Archived: Stubby Leas Nursing Home

Stubby Leas is a nursing home providing personal and nursing care and treatment of disease and disorder for up to 48 people in one adapted building. The service provides support to older people, younger adults and people living with dementia. At the time of our inspection there were 40 people using the service.

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

People were kept safe from abuse as staff understood the signs to look for and any incidents were reported for investigation. Risks to people’s safety were managed by risk assessment and care plans being put in place. Staff understood how to support people to minimise risks to their safety. People received support when they needed it by enough suitably skilled staff. Staff were recruited safely.

People had their medicines as prescribed and there were systems in place to ensure medicines were always available and stored safely. People were protected from the risk of cross infection as staff understood the procedures in place for infection prevention control. Where incidents happened, people had their care plans reviewed and changed to prevent this from happening again and lessons were learned and shared with staff.

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 provided person centred care and people felt staff understood their needs and preferences. Relatives confirmed staff ensured people received the care they needed. People and relatives felt involved in the home and peoples care. Staff told us they felt supported and we saw they worked well as a team to support people.

There were systems in place to check on the quality of the care people received. These systems were driving improvements and there was a learning culture in the home. Staff had regular training and there was a partnership approach with other agencies to developing care plans for 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 29 January 2020).

Why we inspected

We received concerns in relation to staffing and risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all are 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.

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 has remained good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

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

Follow up

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

Stubby Leas Nursing Home is registered to provide personal and nursing care for up to 48 people aged 65 and over. At the time of the inspection there were 36 people living in the home.

The home operates as two separate units known as Cottage Unit and Main Unit; both units care for people living with dementia and some people experience mobility difficulties and make use of the separate lifts in each unit. The home provides bedroom accommodation on the ground and first floors of the home with ten bedrooms having en-suite toilet facilities; people in the other bedrooms have shared use of bathrooms and toilets conveniently located throughout the home.

The inspection was conducted over three separate days. The third day of the inspection was prompted by concerns received about a safeguarding incident. A decision was made for us to inspect and focus on interviewing night staff and to look at their supervision and support to examine those risks. This incident is subject to a possible criminal investigation. As a result, this inspection did not examine the circumstances of the incident. We found no evidence during this inspection that any people were at an ongoing risk of harm from this concern.

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

People were cared for and supported by staff who had been safely recruited following robust recruitment practice. Vacancies had been covered by care staff from an agency who had received induction before commencing work in the home. Most of the agency staff undertook regular shifts in the home and had got to know people well. People received prompt care and support with enough numbers of staff on duty to ensure no one was left waiting for support. The home had been set out to operate as two units and ongoing maintenance ensured people were protected from risks related to unsafe premises.

Relatives spoke well about all aspects of the care and support provided in the home and regarded staff as kind, caring and attentive. They advised they felt confident people were being cared for by staff who were well trained, patient and skilled and felt comfortable leaving them to be cared for in the home.

People who lived at Stubby Leas received help to receive personalised support to engage in activities and interests which met their needs. The activities provided supported people to become involved things they found meaningful which in turn supported their well-being. Support was provided to ensure everyone had opportunities to find new interests, try out new activities and engage in activities they enjoyed alongside ensuring their physical care needs were met.

Staff valued people and their life experiences, and they knew people extremely well. They provided care individual to each person and their likes, dislikes and preferences were known and taken into consideration.

Medication was safely managed in the home and people received good skilled support to move safely around the home. 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 received support with meals and drinks and staff attention ensured people ate and drank enough to maintain good health. Contact was made with external health care professionals whenever staff were concerned about a person’s health.

Staff were well trained and were supported to undertake training whilst working in the home. Systems and processes in the home were up to date and checks and audits were used to quality assure the support provided to people and ongoing adherence to regulations were consistently delivered to a high standard.

Staff and relatives spoke positively about the registered manager and advised they were approachable and committed to delivering care and support to a high standard. The registered manager was positive about providing good leadership and management through example. They knew people and their relatives well and addressed any issues promptly and with sensitivity.

Rating at last inspection

The last rating for this service was good (published on 7 July 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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.

People continued to receive care that was safe, and were protected from harm by staff that understood how to promote people’s safety. Risks to people were assessed, monitored and reviewed to minimise potential harm. There were enough staff to meet people’s needs and there were effective systems in place to ensure staff were suitable to work with people. Medicines were managed safely, and people were protected from any risks associated with them.

Staff had the knowledge required to carry out their roles effectively and they received training to develop their skills. People were supported to make decisions, and when they were unable to, any decisions made were seen to be in people’s best interests. When people who lacked capacity to make decisions were seen to be restricted, this was done legally.

