CQC report explained · a nursing home
What the CQC found at Ruislip Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, October 2022
Rated Requires Improvement; inspectors found safe staffing and medicines management, but risks and quality checks were not consistently managed.
This was an unannounced focused inspection on 24 August 2022. Inspectors looked at Safe and Well-led. They spoke with people, staff and relatives, observed care and checked care, medicines, recruitment and management records.
The home had enough staff, followed safe recruitment procedures and managed medicines safely. People and relatives said people felt safe. Staff understood safeguarding procedures and the service worked within the Mental Capacity Act.
However, risk assessments and care plans were not always updated after falls or other incidents. Some cleaning products and paint were accessible, and a stair gate and loft door were not secure. The home’s checks had not found these problems, so inspectors rated Safe and Well-led Requires Improvement.
This was a focused inspection, so the other question ratings were carried forward from the previous inspection. The overall rating remained Requires Improvement. The provider was still in breach of regulations about safe care and treatment and good governance.
Enough staff
Inspectors found enough staff to meet people’s needs, and people and relatives agreed that staff were available.
“We observed there were enough staff to meet people's support needs on the day of the inspection.” from the report
Medicines
Medicines records were completed properly, staff were trained and checks were in place.
“Medicines were managed safely in line with national guidance and the provider had a medicines policy and procedure in place.” from the report
Safeguarding
Staff knew how to recognise and report possible abuse, and the provider had systems for investigating concerns.
“Staff had received safeguarding adults training, could give examples of signs of abuse and knew how to report concerns” from the report
Supportive culture
People and relatives said managers were approachable and listened to concerns. Staff said they received support and training.
“People and their relatives felt they could raise concerns and consistently said the registered manager was approachable and listened.” from the report
Risk plans after incidents
seriousRisk assessments and care plans were not always updated after falls or other incidents. Preventative actions were often generic rather than tailored to the person.
“Systems had not been effective in assessing, monitoring and mitigating risks to the health, safety and welfare of people using the service” from the report
Unsafe access and storage
seriousA stair gate was open, a loft door was not securely locked, and cleaning products and paint were accessible. The provider sent photographs after the inspection showing that some areas had been locked.
“In the garden we saw open sheds with cleaning products and paint in them.” from the report
Weak quality checks
seriousAudits did not identify several safety problems or analyse patterns in incidents. This meant managers did not have reliable oversight of improvements.
“The provider's quality assurance systems such as audits were not being operated effectively.” from the report
Infection control and furniture
needs fixingSome communal armchairs were stained, worn and torn. Inspectors recommended that the provider review current infection prevention and control guidance and update practice.
“However, armchairs in the communal areas were stained.” from the report
- 01How are you making sure each person’s risk assessment and care plan is updated after a fall or other incident?
- 02What specific preventative measures are now in place for people who have fallen or become distressed?
- 03How do you check that cleaning products, paint, stairs and other environmental risks are securely managed?
- 04What changes have you made to your audits so they identify patterns and confirm that care plans have been updated?
- 05What action have you taken about the stained, worn or torn communal chairs and infection prevention practice?
This was an unannounced focused inspection of Safe and Well-led; the other question ratings were carried forward from the previous inspection. This explanation was written from the published report of 14 October 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.
What inspectors found, August 2021
Rated Requires Improvement; inspectors found kind, responsive care, but safety checks and quality monitoring were not reliable enough.
This was an unannounced, focused inspection on 20 May 2021. Inspectors spoke with people, staff and relatives, and checked care records, medicines records, staff files and management records. They also checked infection prevention and control.
The home was rated Requires Improvement overall. Safe and Well-led were rated Requires Improvement. Responsive was rated Good. Effective and Caring were not rated during this focused inspection.
People said they felt safe and were supported by staff who knew them well. Medicines were managed safely, care was personalised, and activities were available. However, inspectors found environmental safety problems and quality checks that had not identified them. The home corrected the environmental issues during the visit and later changed its visiting arrangements to follow government guidance.
Safe medicines support
Inspectors found that medicines were stored, recorded and administered safely. Staff were trained and their competence had been checked.
“Medicines were stored correctly, and people were supported to take their medicines as prescribed by staff who had been trained and competency assessed.” from the report
Personalised care
People and relatives were involved in care planning and reviews. Plans included people's preferences, communication needs, cultural needs and end of life wishes.
“People and their relatives were involved in their care planning and staff delivered care in line with people's preferences.” from the report
Activities and social contact
The home had an activities coordinator and a daily programme. Staff also spent one-to-one time with people who stayed in their rooms.
“We saw a programme of activities displayed in the home.” from the report
Environmental safety risks
seriousInspectors found a water outlet that was hot enough to create a scalding risk. They also found missing emergency pull cords and a window restrictor that could be disengaged. The home took action during the inspection.
“While touring the premises we identified at least one water outlet where the water temperature was higher than 44 degrees centigrade which could pose a risk of scalding to people.” from the report
Weak quality monitoring
seriousThe home's audits and checks had not identified several safety problems or the failure to follow visiting guidance. This led to a breach of the good governance regulation.
“Failing to operate effective systems to monitor and improve the quality of the service and mitigate risk was a breach of Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Visiting arrangements
needs fixingAt the inspection, named visitors were not being allowed to visit people in their rooms, which did not follow government guidance. The provider changed this after the inspection.
“On the day of our visit we found that the service was not following the COVID-19 government visiting guidance by not allowing indoor visiting by named visitors to take place in people's rooms.” from the report
Limited evidence of residents' views
minorResident meetings took place, but records did not show clearly how people's suggestions were considered or what actions followed.
“There was a lack of evidence to demonstrate the contribution and involvement of people's voices during those meetings.” from the report
- 01What evidence can you show that the scalding risk, missing pull cords and window restrictor problem were fully fixed and are now checked regularly?
- 02What changes have you made to the quality audits since the inspection, and how do you know they identify risks promptly?
- 03How are named visitors currently allowed to visit people in their rooms, and how is this kept in line with current guidance?
- 04How do you record residents' suggestions from meetings and show what action was taken?
- 05What progress has been made since the previous Good rating, when Safe and Well-led were rated Requires Improvement?
This was a planned focused inspection that covered Safe, Responsive and Well-led, including infection prevention and control; Effective and Caring were not rated and the other ratings did not carry over because they were not assessed in this report. This explanation was written from the published report of 27 August 2021 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 Ruislip Nursing Home
5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- October 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- March 2020Goodstayed GoodSafe: GoodResponsive: GoodWell-led: Good
- August 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015GoodSafe: GoodEffective: OutstandingCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Registered with the Care Quality Commission on 8 July 2014.
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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