About the service:

Littleover Nursing Home accommodates 40 people, providing long-term, respite care and palliative care. The home is over two floors, with bedrooms on both floors. There were 30 people living at the service at the time of our inspection visit. Littleover Nursing Home is situated in a residential area in the Littleover area of Derby.

People’s experience of using this service:

We found some staff did not always use dignified terminology when describing people who required assistance at mealtimes. This did not ensure people were always treated in a dignified manner by staff.

Recruitment procedures did not ensure that all the required pre-employment checks were in place prior to new staff commencing employment. The registered manager explained this had been identified by an internal audit and they were working through recruitment files to ensure all the required information was in place.

People told us they felt safe with the care provided by staff. People were protected from the risk of harm by staff who understood their responsibilities to safeguard people. Risks were identified and assessed. Staff we spoke with understood their responsibility in protecting people from the risk of harm. Staff told us they had received training and an induction that had helped them to understand and support people.

The deployment and planning of staff had improved since the last inspection visit. There were sufficient staff to meet people’s needs who were currently receiving support from the service. People were supported to take their medicines in a safe way.

Staff had received training in infection control and were provided with the necessary personal protective equipment to use when carrying out care and support tasks. The environment was clean and tidy.

People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required. People were supported with their dietary needs. Refreshments were available to people throughout the day

People and their representatives were involved in their care to enable them to receive support in their preferred way. People were supported to take part in activities of their choice and were supported to access local community facilities to enhance their well-being.

The provider’s complaints policy and procedure was accessible to people who used the service and their representatives. People knew how to make a complaint and there had been improvements made to recording and responding to complaints. Systems were in place monitor the quality of the service to enable the registered manager to drive improvement.

Rating at last inspection:

At our last inspection, the service was rated "requires improvement". Our last report was published on 13 April 2018.

Why we inspected:

This was a planned inspection based on the rating of the last inspection. At this inspection we saw improvements had been made and the service was rated ‘Good.’

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this service on 19 December 2017 and the inspection was unannounced. At our previous inspection on 16 February 2016, the service was meeting the regulations that we checked and received an overall rating of Good. At this inspection we found that the service had deteriorated under safe, responsive and well-led and has been rated as Requires Improvement. This is the first time the service has received an overall rating of Requires Improvement.

Littleover Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Littleover Nursing Home accommodates 40 people, providing long-term, respite care and palliative care. The home is over two floors, with bedrooms on both floors. There were 34 people living at the service at the time of our inspection visit. Littleover Nursing Home is situated in a residential area in the Littleover area of Derby.

A registered manger was in place. 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.’

People who were supported with their medicines were not always protected against the risks associated with poor medicines management, as safe systems were not always in place to manage their medicines.

We found that pressure relieving mattresses for two people were set at incorrect settings. This would increase people's risk of acquiring a pressure ulcer.

The deployment of staff did not always ensure people’s needs were met in a timely manner. For example, our observations showed that on a few occasions the communal areas were left unattended by staff.

There were processes in place for people to raise any complaints and express their views and opinions about the service provided. However, complaints had not always been resolved to the complainant's satisfaction.

Systems to monitor the quality of the service were not effective in ensuring where improvements were required, these were acted upon.

People and relatives we spoke with felt people were safe at Littleover Nursing Home. Staff had an understanding of potential abuse and their responsibility in keeping people safe.

The provider's arrangements for staff recruitment were thorough, ensuring suitable people were employed. Staff had training to support people's individual needs. Staff told us they enjoyed working at the service and felt supported by the management at the home.

People were supported to have maximum choice and control of their lives. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005.

People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required. People were supported with their dietary needs.

People were cared for by staff who were kind and caring. Staff respected people’s privacy and dignity. People were supported with their independence by staff and had control over their choices. Visitors were welcomed at any time.

People were protected by the provider's infection control procedures, which helped to maintain a clean and hygienic environment.

The inspection visit took place on 16 February 2016 and was unannounced. This meant the staff and provider did not know we would be visiting.

Littleover Nursing Home provides nursing and residential care for up to 40 people. At the time of our inspection there were 37 people in residence.

The service had a registered manager in place at the time of our inspection. 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.

Staff responded to people’s needs quickly. People had been involved in planning their care and the support they required from the service. Their needs had been identified, assessed and reviewed on a regular basis.

Staff showed patience, they had time for people and treated them with respect. People received care in a dignified manner that protected their privacy. Staff encouraged people to be as independent as possible and offered them choices in their day to day living.

People were protected from the risk of abuse as staff could demonstrate they understood what constituted potential abuse or poor care. Staff knew how to report any concerns and they felt confident the provider would address these appropriately.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Mental Capacity Assessments were carried out where key decisions were required and the principles of the MCA had been adhered to. Applications had been made to the supervisory body for consideration under DoLS.

Staff had been employed following appropriate recruitment checks that ensured they were safe to work in health and social care. We saw that staff who had been recruited had the right values and skills to work with people who used the service. We saw there were enough staff required to ensure all people’s needs were met and helped to keep them safe.

The registered manager and registered provider continuously assessed and monitored the quality of the service and action plans were in place where areas of improvement had been identified. They obtained feedback from people who used the service and their relatives. Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were managed well.