People were supported to maintain a balanced diet and were able to access healthcare service when needed. They were supported by staff who were caring, kind and compassionate. Staff understood people and promoted their independence, dignity and privacy. People were able to maintain relationships that were important to them.

The care that people received was personal to them and met their individual needs. They were involved in the assessment and planning of their care. People were able to take part in activities they enjoyed and the provider encouraged people to give feedback about their care. The provider listened to people’s views and acted on any concerns or complaints.

People were positive about their experiences of living at Stubby Leas. There was a positive, open culture promoted, and staff enjoyed their work and were motivated in their roles. There was an effective quality assurance system in place, and this was used to drive continuous improvements within the home.

At this visit we saw that people's dignity was maintained. People were offered a choice of meal and drink.

Care plans had been reviewed and more detail was included. This would enable staff to provide appropriate care which met people's individual needs.

Medication systems and audits were introduced to try and reduce the number of medication errors previously identified.

Work had been undertaken to refurbish parts of the home. New furnishings and flooring had also been purchased.

Staffing levels had been increased. People we spoke with praised staff saying that they were friendly and helpful.

Improvements had been made to quality assurance systems, to include introducing satisfaction surveys, relatives meetings and audits of systems and practices. Complaints received were logged and action taken to address issues raised was recorded.

Improvements were noted to records held at the home. Work had been undertaken to ensure records were up to date and in good order.

During our visit we looked at the care files of six people who lived at Stubby Leas. We found that there were some improvements in relation to the care and welfare of the people who used the service. The manager told us that a lot of work had been undertaken to try and make care plans more 'person centred' and to bring them up to date. However, a failure to ensure that all information in care plans was up to date and was available to clearly demonstrate the care to be given meant that the requirements of the regulations and our warning notice were not met. This meant that sufficient steps had not been taken to ensure that each service user was protected against the risks of receiving care or treatment that was inappropriate or unsafe.

We looked at staff files and saw that a new system of staff supervision had been introduced. In addition to supervision sessions, other staff support mechanisms introduced included staff meetings and staff training. We found that sufficient improvements had been made to meet this warning notice.

We saw staff practices that did not meet infection control standards. Staff were not clear on the approved practice for cleaning commode pans.

We identified medication errors at our visits of 7 and 28 May 2013. Staff were not always ordering medication in a timely manner to ensure that medication was available as required.

We spoke with staff and looked at staff records. We were told that staff did not receive training in dementia care. Staff said that they had requested other training. Records seen confirmed this.

We observed that there did not appear to be sufficient staff on duty to ensure that everyone's nutritional needs were met. Staff did not always take people to the toilet in a timely manner. Staff said that they had raised concerns with the management about this.

There was limited evidence to demonstrate that complaints made were acted upon in a timely manner and that people's concerns were responded to appropriately.

Records were not all up to date, clearly written or made available to us during this inspection.

People's dignity and privacy was not always maintained. We saw two people wearing food stained clothing and another person with urine soaked trousers.

Staff did not always act in accordance with the instructions recorded in people's care files. Inappropriate moving and handling techniques could put people at risk of injury.

Improvements were noted to medication management, although further work should be undertaken to become fully compliant.

Improvements had been made to infection control within the home. Further work was required regarding cleaning, cleaning records and staff training.

Some areas of the home were in need of maintenance.

Staffing levels had increased recently. However sufficient staff should be on duty to monitor those people with behaviour that may challenge so that staff and people who live at the home are safe from harm. Supervision of staff had not taken place recently and regular staff meetings had not been held.

Systems were not in place for auditing and monitoring the quality of the service provided to reduce the risk of people receiving inappropriate or unsafe care.

The complaint log did not record details of investigations undertaken and action taken to address issues raised.

Records were not all available or up to date.

We last visited Stubby Leas in July 2012. At that time, we found that assessments were not in place to identify whether people who lived at the home had the mental capacity to make important decisions. We saw that "do not attempt resuscitation" orders were not always fully completed. People, and where appropriate their families, can make the decision that they do not wish to be resuscitated in the event of severe illness. Medication systems did not fully protect the people that lived there. The home sent us an action plan following this visit. This recorded the action that they would take to improve upon the medication systems and practices in place. This visit was undertaken to check on improvements made.

We arrived at the home at 6.45am. We saw that 20 people were dressed and seated in the two lounges. We looked to see if people's preferred routines regarding rising and retiring were recorded. We could not see any documentary evidence to demonstrate that people's preferences were taken into consideration when planning care.

We looked at documentation regarding mental capacity. We could not see any evidence to show that people's mental capacity to make important decisions had been assessed.

We looked at medication, storage and records. We saw that there had been some improvements but medication errors were identified at this inspection.