Archived: Nower House

Nower House is a residential care home providing personal care to up to 50 people aged 65 and over, some of whom live with dementia. At the time of the inspection they were supporting 35 people. The care home is one adapted building and at the time of the inspection people were only residing on one floor, the ground floor. The lower ground floor was only being used for the kitchen and domestic purposes.

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

People were not always kept safe from risks. Risk assessments were not always completed and care plans did not always adequately detail risks.

The home did not have enough staff to meet people’s needs. We saw staff did not have time to support in a personalised way and people and staff told us there were not enough staff working at the home. This had impacted the ability of staff to meet basic bathing choices of people, such as more than one shower a week.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The environment of the home did not always meet the needs of the people living there. For example, it was not a dementia friendly environment.

There was not always full oversight of the quality and safety of the home. There were some essential audits not being completed, these included quality assurance audits. This meant that shortfalls in practices were not being identified and action could not be taken to drive improvement in the home.

For the last two inspections the provider had failed to make adequate improvements to ensure people were kept safe and the home was effectively monitored. As a result, in certain areas the home had deteriorated.

People told us they felt safe and staff were caring towards them. However, the level of care people received had been directly impacted by the shortage of staff. Staff were knowledgeable in safeguarding procedures they needed to follow.

People told us they felt comfortable to raise complaints and they felt they could talk to the registered manager.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 03 August 2021) and there were multiple breaches of regulation. The provider had a condition placed on their registration to complete monthly audits specific to the concerns found at the last inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about training and staffing. A decision was made for us to inspect and examine those risks.

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

We have found evidence that the provider needs to make improvements. Please see all sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Nower House is a residential care home providing personal care to 41 people aged 65 and over at the time of the inspection. The service can support up to 50 people. Nower House accommodates people across two separate wings, each with their own adapted facilities.

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

People’s risks were not always managed or recorded in a safe way. People did not always receive safe care and support with medicines.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People did not always receive person-centred care. Care plans lacked person-centred detail which meant staff lacked knowledge of people’s individual needs.

Quality assurance processes had not always been effective in identifying issues we found at the inspection. There was no registered manager and a temporary manager was in post whilst recruitment continued. This had led to people feeling there was little management presence or visibility in the home.

People told us they enjoyed the food at Nower House and we saw evidence that staff were knowledgeable about modified diets. People said they were supported by kind staff that had received appropriate training to prepare them for their roles. Staff received regular training and were recruited safely.

The management team had a positive plan to improve the service, however, a lot of the planned improvements still needed to be implemented and embedded into the service. For this reason, we were unable to see whether these changes would be effective to drive the improvement required.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 August 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 June 2019. Breaches of legal requirements were found in regards to safe care and treatment, consent, person centred care and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same of requires improvement. The provider continues to be in breach of regulations relating to safe care and treatment, consent, person centred care and good governance. This is based on the findings at this inspection.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Nower House is a care home providing accommodation and personal care for up to 50 older people with a wide range of care needs. At the time of our inspection 46 people were using the service. Nower House is one large house which is split into two sections called Woodcote and Newra.

The building is laid out over two floors, with two large lounges and two large dining areas on the ground floor. One smaller lounge, two TV rooms, a conservatory and a lift for people to use.

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

We found there was a lack of risk assessments for people and their ongoing care needs. Nobody had risk assessments in place for things such as requiring a hoist, falls, moving and handling, risks relating to pressure damage and MUST (malnutrition universal screening tool) and other health concerns.

Medicines were not managed and administered safely. We found shortfalls with the processes in place to account for how much medicines were in the home. We also found people had the wrong amount of medicines stored for them and staff were unable to account for these errors. We raised this with the nominated individual who addressed this immediately..

People who were receiving end of life care did not have a person-centred end of life care plan in place. We raised this with the nominated individual and have signposted the service to linking in with local hospices with a view to developing end of life plans with people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People did not have decision specific capacity assessments or detailed best interest decisions.

Although several audits existed they had not picked up the errors that we noticed during the inspection with regards to medicines, consent to care and risk assessments.

People told us they felt safe and protected from harm and abuse. Staff were confident about identifying potential abuse and actions they would take if abuse was witnessed or suspected.

Staff did know the people they cared for well and were able to demonstrate detailed knowledge of peoples’ needs which lowered the risk around people not having risk assessments.

People told us staff were caring. We observed caring interactions between staff and people during our inspection. Although people were not always aware of what a care plan was, they told us they were involved with making decisions about their care. People told us they were treated with dignity and respect. Relatives also told us that they found staff to be caring and kind.

People were supported to express their views through residents’ forums which were reviewed by the service to identify areas for improvement. We received positive comments from staff about the registered manager. Staff told us they worked together as a team to achieve good outcomes for people.

Staff received training relevant to their roles. People were supported to eat and drink and provided with a variety of food choices at mealtimes. Staff worked well with external healthcare professionals to ensure good outcomes for people. People's needs were met by the home environment. Staff ensured consent was gained before providing care.

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

The last rating for this service was good (published 19th July 2016. There were no previous breaches from the last inspection.

Why we inspected;

We inspected this service in line with our inspection schedule for services currently rated ‘Good’.

We have identified breaches in relation to the safe management of medicines, safe care and treatment, need for consent, person centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nower house is a non for profit charitable service. They provide accommodation and support for up to 50 adults, some of whom have dementia. At the time of our inspection 44 people were using the service. Nower house is split into two units – Woodcote and Newra. Generally people stayed on their own units, but they were able to mix if they wished to and to participate in activities.

