. The breaches of regulation were in regards to the provider not ensuring that people were protected from the risks associated with receiving a medicine service not safely managed, not protecting people against the risks associated with receiving a service that did not have sufficient numbers of staff deployed at all times and not protecting people from the risks associated with staff not receiving appropriate supervision to enable them to carry out their duties. A recommendation was for the provider to seek good practice guidance for the use of mobile armchairs. Following the inspection the provider sent us an action plan which highlighted the action they would take in order to improve. At this inspection we found the provider had met the breaches of regulation and had taken action to implement the recommendation.

The provider had achieved improvements in relation to the management of medicines. However, we found that medicines were not being stored at an appropriate temperature in line with the manufacturers’ guidance. This meant that people were at risk of receiving prescribed medicines that could have changed composition or deteriorated. We also found that although staff told us they visually assessed if people who were not able to verbally express their views were in pain, we did not find evidence of the use of structured clinical assessment tools to support staff to make appropriate judgements about people's pain management.

There were sufficient staff on duty to provide people with care and support; however, staff were not always safely and effectively deployed. This placed people at risk as they were not able to locate staff at all times. Robust systems were in place to ensure that staff were safely recruited.

Assessments were in place to identify potential and actual risks that could harm people, restrict their independence and impact on their safety and wellbeing. Information about how to manage these risks was contained in people’s care plans.

Staff were aware of how to protect people from the risk of abuse and were familiar with the provider’s policy about how to raise concerns about the conduct of the service.

Suitable training and support was offered to staff to enable them to effectively meet people’s needs. This included the recent introduction of one to one formal supervision and the introduction of training to meet the needs of people living with dementia.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is necessary to restrict their freedom in some way, to protect themselves or others. The provider demonstrated that mental capacity assessments had been carried out in accordance with MCA legislation and applications for DoLS authorisations were made when required.

People were provided with a balanced diet that met cultural and medical needs. They were assisted by staff to meet their nutritional needs, however some staff needed additional guidance about how to support people at mealtimes and provide a calm, pleasant environment.

Care plans demonstrated that people’s health care needs were suitably identified and met. People were supported to access a wide range of health care professionals as required.

It was noted that although staff were aware of people’s resuscitation status, concerns were expressed that some staff were not as computer literate as others and would benefit from the security of having a secondary system that recorded if people were subject to Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR).

We observed some positive interactions between people and staff, and received complimentary comments from people and their relatives about the kindness of some staff. However, we saw that some staff did not present a sensitive and compassionate manner.

People’s privacy during personal care was promoted, however people’s confidential files were not always stored safely.

The provider ensured that people and their representatives were supplied with useful information about how the service operated.

People’s health, care and support needs were assessed and regularly reviewed. However, we found that the care plans did not demonstrate a person – centred approach that took into account people’s relevant history and personal interests.

Information was given about how to make a complaint and people were confident that their complaints would be dealt with professionally and sympathetically. The provider had clear systems for investigating complaints and where necessary, learning from complaints.

Relatives told us they were pleased with how the service was managed by the registered manager.

There were clear practices and systems in place to monitor the quality of the service, although ongoing auditing was required to make sure that staff followed guidance about their safe deployment within the premises.

The provider sought people’s views about the quality of the service and how to make improvements.

We have made three recommendations to the provider. We have recommended that improvements are made to address the storage temperature for medicines and address the lack of clinical guidance for staff to assess people’s pain. It is recommended that the provider implements a supplementary system to enable staff to quickly access DNACPR information and that the provider seeks guidance from a reputable source about how to put in place person centred care planning that reflects people’s wishes and interests.

The care plans showed that people's care was planned and delivered in a way that took into account their individual needs and wishes. There were systems in place to ensure that people's needs were regularly monitored and reviewed. One person said, "I've been here longer than most and think the nurses give their best." A relative said, "the care is excellent and the manager is fantastic."

People told us they liked the food and were offered choices, although a few people said they would like to be offered foods that met their cultural needs. We saw that people were provided with the appropriate support and encouragement they needed to meet their nutritional needs.

Some people told us that staff appeared to be busy during the mornings but they felt their needs were being safely met.

There were systems in place to seek the views of people using the service and their representatives and to monitor the quality of the service. People using the service and their representatives said they regularly saw the manager on the units and found him approachable.

People were asked about their needs, preferences and interests as part of the planning and delivery of their care.

People were receiving safe and appropriate care, which took into account their preferences and interests. People told us they felt safe and knew how to raise concerns. We saw there were measures in place to protect people from the risk of abuse.

We found people's medications were being safely managed.

Staff received regular training and support to meet the needs of people using the service, including training to meet the specific needs of people living at Mary Seacole Nursing Home.

People were given information about how to make complaints and any complaints were investigated.