Douglas Bank Nursing Home is situated on the outskirts of Wigan, in a semi-rural setting. The home enjoys panoramic views of scenic countryside and overlooks the picturesque village of Appley Bridge. The home accommodates up to 40 adults, who need help with personal or nursing care needs, including those who are living with dementia. The majority of bedrooms have en-suite facilities and are of single occupancy, although a few double rooms are available for those wishing to share facilities.At the time of our inspection the manager of the home had been in post for a very short period of time. Therefore, she had not submitted an application to the Care Quality Commission to become the registered manager of Douglas Bank Nursing Home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they 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.
This comprehensive inspection was conducted over two days. The first day was unannounced. This was conducted on 23 January 2017. The provider was given short notice of the second day of our inspection, which took place on 1 February 2017.
The last comprehensive inspection of this service was conducted on 22 March 2016, when shortfalls were identified in relation to person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, receiving and acting on complaints, good governance and staffing. The provider submitted an action plan, as requested. Comments contained in the action plan were considered during this inspection.
At our last inspection on 22 March 2016 we found the provider had not always ensured that the plans of care had been designed to reflect individual needs. Therefore, this area was in need of improvement to ensure that the health and social care needs of people were being appropriately met.
This was a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 1 January 2017.
At this inspection we found that the care plans were not always person centred and did not accurately reflect people’s needs. This constituted a continued breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that some risk assessments were not person-centred; as they did not accurately reflect people’s current needs.
At our last inspection on 22 March 2016 we found that the provider had not always ensured that people were treated with dignity and respect. Therefore, this area was in need of improvement to ensure that people who lived at Douglas Bank were treated in a proper manner. This was a breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this. The provider sent us their action plan, which showed that actions in this area had been completed.
At this inspection we observed two staff members preparing one person to be transferred in the hoist. This process did not promote dignity and respect for the person involved. Therefore, this was a continued breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection on 22 March 2016 we found the provider had not always ensured that consent had been obtained from the relevant person before care and treatment was provided. Therefore, this area was in need of improvement to ensure that people who lived at Douglas Bank were in agreement with the care and support delivered to them. This was a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 1 October 2016.
At this inspection we found that consent had not always been obtained before care and treatment was provided. Therefore, this was a continued breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection on 22 March 2016 we found that the premises were not safe throughout and equipment used for providing care or treatment was not always safe for such use. We identified that risks associated with infection control had not always been appropriately assessed, in order to prevent, detect and control the spread of infections. We also found that the provider had not ensured systems were in place for the proper and safe management of medicines. Therefore, these areas were in need of improvement to ensure that people who lived at Douglas Bank were protected from harm. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed at various times, the latest being 1 January 2017.
At this inspection we found the management of medicines had significantly improved. Therefore, this part of regulation 12 had been appropriately met. However, although some environmental improvements had been made since our last inspection, we still identified many safety concerns, associated with the premises and the provision of care, which presented a risk of potential harm for those who lived at Douglas Bank. Although some improvements had also been made in relation to infection control, further improvements were still needed to the cleanliness of the environment. This constituted a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection on 22 March 2016 we found that the provider had not always ensured that lawful authority had been granted in order to deprive someone of their liberty. Therefore, this area was in need of improvement to ensure that people who lived at Douglas Bank were not unlawfully restricted. This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 1 January 2017.
At this inspection we found that the records of one person showed that they were unable to make safe decisions about their planned care and treatment. However, a mental capacity assessment had not been conducted and there was no evidence available to show that best interest decision meetings had been held, in order to ensure that care and treatment was provided in accordance with the best interests of this person.
The care records for one person, who lived at the home, indicated they were being gently restrained against their will. This represented a deprivation of liberty. There was no evidence to demonstrate that a Deprivation of Liberty Safeguards (DoLS) application had been submitted.
This constituted as a continued breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection on 22 March 2016 we found the provider had not established and operated effective systems to assess, monitor and improve the quality and safety of the services provided or to mitigate risks relating to the health, safety and welfare of those who lived at the home and others who used the premises. Therefore, this area was in need of improvement to ensure that the services provided were sufficiently assessed and monitored to ensure any areas of risk were identified and mitigated as soon as possible. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this. The provider sent us their action plan, which showed that actions in this area were on-going.
At this inspection we found quality monitoring systems had been implemented, but these were not effective. Some documentation, such as care plans, falls risk assessments, dependency assessments and Personal Emergency Evacuation Plans (PEEPs) did not always reflect people’s current needs and some documents, such as dietary and fluid charts, were being inaccurately completed. These failings could have had a detrimental impact on the health and safety of those who lived at the home. Therefore, this constituted a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection on 22 March 2016 we found that the provider had not ensured the premises throughout were being properly used or properly maintained. Therefore, this area was in need of improvement to ensure that all parts of the home used by residents were suitable for their use. This was a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 26 June 2016.
At this inspection we found that all parts of the home were suitable for the use of the people who lived there. Therefore, regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met on this occasion.
At our last inspection on 22 March 2016 we found that the provider had not ensured an effective system had been implemented for identifying, receiving, recording, handling and responding to complaints. Therefore, this area was in need of improvement to ensure that complaints were being appropriately managed. This was a breach of regulation 16 of the Health and Social Care Act 2008 (Regulated Activities)