The service had a registered manager. However, they were on annual leave during our inspection. The rest of the management team ensured the service was adequately managed whilst they were on leave. 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 received their medicines as prescribed. However, some of the medicines management processes were not robust and we recommend that the provider reviews their practice in line with good practice guidance for managing medicines in care homes.

People were happy staying at the service and enjoyed the interactions they had with each other and the staff. Staff were knowledgeable about the support people required and provided them with this. However, we identified that one person’s care records did not accurately reflect the support people required or what was delivered.

People were supported to have their health needs met and staff liaised with healthcare professionals as required. Staff accompanied people to hospital appointments if people wanted them to.

Staff supported and encouraged people to manage their nutritional needs. Staff were aware of people’s dietary requirements and supported them appropriately, this included supporting people to put on weight when required and helping those who required a diabetic diet.

Staff treated people with kindness and respect. Staff were patient and polite when supporting people, and respected their decisions. People were given choice about how they spent their time and how they were supported. Staff adhered to the Mental Capacity Act 2005 and best interests decisions were made for people who were unable to make decisions for themselves.

Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by senior staff members and received regular supervision. Knowledge and competency checks were undertaken to ensure staff retained the information they received on training courses.

Staff, people and their relatives were able to feedback their views on the quality of the service. This was achieved through regular meetings, the use of suggestion boxes and completion of satisfaction surveys. A process was in place to acknowledge, investigate and respond to complaints.

Checks were undertaken on the quality of the service. This included regular visits by a board member. Where improvements were required, actions were taken to address these. Systems were in place to record and respond to incidents that occurred, and a member of the management team ensured that notifications of all serious incidents were made to the Care Quality Commission, as required by their registration.

As part of this inspection we spoke with six people who used the service, the registered manager and six staff members. we also reviewed records relating to the management of the home which included four care plans, daily care records, staff duty rotas and activity arrangements.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

Is the service safe?

Some people told us they felt safe living in the home. They said they could talk to the manager and the staff if they felt upset or unsure about anything. Other people were not able to communicate with us because of their poor communication skills. Safeguarding procedures were in place and staff understood their role and responsibility in safeguarding.

We saw staff observed the safety and welfare of people living in the home and saw no negative practices during our visit.

The service was clean and safe and provided people with safe access to all areas of the home.

The staff recruitment practice was thorough.

Is the service effective?

People's health care needs were assessed with them whenever possible and written in a care plan. Arrangements were in place for people to have visits from GP when appropriate to monitor their individual health care needs. People also had effective support from other health care professionals. For example the chiropodist, district nurse, dentist and the community psychiatric nurse (CPN), and the dietician.

Is the service caring?

People who used the service told us the staff were very caring and always treated them well. We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner. We saw staff explained things to people when they were having difficulty to understand. For example when people asked where they were or when to expect a visit from relatives. We saw people were supported to eat their meals by staff in a sensitive and caring way and they took the time to enable people to be as independent as possible. People who used the service told us that staff always kind and that was why it was a good place to live.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allowed the individual to be as independent as possible. This included the management of people's changing needs for example the provider allocated an additional staff member to night duty to manage an identified need. The service also referred a person for psychiatric support appropriately.

Is the service well led?

The home is well managed by the registered manager who had been in post for several. They had the support of a compliance manage and a general manager who had designated responsibilities for overseeing the effective management of the home. The registered manage also had the support of a well established staff team who had a good understanding of the needs of the people who used the service.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment. Complaints and accidents were monitored and lessons learnt from the outcome of these were documented and discussed with staff to further improve quality.

Some of the people using the service had dementia care needs, which meant they were not always able to describe their experiences of the service. To help us gather evidence of their experiences we used a Short Observational Framework for (SOFI). The tool is used to capture the experiences of people who may have cognitive or communication impairments and cannot verbally give their opinions on the service they have received.

We spent time observing how people spent their time, the support they received from staff and whether or not they had positive experiences.

Our observations of staff practice showed that people were receiving effective, safe and appropriate care, which was designed to meet their specific needs.

We saw people felt comfortable in approaching staff and asking for assistance. People were relaxed and content in their surroundings. Staff engaged positively with people using the service to encourage them to communicate their consent, wishes and choices.

One person who used the service said "The service here is excellent and I have no reason to complain." Another person told us that 'The food is nice and staff nice too.'

Where people did not have the capacity to consent, the provider had not acted in accordance with legal requirements.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

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.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

One person we spoke with commented, "If I want to relax in my own room, I do. I have the choice, but there is always plenty to do if I want to join in with what is going on. That suits me." Another person said that the staff were "always helpful, cheerful, and very kind."

Everyone we spoke with confirmed that they enjoyed their meals and had plenty to eat and drink. They all said they received the care and support they needed and felt safe at 'Nower House' because they could rely on the staff.

We saw that the communal areas of the home, such as the lounges and access corridors, were well maintained, appropriately lit and heated, and were free from odour. The people we spoke with all said 'Nower House' they were comfortable and liked their surroundings.

We saw that furnishings were in good condition and people said they liked the d'cor. The bedrooms we saw were clean, and each person had personalised their room with their belongings and had arranged their private space the way that suited them.