This inspection took place over three days, 17, 18 and 24 March 2015. The first day of the inspection was unannounced. We last inspected Craigielea Nursing Home in October 2014. At that inspection we found the service was meeting the regulations we inspected.
Craigielea Nursing Home provides accommodation, nursing and personal care for up to 64 older people, including people living with dementia. At the time of the inspection there were 48 people living at the service.
The service had a registered manager who had been in post since November 1999. 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.
Out of 26 Medicines administration records viewed a number of recording errors were identified in four records, however we observed people’s medicines were administered and stored appropriately.
The provider’s policies and procedures were out of date. This meant current information and guidance was unavailable for staff to refer to and what was expected of them when providing care for people and ensuring their safety and wellbeing.
Staff recruitment practices at the home did not always ensure that appropriate recruitment checks were carried out to determine the suitability of individuals to work with vulnerable adults, placing service users at risk of harm. Satisfactory reference checks and confirmation of applicant’s identity had not been conducted and information on application for employment forms were incomplete.
The service did not always protect people against the risk of unclean, insecure and properly maintained premises and equipment. Infection control was not appropriately managed and this presented a risk of infection to service users, staff and visitors.
We viewed safeguarding adults and whistleblowing policies at the service. We found they were not current and were last reviewed and updated in January 2013. Some staff had not received, or were overdue safeguarding adults instruction. Not all staff we spoke with were able to tell us what procedures or who they would contact outside of their organisation if they needed to report a safeguarding incident externally. Staff were able to tell us what constituted abuse and the procedures they would follow internally if they witnessed abuse. Each member of staff we spoke with told us they were confident management would deal with any reports they made effectively.
People using the service told us they were well cared for and felt safe with the staff who provided their care and support. One person told us, “Oh yes (I feel safe); this is ideal for me… I am much safer here than at home.” Another person commented, “Yes (I feel safe); the people we have got (staff) are exceptional.”
The service was not effective. We found there were gaps in the provision of training for all staff which meant people were at risk of unsafe working practice from staff who did not have the skills and knowledge to consistently meet their need. Almost 50% of the staff who provide care for people living with dementia at the home had not received training in how to provide good dementia care.
We found that regular supervision sessions were being conducted, though some staff were overdue an annual appraisal. All new staff received appropriate induction training and were supported in their professional development. However, no specialist care related training was undertaken by staff regarding specific conditions some of the people they cared for may have.
People were not always supported to make sure they had enough to eat and drink. People and their relatives were complimentary about the variety and quality of their meals and told us they enjoyed the food prepared at the home and had a choice about what they ate.
We found that there was limited understanding of Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) which meant the code of practice was not applied consistently or appropriately so some people were at risk of their human rights to make particular decisions was being denied to them.
People were supported to keep up to date with regular healthcare appointments and we were told where referrals were needed for external professionals to support people, this was done in a timely manner.
The service was not consistently caring. We saw occasions where people had been left unsupervised without interaction and contact with staff. A specific observation confirmed that some people did not receive supervision or interaction with staff.
Meetings for people using the home and their relatives were held. Advocacy information was accessible to people and their relatives. However, no surveys or questionnaires, in order to seek and act on feedback from people and their relatives in order to evaluate and improve the service were currently undertaken by the service.
We observed staff acting in a professional and friendly manner, treating people with dignity and respect. However, occasionally some staff appeared task driven and orientated, and as such, appeared to ignore people and did not take the time to listen to them. People were sat in the dining areas for long periods before they were served their meals.
We observed some good caring relationships between staff and people living in the home. Staff were seen checking on a regular basis if people needed support. Staff were seen acting in a professional and friendly manner, treating people with dignity and respect.
Care plans were not regularly reviewed and evaluated. They did not contain up to date information on people’s needs and risks associated to their care.
There was a lack of planned activities, stimulation and involvement of people in meaningful activities. The service did not currently employ an activities coordinator. This meant people who were nursed in bed, or preferred to remain in their bedrooms were at risk of social isolation.
An effective complaints process was in place. People and their relatives told us they felt able to raise any issues or concerns. Records confirmed complaints made were investigated and appropriate action was taken.
The service had a registered manager. We received positive feedback from people, their relatives and staff about the registered manager and how the service was managed and run. Staff told us they enjoyed a good relationship with the registered manager. One care assistant told us, “Any issues I have’ I will go and see the manager.” Another care assistant said, “I feel happy about going to see Deborah (registered manager) if I need to.” One relative told us, “It’s a nice home, it has a lovely feel to it,” Another relative told us a meeting had been arranged recently by the registered manager for relatives to explain the on-going building work and explaining the anticipated time for it to be completed.
Quality monitoring systems currently being used did not always ensure the service was operating safely and effectively.
Current quality assurance audits undertaken were irregular and ineffective. Monthly medicines audits conducted repeatedly identified discrepancies and shortfalls in the service’s management of medicines, yet no remedial action was taken. Monthly care plan audits conducted were not regularly undertaken and were ineffective.
The provider was not considering best practice in relation to meeting the needs of people using the service.
During our inspection we identified a breach in seven regulations. You can see what action we told the provider to take at the back of the full version of this report.