Littleover Nursing Home provided nursing care for up to 40 people. There were 36 people using the service on the day of our visit. Two inspectors carried out this inspection. We spoke with seven people who used the service, five staff and three relatives. We also spoke with the registered manager and deputy manager who were in daily charge of the service. During our inspection we wanted to understand people’s experience of the service. We did this by spending time sitting and talking with people. We used a Short Observational Framework Inspection (SOFI). SOFI allowed us to observe the care experiences of people who had communication difficulties. SOFI was used in the communal setting of the lounge. We observed the way staff responded to people. We also read care records about their care and spoke with staff about people’s needs.

Our inspection was unannounced and in response to information of concern. This included staffing levels and the staff’s ability to meet people’s needs safely. We found whilst staffing levels were assessed, the provider may wish to note the importance of reviewing how staff are deployed so that people can experience care that will always meet their individual needs. We found that by not having a regular informal feedback process, people using the service were not able to express their concerns.

The evidence we collected helped us to answer five key questions.

Below is a summary of what we found.

Is the service safe?

We looked at the suitability of the environment to ensure people lived in a home where the décor and environmental standards were appropriate. We found the home was mostly clean although we found the upper floor sluice room to be in need of infection was reduced.

Procedures for dealing with emergencies were in place and staff were able to describe how they would act in the event of an emergency.

The provider used a staffing tool to help them to decide the staffing levels needed for the home. We found that due to the deployment of staff there were times when people were left unsupervised. This could affect their safety and well being.

We found safe recruitment practices were in place to protect people using the service. This was because the provider had safe systems in place and senior staff followed them.

Is the service effective?

We spoke with three people who told us they were treated well. They told us when they needed to see a doctor this was arranged quickly for them. Regular monitoring of people’s healthcare was in place to ensure that any changes were discussed. Records showed that people received additional interventions from chiropody services, opticians and community based specialist nurses, as required.

People’s records were held electronically and updated by staff. This was to ensure people’s day to day health needs were met. We saw people were provided with an individual care plan which set out their assessed care needs. We saw people and their families were involved in their care planning.

Is the service caring?

People we spoke with told us they were happy with the care at the home and they said staff were good with them. We observed that staff made regular visits to people who received care in their bedrooms. We found they were provided with the care they needed.

One person told us “My care is good.”

We spoke with staff who were able to describe the care they provided for each of the people we discussed.

Is the service responsive?

During the inspection we saw staff responding to people as part of their end of life care. One visitor explained how staff responded to their relative’s needs, gave advice and dealt with situations. However another family member told us they did not always find staff to be responsive. This was because they found their relative had to wait for their care. This meant people received different experiences.

A complaints procedure was available for people to use. We saw complaints were investigated and recorded with actions taken where necessary.

Is the service well led?

We found that the provider’s quality assurance procedures were not always consistent. People who used the service and their relatives were not routinely asked for their opinions. Meetings for staff were not always well attended. This meant it was difficult to monitor how feedback on the delivery of the service was met.

People using the service and their relatives told us that they were happy with the care and services provided at Littleover Nursing Home. Comments included, “I like it here, it’s kept very clean, the food is good and the staff are all very nice.”

We observed care practices throughout the day and saw that staff were responsive to people’s needs and wishes. People using the service confirmed that staff were friendly and attentive to their needs. Comments included, “The staff are very friendly and polite, I think this is a very good home.”

Information in assessments and care records ensured people could be supported appropriately according to their needs and preferences.

Information was available to the cook regarding people’s dietary needs and preferences. We saw that staff were responsive to people’s needs and wishes, for example we observed staff offering choices at the lunch time meal and supporting people with their meal in a caring and patient manner. People told us they enjoyed the meals and confirmed there was enough variety in the choices available.

Staff spoken with told us they enjoyed their job and we saw a good rapport between the staff and the people using the service and their visitors.

Although training was provided to the staff team not all staff had received mandatory updates as required to ensure staff worked to current guidelines.

People who used the service we spoke with were not able to share their views about the service. We used the Short Observational Framework for Inspection (SOFI). This tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences.

During the lunchtime we used the SOFI tool to help us see what people's experiences at mealtimes were. We spent one hour watching at lunchtime and found that people had positive experiences. The staff supporting them knew what support they needed and they respected their wishes if they wanted to manage on their own.

We saw that care plans were person centred including specific personal and medical needs were recorded as well as specific risk assessments. We observed a person using the service display some signs of discomfort during lunch. This was very quickly noticed by staff who provided appropriate care. This shows that staff deliver care and treatment so that people are safe and their needs are met.

The provider had clear procedures in place to ensure that medications were managed effectively and used a local pharmacy to ensure good continuity.

The provider has effective recruitment and selection procedures in place and carries out relevant checks when they employ staff.

We saw that personal records, including medical records, were accurate, fit for purpose, held securely and remained confidential.

We carried out this responsive inspection because we had concerns that this service had not been visited since 1 May 2008.

During our visit six people using the service were taking part in armchair exercises. The activity was being conducted by the activities co-ordinator and everybody appeared to be enjoying taking part.

The people we spoke to told us that they were happy living in the home, “They really look after me. All the staff treat me well. There is a party tomorrow and I can spend time in my room if I want to.”

We asked people about the nursing care that they received and we were told “The nurses here are good, they look after me well. I’ve got a few ongoing health problems but the nurses are looking after me.”