This inspection took place on 15 and 16 August 2018 and was unannounced. Inglefield Nursing & Residential Home is a ‘care home’ and is registered to accommodate up to 49 people who require nursing or personal care. At the time of the inspection 39 people were accommodated at the home. People in care homes receive accommodation and personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection. This home provides a service to older people some living with dementia or mental health needs.
The home 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.
At our last inspection, in July 2017, we identified breaches of Regulations 10 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always treated with consideration and quality assurance systems were not always effective. At this inspection, we found action had been taken and there were no longer any breaches of regulation. However, further improvement was still required.
Although new quality assurance procedures had recently been put in place, these needed further development and time to become embedded in practice and bring about the necessary improvement.
People had mixed views about the adequacy of staffing levels. Although we found these were adequate to meet people’s essential needs, we could not be assured that people’s call bells were always responded to in a timely way.
Recruitment procedures were not followed consistently, so the provider was unable to confirm that all staff employed were suitable.
Medicines were generally managed safely, although medication administration records had not been completed fully, some medicines could not be accounted for and there was a lack of information about when and how ‘as required’ medicines should be given.
People’s rights and freedom were not always protected. Although staff said they acted in people’s best interests, they did not always document decisions they had taken on behalf of people. There was no process to ensure applications were made to renew legal restrictions imposed on people’s freedom and staff did not know which people were subject to such restrictions.
People told us staff were competent and provided effective care; however, some staff training was out of date. Although nurses usually followed best practice guidance, we found they did not take a consistent, evidence-based approach to supporting people with diabetes.
Staff demonstrated a good awareness of the individual support needs of people living at the home. However, people’s care plans did not always support staff to deliver care in a personalised way; they lacked information about the support people needed when they became agitated and people’s end of life wishes and preferences had not been recorded.
Staff were appropriately supported in their role through one-to-one sessions of supervision, staff meetings and observations of their practice. Although some staff appraisals were overdue, plans were in place to complete these.
There was an open and transparent culture where visitors were welcomed. However, written information had not been provided to the family of a person who came to harm.
Individual and environmental risks to people were usually managed effectively and there were systems in place to protect people from the risk of infection.
People told us they felt safe living at Inglefield and staff understood their responsibilities to safeguard people from harm.
People's nutrition and hydration needs were met and most people were satisfied with the quality of their meals.
Some adaptations had been made to the environment to make it supportive of the people who lived there and further enhancements were planned.
People were supported to access other healthcare services and information was made available when they were admitted to hospital, to help ensure the continuity of their care.
People consistently told us they were treated in a kind and compassionate way and we observed positive interactions between staff and people. Staff encouraged people to be as independent as possible and involved them in discussions about their care.
People had access to a range of activities based on their individual interests, including on a one-to-one basis.
There was an accessible complaints procedure in place. People told us they felt able to raise concerns and were consulted in a range of ways about the way the service was run.
Staff communicated effectively between themselves. They told us they were happy and motivated in their work and demonstrated a willingness to learn from mistakes.