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We are carrying out checks at Stretton Nursing Home using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Inadequate

Updated 22 February 2018

The inspection took place on 19, 21, 23 and 24 January 2018 and was unannounced.

Stretton Nursing Home is located in Hereford, Herefordshire and is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation and nursing care for up to 50 older people. On the day of our inspection, there were 41 people living at the home. This included a number of people who lived with dementia.

At our previous inspection in October 2017, we identified breaches of regulation. These were in relation to staffing, governance, protecting service users from abuse or improper treatment, and notification of incidents. The provider was asked to complete an action plan to set out how they would comply with the regulations.

At this inspection, we found the provider remained in breach of these regulations. We also identified further breaches of regulation. These were in relation to person-centred care; need for consent; safe care and treatment; and meeting nutrition and hydration needs.

The overall rating for this service is “Inadequate” and the service is therefore in “special measures”. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was a registered manager at this home, but they had been absent from work for a period of four months. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staffing levels had not been determined according to the assessed needs of people living at the home, which meant there were not enough staff to care for people safely. The lack of staff had an adverse effect on people's personal care needs, hydration and emotional wellbeing.

Systems and processes in place to protect people from abuse were not always followed. Action had not been taken by the provider to address failures to report alleged abuse or harm.

People did not always receive their medicines in accordance with updated instructions from the prescriber. Medicines were not always signed for, which made it difficult to tell whether prescribed creams or liquid medicine had been administered correctly.

Risk assessments were not in place for specific health conditions and infection control. The lack of clear guidance about how to keep people safe placed people at risk of harm

Decisions made on behalf of people who lacked capacity were not always the least restrictive, nor had they been made in accordance with the Mental Capacity Act.

People did not always have enough to drink, even when they expressed symptoms of dehydration. Staff did not always have time to spend with people to encourage them to eat, which placed people at risk of malnutrition.

Staff did not receive sufficient training and supervision to enable them to be effective in their roles. New staff did not have a structured induction before caring for people.

Due to the time constraints staff were under, people were sometimes placed in undignified situations and did not have their personal and continence care needs met in a timely way. People's choices about how they wanted to be cared for were not always taken into account. Staff were unable to spend quality time with people.

People's call bells did not always work, nor were they always kept within people's reach. This meant people could not always alert staff, when needed. People's requests for help were not always responded to.

People's care plans were not reflective of their current healthcare and wellbeing needs, and they sometimes contained incorrect information which then affected the care and treatment people received.

Key information about the service, such as service user guides and complaints procedures, were not in accessible formats for people with physical impairments and disabilities.

There was a lack of clinical and general management of the home, which affected the quality and safety of care provided. Quality assurance measures were not effective in identifying risks to people's health and wellbeing, nor in identifying shortfalls in the service. Where care records were completed, these were not audited or reviewed.

Morale was low amongst the staff team, and they did not feel valued in their roles. Staff consistently expressed concern about unsafe working practices within the home and the pressures they were under.

The provider told us they recognised significant improvements were needed to the quality and safety of care people received, and that they were committed to working in partnership with other agencies to achieve this. During and immediately after our inspection, the provider sought advice from another local provider and asked them to support them in a mentoring capacity. This arrangement is now in place. The provider also implemented the urgent recommendations from the Local Authority and the Clinical Commissioning Group, who are working closely with the provider to bring about improvements. The provider told us that an acting manager was due to start working at the home on 29 January 2018; they are now in post. The provider has implemented a stop on further admissions to the home along with a formal placement stop by Commissioners until improvements are made.

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.

Inspection areas

Safe

Inadequate

Updated 22 February 2018

The service was not safe.

Staffing levels were not sufficient to meet people's needs. People were not protected from the risk of infection.

Important changes to people's medicines were not always communicated and shared, resulting in medicine not being given in accordance with prescriber's instructions.

Risk assessments were incomplete, or not in place at all, which meant there was no clear guidance for staff on how to safely care for people.

Effective

Inadequate

Updated 22 February 2018

The service was not effective.

People were placed at risk of dehydration and malnutrition. The principles of the Mental Capacity Act had not been followed, with the least restrictive option not explored for people.

Staff did not receive structured inductions to enable them to care for people effectively.

Caring

Requires improvement

Updated 22 February 2018

The service was not always caring.

People were sometimes placed in undignified situations and did not always have their personal care needs met promptly.

People did not always have choices in terms of how they were cared for.

Staff knew people well as individuals and demonstrated a respectful approach towards them.

Responsive

Inadequate

Updated 22 February 2018

The service was not responsive.

People could not always alert staff to their need for help as their call bell was broken or out of reach.

Care plans were not reflective of people's current needs, which placed people at risk of not having their needs met appropriately. People's changing wellbeing needs were not always responded to.

Well-led

Inadequate

Updated 22 February 2018

The service was not well-led.

The systems used to monitor risks to people were ineffective. There was a lack of oversight and clinical leadership at the home, which affected the quality and safety of the care people received.

Staff did not feel valued or supported in their roles.