CQC report explained · a nursing home
What the CQC found at Signature House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- The inspection focused on whether people were protected from harm at night. Staff understood safeguarding and the use of soft holds, and inspectors found no evidence that people were at risk from the concern examined.
- Effective?
- Good
- This area was not assessed during the targeted inspection.
- Caring?
- Good
- This area was not assessed during the targeted inspection, although inspectors observed relaxed interactions between people and staff.
- Responsive?
- Good
- This area was not assessed during the targeted inspection.
- Well-led?
- Good
- The provider had responded to the safeguarding concern, supported staff and used audits and a development plan to monitor improvements.
What inspectors found, June 2023
Rated Good overall; the targeted night-time inspection found people appeared safe, but Safe and Well-led were not re-rated.
Inspectors made an unannounced night visit on 13 June 2023. They spoke with night staff, the manager and the provider, observed three people, and reviewed training and care records.
The inspection was prompted by concerns about people being protected from harm at night after a safeguarding incident. Inspectors found no evidence that people were at risk of harm from this concern. People appeared relaxed with staff, and staff understood safeguarding responsibilities.
The provider had responded to the concern, supported staff and used audits to monitor improvements. Infection prevention arrangements were also assessed and gave inspectors assurance.
The overall rating remained Good from the previous inspection. This was a targeted inspection, so Safe and Well-led were inspected but not rated, and the other three areas were not assessed.
Calm night-time care
The people inspectors saw appeared relaxed and comfortable with staff. They sought staff out for reassurance.
“They were visibly relaxed and comfortable with the staff supporting them and sought the staff out for reassurance.” from the report
Safeguarding knowledge
Staff had completed safeguarding training and could explain how they would respond to concerns about someone's safety or wellbeing.
“They were able to describe the actions they would take if they were concerned about a person's safety or well-being.” from the report
Response to the incident
The provider acted after the safeguarding concern, was open with relatives and professionals, and supported the staff team.
“The provider responded robustly following the safeguarding concern and had been transparent with relatives and professionals.” from the report
Quality monitoring
The manager and provider used audits covering night checks, whistleblowing and restraint. These fed into a development plan.
“These tools were effective in identifying areas for improvement and fed into a service development plan where improvement was monitored.” from the report
Infection control
Inspectors were assured that the home had arrangements to prevent and manage infections, including safe use of protective equipment.
“We were assured that the provider was using PPE effectively and safely.” from the report
Manager registration not complete
minorThere was no registered manager in post at the time of the visit. The manager had started the registration process.
“At the time of our inspection there was not a registered manager in post.” from the report
Reporting still being improved
needs fixingInspectors noted that work to improve reporting was still under way when they visited.
“There was ongoing work to improve reporting when we visited.” from the report
- 01What changes were made after the safeguarding incident about people's safety at night?
- 02How are night checks now completed, recorded and reviewed?
- 03Has the manager completed registration, and if not, what is the current position?
- 04How are soft holds decided, kept to the minimum time and recorded?
- 05What reporting improvements were still in progress at the inspection, and have they now been completed?
This was an unannounced targeted inspection focused on a concern about night-time care, with infection control also reviewed; Safe and Well-led were inspected but not rated, and the other key questions were not assessed. This explanation was written from the published report of 24 June 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, October 2022
Signature House was rated Good; inspectors found people were safe and well cared for, but meaningful activities and some records needed attention.
This was an unannounced, focused inspection on 30 August and 2 September 2022. Inspectors looked only at Safe and Well-led, following concerns about staffing and risk management. They spoke with people, relatives, staff and health professionals, and checked care records, recruitment files, audits and safety checks.
The home was rated Good for Safe and Well-led. People said they felt safe, staff understood their risks, medicines were managed safely and infection control arrangements were effective. There were enough staff for care needs, although recruitment was continuing for activity roles.
Inspectors found the registered manager visible and the provider responsive when issues were raised. They found no evidence that the concerns that prompted the inspection had put people at risk of harm. The overall Good rating stayed the same as at the previous inspection, with the other three question ratings carried forward from 2019.
People felt safe
People and relatives told inspectors they felt safe. Staff understood people's risks and the measures needed to reduce them.
“People said they felt safe and staff understood the risks they faced.” from the report
Safe medicines and infection control
Inspectors found medicines were given, stored and checked safely. They were also assured that infection prevention arrangements were effective.
“We were assured that the provider was responding effectively to risks and signs of infection.” from the report
Kind and respectful staff
Staff were described as attentive, kind and friendly. People’s lifestyles and beliefs were respected, including their own routines.
“Staff were attentive, kind and friendly.” from the report
Visible management
The registered manager spent time in the home, attended daily handovers and sought people's views. Audits were used to identify and monitor improvements.
“The registered manager was visible in the home.” from the report
Limited meaningful activity
needs fixingThe home was recruiting for activity roles, and staff and relatives said vacancies affected people's access to meaningful activities.
“The registered manager and provider explained they were currently recruiting to fill roles to support people with activities.” from the report
Gaps in recruitment records
minorRecruitment checks were being carried out, but inspectors found some gaps in how those checks were recorded. The senior team addressed this immediately.
“We identified some gaps in the recording of these checks.” from the report
Broken equipment and isolation risk
seriousInspectors found one case where broken equipment had put a person at risk of isolation and the issue had not been reported to the manager. Alternative arrangements were made and a safeguarding alert was raised immediately.
“We identified one situation where a person had been at risk of isolation due to broken equipment and this had not been reported to the registered manager.” from the report
Visiting arrangements
minorSome relatives felt restricted by the booking system. The management team said it would review the system and make sure families knew they could visit at convenient times.
“We received some feedback from relatives who felt restricted by the booking system” from the report
- 01How many activity staff are now in post, and what meaningful activities are currently available?
- 02How do you make sure all recruitment checks are completed and recorded before staff start work?
- 03What changes have been made to the visiting booking system, and can families visit at convenient times?
- 04How are broken equipment and possible risks of isolation reported, investigated and followed up?
- 05How are safeguarding concerns shared with families and reviewed after an incident?
This was a focused inspection of Safe and Well-led only; the Effective, Caring and Responsive ratings were carried forward from the previous inspection published on 2 August 2019. This explanation was written from the published report of 11 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.
Every inspection of Signature House
5 rated inspections over 8 years: the service has improved, from Requires improvement to Good.
- June 2023Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2022Goodstayed Good
- August 2019Goodstayed GoodSafe: GoodWell-led: Good
- October 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2013
Report published without a new overall rating.
- November 2012
Registered with the Care Quality Commission on 30 November 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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