This inspection took place on 20 and 23 June 2016 and was unannounced. Fulford Nursing Home provides nursing and personal care for up to 28 older people. It is an independent, family-owned business. The home has accommodation on three floors and a communal dining room, living room and conservatory sitting room on the ground floor. All floors can be accessed by a lift. The accommodation includes a small number of double rooms. The home also has an outside courtyard garden and seating area which people using the service and visitors can utilise. At the time of our inspection there were 24 residents using the service. As well as people living at the home on a permanent basis, the home takes referrals from the local NHS Rapid Assessment and Treatment Service, for people who required a short stay, with a focus on rehabilitation before moving back to their own home.
The service is required to have a registered manager, and at the time of our inspection 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.
We found that people’s needs were assessed and risk assessments were in place to prevent avoidable harm. The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.
The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. There were sufficient numbers of suitable staff to keep people safe and meet their needs.
There were policies and procedures in place to ensure people received their medication, but these were not always consistently followed. For example, the date of opening was not always recorded on some medications which had a limited shelf life once opened, and the stock count of some medication was inaccurate. We have made a recommendation about this in our report.
Staff completed a range of training to help them carry out their roles effectively and the majority of staff were up to date with their training. Some staff that were overdue their medication refresher training were booked to complete this training the month after our inspection, so systems were in place to ensure everyone had the necessary up to date knowledge and skills they required.
The registered provider sought consent to provide care in line with legislation and guidance. Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the principles of the MCA.
People were supported to maintain good health and access healthcare services. We saw evidence in care files of contact with healthcare services, such as GPs, the community mental health team, podiatrists, the tissue viability nurse and the community dentist.
There was generally positive feedback about the quality and variety of food available, and people told us they got sufficient to eat and drink. Care plans contained information about people’s nutritional needs and preferences, and the cook we spoke with was knowledgeable about people’s dietary needs. Food and fluid monitoring charts, for people identified as being at high nutritional risk, contained insufficient information to effectively monitor people’s food and fluid intake. We have made a recommendation about this in our report.
Most people told us that the staff who supported them were kind and caring. We saw that interactions between staff and people using the service were positive, respectful and friendly and staff were knowledgeable about people’s needs and preferences.
The registered provider completed care plans which contained information about people’s needs and wishes; these were regularly reviewed.
There was a complaints procedure in place and most people using the service told us they knew how they could raise a complaint if they needed to. People also had opportunity to raise concerns through resident’s forums and relatives meetings.
The registered provider had a quality assurance system in place and the registered manager conducted a range of audits. This enabled the registered provider to identify issues and measure the delivery of care.