CQC report explained · a nursing home
What the CQC found at Nazareth House - Plymouth
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe, medicines were managed safely and staffing levels were considered sufficient. However, risk assessments for choking and diabetes were not in place at the time, and employment history gaps had not always been fully checked.
- Effective?
- Good
- Staff had relevant training and people had personalised care plans, nutritional support and access to health professionals. Some care plans did not include details of Deprivation of Liberty Safeguards applications.
- Caring?
- Outstanding
- People were strongly involved in running the home and in decisions about their care. Inspectors found a visible person-centred culture, with privacy, dignity and individual wishes at its centre.
- Responsive?
- Good
- Care was personalised, activities included group and one-to-one options, and end-of-life support was compassionate. Some communication needs were known by staff but not always recorded, and some notices were not in suitable formats.
- Well-led?
- Good
- People, relatives and staff spoke positively about the leadership, and there was a strong management team. However, audits had not identified several gaps in records, recruitment checks and communication support.
What inspectors found, February 2019
Rated Good, with Outstanding caring; inspectors found respectful, person-centred care but some records and information needed improvement.
Inspectors visited the home without notice on 7 and 10 January 2019. They spoke with people, a relative and staff, reviewed six care plans and medicine records, and checked the home's audits and other records. They also asked outside professionals for feedback.
The overall rating remained Good. Safe, Effective, Responsive and Well-led were all rated Good. Caring improved from Good to Outstanding because people were treated as individuals, involved in decisions and supported with exceptional kindness and respect.
Inspectors found enough staff, safe medicines practices, personalised care and good links with health professionals. They also found gaps in some risk assessments, care records, recruitment checks and accessible information. The manager said immediate action would be taken on several of these issues during the inspection.
Exceptional involvement
People had an active role in improving the home, including reviewing meals, attending forums and helping with staff recruitment. Their feedback led to changes such as new drinking glasses, bookcases and paving.
“People were at the heart of the service, and the service was exceptional at empowering people to express their views.” from the report
Kind and respectful care
Inspectors found staff to be exceptionally compassionate and kind. People were supported according to their wishes, including at the end of life.
“Respect for people's privacy and dignity was at the centre of the provider's values and imbedded into the culture of the service.” from the report
Personalised support
Care plans reflected people's needs and preferences. Staff used people's histories and interests to support meaningful conversations and activities.
“People were empowered to be in charge of their own care.” from the report
Good health and nutrition support
People had nutritional care plans, flexible meal choices and support from external health professionals. The home also offered exercise and mental stimulation.
“People's health and social care was co-ordinated with external professionals to help ensure they got the support they needed.” from the report
Missing risk records
needs fixingRisk assessments for choking and diabetes were missing when inspectors checked. The manager took action during the inspection and said more diabetes training would be introduced.
“Despite staff knowing how to support people, risk assessments were not in place for people who were at risk of choking or those living with diabetes.” from the report
Recruitment checks
needs fixingSome gaps in employment histories had not been fully examined, although the manager said immediate action would be taken.
“Whilst staff were recruited safely, gaps in people's employment history had not always been fully scrutinised.” from the report
Information was not always accessible
needs fixingSome meeting minutes and noticeboard information were not in formats that people with sensory or other access needs could read. Some communication needs were also not recorded in care plans.
“However, two people told us minutes of meetings, and notices on the notice boards were not always in the correct format for them to be able to read.” from the report
Public information was not fully inclusive
minorPeople and staff said everyone was welcome, whatever their religion. However, the website, statement of purpose and service user guide did not clearly explain this.
“However, despite this the provider's website, Statement of Purpose and service user guide did not make this clear.” from the report
- 01Have the missing choking and diabetes risk assessments now been completed and reviewed?
- 02How are employment history gaps checked before staff start working at the home?
- 03How will you make notices, meeting minutes and other information accessible to people with visual or hearing needs?
- 04Have details of any Deprivation of Liberty Safeguards applications been added to the relevant care plans?
- 05How have you updated the website, statement of purpose and service user guide to make clear that people of all beliefs are welcome?
This was an unannounced inspection covering all five CQC questions, and the home and the care provided were both considered. This explanation was written from the published report of 9 February 2019 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 Nazareth House - Plymouth
2 rated inspections over 2 years: the service has held its Good rating throughout.
- February 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Good
- August 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- April 2012
Registered with the Care Quality Commission on 2 April 2012.
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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9 live-in carers within about an hour of Plymouth
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 9 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.