This inspection took place on 4 April 2016 and was unannounced. This meant the registered provider did not know we would be visiting. The service was previously inspected in April 2015 and was meeting the regulations we inspected. Astune Rise Nursing Home is located in purpose built premises and can accommodate up to 38 people. The home is situated in Eston, and accommodation for people using the service is provided over two floors. At the time of the inspection 28 people were using the service, some of whom were living with a dementia.
The service had a registered manager. 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.
Medicines were not always managed safely. Consistent records were not kept on how people should be supported with ‘as and when required’ medicines, the storage temperature of medicines was not effectively monitored, controlled drug stocks were not regularly checked, medicine records for the same person did not always match and some supplements lacked prescription labels. Care plans were not always consistently completed or followed.
Staffing levels had not been effectively reviewed since January 2016, and during the inspection there were periods when there was little or no staff presence in communal areas as they were busy helping people in their rooms. Staff did not have time to engage in meaningful activities with people.
The service’s recruitment process minimised the risk of unsuitable staff being employed, including seeking references and carrying our Disclosure and Barring Service (DBS) checks.
Risks to people were assessed and plans put in place to reduce the chances of them occurring. These covered risks arising from the person’s individual support needs and the physical environment of the service. The registered manager monitored accidents and took remedial action to reduce the risk of them being repeated. Safety checks of the building and equipment were regularly undertaken.
Plans were in place to safely evacuate people from the building in case of emergency and to provide a continuity of care should the service be disrupted.
Staff were familiar with safeguarding issues and the types of abuse that can occur in care settings. Staff said they were confident to raise any concerns they had, and the registered manager understood how to raise these with the relevant authorities.
Staff received regular training in the areas needed to support people effectively. Staff felt confident to request any additional or specialist training they needed, and could give examples of where this had been arrange in the past. Staff felt supported by regular supervisions and appraisals at which they could raise any issues they had.
Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves.
People were supported to maintain their health through access to food and drinks. Appropriate tools were used to monitor people’s weight and nutritional health. People spoke positively about the food on offer.
The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met.
People and their relatives spoke positively about the care they received. Throughout the inspection we saw people being treated with dignity and respect and observed caring interactions. Staff enjoyed getting to know the people they supported, though they did not think they always had time to do so.
The service supported people to access advocacy services. Procedures were in place to provide people with end of life care.
Care plans were based on people’s assessed needs and preferences, but were not always consistently or accurately completed.
There was evidence of activities provision, but people and staff did not always think people had enough to do on a regular basis. The need for an activities co-ordinator had been identified at our April 2015 but this role had still not been recruited.
There was a complaints policy in place, which was publically promoted in communal areas throughout the service. No complaints had been received since our last inspection in April 2015, but the registered manager was able to describe how they would be investigated.
Quality assurance checks were undertaken on a regular basis, though these had not always identified the issues we found at this inspection.
Staff felt supported by the registered manager, who they described as approachable and inclusive.
Feedback was sought on a regular basis from people and their relatives on how to improve the service. The most recent feedback questionnaires resulted in positive feedback.
The registered manager understood their roles and responsibilities, and felt supported by the registered provider.
We found three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to medicines management, care plans and staffing levels. You can see what action we took at the back of this report.