CQC report explained · a nursing home
What the CQC found at Nairn House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Skin integrity and falls assessments were not always completed correctly. Care plans for people on short-term rehabilitation did not clearly explain how their rehabilitation should be managed.
- Effective?
- Requires improvement
- This question was not inspected during this focused inspection. Its rating carried over from the previous inspection.
- Caring?
- Good
- This question was not inspected during this focused inspection. Inspectors nevertheless observed kind, respectful and dignified interactions.
- Responsive?
- Good
- This question was not inspected during this focused inspection. Inspectors found limited interaction and stimulation for many people who stayed in their rooms or were unable to attend group activities.
- Well-led?
- Requires improvement
- Management changes had led to inconsistent oversight. Audits had not identified important problems with risk records, call bell records, emergency plans and opportunities for stimulation.
What inspectors found, February 2023
Rated Requires Improvement; inspectors found kind care and safer medicines, but risks and management oversight were not reliable.
This was an unannounced focused inspection on 31 October, 9 November and 17 November 2022. Inspectors spoke with people, relatives and staff, and checked care plans, risk assessments, medicines records, recruitment files and management records.
The home was rated Requires Improvement overall. Safe and Well-led were both rated Requires Improvement. Inspectors found that skin, falls and rehabilitation risks were not always assessed or recorded correctly. Emergency evacuation plans were also not up to date at the time of the visit.
Relatives generally described staff as kind and caring, and inspectors observed people being treated with dignity. Medicines were given safely and on time, and previous concerns about medicines had been addressed. However, the home had staffing vacancies, used agency staff, and people staying in their rooms did not always receive enough interaction or stimulation.
The home had breached Regulation 12, Safe care and treatment, and Regulation 17, Good governance. CQC asked for an action plan and said it would work with the provider and local authority to monitor progress.
Kind and respectful staff
Relatives gave positive feedback about the care. Inspectors saw staff speaking gently, listening to people and treating them with respect and dignity.
“During the inspection we observed people being treated with respect and dignity.” from the report
Medicines were safer
The previous concerns about medicines had been addressed. Staff used guidance for medicines given when needed, recorded creams and patches, and the medicines records checked gave assurance that medicines were being given as prescribed.
“At this inspection we found these issues had been addressed.” from the report
Safeguarding and legal safeguards
Staff had safeguarding training and understood how to report concerns. Inspectors found the home was working within the principles of the Mental Capacity Act.
“Staff had received training on safeguarding and were able to tell us what they would do if they suspected a person was at risk of harm or abuse.” from the report
Visiting remained open
There were no restrictions on visiting during the inspection. Relatives and friends were seen visiting throughout the inspection.
“There were no restrictions on visiting and we observed relatives and friends visiting people throughout the inspection.” from the report
Clean environment
Inspectors found the home clean and fresh. Relatives also spoke positively about its cleanliness.
“During the inspection we found the home was clean and smelled fresh.” from the report
Risk assessments were inaccurate or incomplete
seriousSkin integrity and falls assessments were not always completed correctly. Rehabilitation records did not explain clearly how staff should support people recovering from fractures.
“People's risks were not consistently assessed, monitored and mitigated to ensure the health, safety and welfare of people using the service.” from the report
Management checks missed problems
seriousAudits did not identify the problems found with risk records, emergency evacuation plans or call bell records. This meant leaders did not have reliable oversight of care quality.
“Not enough improvement had been made at this inspection and the provider was still in breach of regulation 17” from the report
Limited stimulation for people in rooms
needs fixingMany people remained in bed with little interaction or stimulation. People unable to go downstairs or get out of bed could not access the activities programme.
“A lot of people remained in bed with very little interaction or stimulation.” from the report
Staffing and management changes
needs fixingThe home had vacancies and used agency staff, so staff did not always know people well. There had also been several management changes, which staff found unsettling.
“At the time of the inspection the home was using agency staff to help fill vacancies within the staff team.” from the report
Families were not always involved in care planning
needs fixingSome relatives said they had not been involved in planning or reviewing their relative's care plan.
“At this inspection, feedback form relatives confirmed this remained a concern and they had not always been involved in planning care where this was appropriate.” from the report
- 01How are you now checking that each person's falls and skin integrity risks are assessed correctly and kept up to date?
- 02What information is now recorded for people receiving short-term rehabilitation after a fracture, and how do you check that staff follow it?
- 03How are staffing vacancies being covered, and how do you ensure agency staff know each person's needs?
- 04What has changed to provide activities or one-to-one stimulation for people who stay in their rooms or are unable to get out of bed?
- 05How are relatives now involved in creating and reviewing care plans?
This was a focused inspection of Safe and Well-led only; the other key question ratings carried over from the previous inspection. This explanation was written from the published report of 21 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2022
Not rated; this focused inspection found good infection prevention and control arrangements during the COVID-19 pandemic.
Inspectors visited the home on 23 March 2021. This was an announced, targeted inspection looking only at infection prevention and control measures during the COVID-19 pandemic.
Inspectors were assured that the home was managing visitors, admissions, PPE, testing, social distancing, hygiene and outbreaks appropriately. Staff were seen following PPE and social distancing guidance, and the home had designated areas for putting on and removing PPE.
The home was sharing health observations with healthcare professionals before appointments and using video consultations where possible. At the time, family visits were paused because of a recent outbreak, with allocated appointments planned to reduce the number of visitors.
The service was inspected but not rated. This does not mean it was rated Good or Outstanding. It means this inspection did not give a standard overall rating.
Infection control
Inspectors were assured that the home had good infection prevention and control arrangements.
“We were assured that this service met good infection prevention and control guidelines.” from the report
PPE and staff practice
Staff had training in PPE and infection control. Inspectors saw staff following PPE and social distancing guidance.
“Staff had been trained in the use of PPE and infection control processes.” from the report
Safe admissions
New residents were tested and isolated when they first arrived. Families were kept informed during this period.
“New residents took a test and then had a period of isolation when first arriving at the home.” from the report
Healthcare appointments
The home shared information about people's health before appointments and used video consultations where possible.
“The provider was sharing observations about people's health with healthcare professionals in advance of appointments.” from the report
Inspectors raised no specific concerns in this report.
- 01What are the current arrangements for family visits, and how would visits be managed during an outbreak?
- 02How are new residents tested and supported during any period of isolation?
- 03How are staff trained and checked on the safe use of PPE and infection control?
- 04How are residents and staff tested if there is an infection outbreak?
- 05How does the home keep families informed about infection risks and changes to visiting arrangements?
This was a targeted inspection of infection prevention and control only; the service was inspected but not rated and the report does not assess the other areas of care. This explanation was written from the published report of 23 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Nairn House Care Home
4 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- February 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2022Inspected but not ratedSafe: Inspected but not rated
- March 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- September 2017Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- June 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 12 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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