Table of Content
We found that a range of internal audits were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service as a result of internal or external audits was identified and followed up. Staff had regular supervision and annual appraisals were being completed. This meant that staff had the right knowledge to meet people's individual needs. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. People could not be sure that they would receive care from staff who had the knowledge and skills to carry out their roles and responsibilities.
We found a similar lapse at a previous inspection after which we were told that new coded locks would be fitted to storage rooms, but they hadn’t been fitted. We saw a door to a stairwell being held ajar by equipment in an area where people using the service were not supervised. Staff acted after we had brought these matters to their attention. We checked to see that the equipment provided for the benefit of people using the service was fit for purpose and appropriately maintained.
Report Date: 2016-07-16
After we spoke with staff it became clear that most staff we spoke with felt they had not been trained to deal effectively with the types of situation we witnessed. The provider had taken action to reduce the instances of people’s privacy being disturbed by other people walking into their rooms. People with special dietary requirements were supported with their specific needs. People were supported to access health services when they needed to. We saw several records that showed the service engaged with a variety of specialist health services to support people with their health needs.
The management also ensured people's concerns were listened to and acted upon in a timely manner. We spoke with six people who used the service, one visitor to the service, eight members of staff. We also reviewed eight care records, five daily monitoring records, four staff files and four staff training records.
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– the service is performing well and meeting our expectations. Our infection prevention and control inspections look at how well people using a service are kept safe from the spread of infections. Staff told us that people who were at risk of malnutrition had food and fluid charts completed for them on a daily basis. We reviewed some of these charts and found there were gaps in the recording of people’s food and fluid intake.
The `hotel services’ manager who managed the kitchen, cleaning and laundry services was an integral part of the management team. Staff at all levels understood the relevance of and acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when they supported people. People were supported by staff with the right skills and experience. A new organisational structure at the service meant that staff had easier direct access to senior staff for support. They also said they could not be sure that all staff were fully trained to care for dementia patients and there was no evidence they had received first aid or nutrition training either. There were no formal arrangements in place to ensure that staff were properly supported and staff had not received all the regular training that they should have had to support them in their roles.
Services offered at Charnwood Hall Nursing Home
People’s mental capacity to consent to their care had been assessed where there was a reasonable belief that they may not be able to make a specific decision. Live-in care is when a fully trained carer lives in the home of the person needing care, allowing them to remain in their own home, maintain independence, and get the dedicated care support required. – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.
The provider had effective procedures for monitoring the quality of the service which included seeking people’s views about their experience of the service. The registered manager took action to make improvements in areas identified as requiring improvement. The breach occurred because some staff were not supported through training and supervision to effectively support people who at times presented behaviour that challenged others. At this inspection we found that the provider had made improvements to the quality of training and support. People who presented behaviour that challenged others were better supported although we saw an isolated example were a non-permanent care worker had not effectively supported a person. We were told that non-permanent staff had not received training at the time of the inspection, but training was scheduled.
The service had staff who acted as `dignity leads' who promoted dignity-in-care amongst staff. The registered manager and senior care workers observed care staff to ensure they treated people with dignity and respect. We observed that staff demonstrated care and compassion in the way they supported people. A reason for this was that the provider had improved the quality of the training and support staff received about how to support people in a caring way.
We found the provider ensured all such equipment was regularly serviced and maintained in accordance with the manufactures recommendations. People using the service and relatives told us they thought the care and support delivered was supportive and met people's care needs. They also told us that care was planned and delivered with their involvement and consent. We found the environment to be busy but the staff were in control and did not appear to be overwhelmed whilst carrying out their duties. During this inspection we found that people did not always have their care delivered as planned. Whilst some improvements had been made, the lack of appropriate planning and delivery did not ensure people’s safety and welfare.
Yes, Charnwood Oaks Nursing Home provides care designed to meet the challenges faced by people living with dementia. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you. We found one instance of a care plan that had not been updated to reflect a person's needs, but that was addressed and rectified after we brought it to the registered manager's attention. The service had two activities coordinators who arranged activities for groups of people and supported people with individual interests and hobbies.
We saw lapses by a very small number of staff which we brought to the provider’s attention and they told us action would be taken to address this through training and closer supervision. The service had not always responded promptly when people had experienced unplanned weight loss, for example by involving dieticians in people’s care. A safeguarding investigation by the local authority found that a person’s health had not been adequately monitored and that this was a contributing factor to a serious incident that occurred.
We spoke with seven people who used the service, one visitor to the service, seven members of staff and two visiting health professionals. We also reviewed six care records, six daily monitoring records, five staff files and four staff training records. Some people who used the service at times displayed challenging behaviour. We heard people repeatedly asking the same questions, often in a very loud tone, over prolonged periods of time. A relative described the situation as "pandemonium." The registered manager described it as "chaotic".
Staff knew how to identify and report concerns about people’s safety. The service had a history of safeguarding investigations most of which were connected to incidents between people using the service. The provider had taken action to reduce the risk of such incidents occurring, but a serious incident had taken place in May 2014 which might have been avoided if staff had been effectively deployed. We found lapses to attention, for example not ensuring that storage rooms were kept locked.
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