Archived: Nower House

Updated 9 February 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors.

Service and service type

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

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 10 people who used the service and one relative about their experience of the care provided. We also spent time observing staff interactions with people. We spoke with nine members of staff including the registered manager, clinical lead, senior care workers, care workers and the chef. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We also sought an urgent update following the inspection to ensure the provider had made immediate changes to keep people safe. We looked at training data and quality assurance records. We spoke with one professional who regularly visit the service. We also spoke with four relatives on the telephone to gain their feedback about their experience of the care provided.

Updated 9 February 2022

About the service

Nower House is a residential care home providing personal care to up to 50 people aged 65 and over, some of whom live with dementia. At the time of the inspection they were supporting 35 people. The care home is one adapted building and at the time of the inspection people were only residing on one floor, the ground floor. The lower ground floor was only being used for the kitchen and domestic purposes.

People’s experience of using this service and what we found

People were not always kept safe from risks. Risk assessments were not always completed and care plans did not always adequately detail risks.

The home did not have enough staff to meet people’s needs. We saw staff did not have time to support in a personalised way and people and staff told us there were not enough staff working at the home. This had impacted the ability of staff to meet basic bathing choices of people, such as more than one shower a week.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The environment of the home did not always meet the needs of the people living there. For example, it was not a dementia friendly environment.

There was not always full oversight of the quality and safety of the home. There were some essential audits not being completed, these included quality assurance audits. This meant that shortfalls in practices were not being identified and action could not be taken to drive improvement in the home.

For the last two inspections the provider had failed to make adequate improvements to ensure people were kept safe and the home was effectively monitored. As a result, in certain areas the home had deteriorated.

People told us they felt safe and staff were caring towards them. However, the level of care people received had been directly impacted by the shortage of staff. Staff were knowledgeable in safeguarding procedures they needed to follow.

People told us they felt comfortable to raise complaints and they felt they could talk to the registered manager.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 03 August 2021) and there were multiple breaches of regulation. The provider had a condition placed on their registration to complete monthly audits specific to the concerns found at the last inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about training and staffing. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.