07 & 08 April 2015
During a routine inspection
This inspection took place on 7 and 8 April 2015 and was unannounced.
The last inspection of Le Grand Nursing Home took place across five dates in September/October 2014. At that time we found concerns in care planning, arrangements to safeguard people against the risk of abuse, procedures for obtaining valid consent were not in place, people were deemed to be unlawfully restrained and their liberty compromised. Systems and processes to monitor and check the quality of the service provided were poor and inadequate. We deemed these concerns to have a major impact on people.
As a result of our findings we commenced enforcement action against the provider who was issued with five warning notices for failing to meet the requirements of regulations 9, 11, 10, 18 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which were in force at that time.
During this inspection we reviewed actions taken by the provider to gain compliance against five warning notices issued to the service following the previous inspection in September/October 2014. We also looked to see if improvements had been made in respect of the additional shortfalls in people’s care we had identified. We found that no improvements had been made.
Le Grand Nursing Home as a condition of its registration should have a registered manager in place. 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. The home had not had a registered manager in place since November 2013.
The manager had not registered with the Care Quality Commission. An application was submitted, however due to recording errors this was declined and returned for amendment.
Le Grand Nursing Home provides nursing and residential care and is registered to accommodate up to 28 people. There were 14 people living at the home when we visited.
We engaged with all people living at the home, feedback varied due to some people having limited communication skills. We spent time observing care delivery and spoke with people who visited the service.
People told us that they felt safe, however comments about a lack of staffing consistency infringed on the day to day experiences of care received.
We found that people were not protected against avoidable harm and quality assurance systems at the home failed to identify or resolve associated risk, therefore placing people at significant risk of harm and neglect. We communicated our concerns to associated commissioning teams and ensured that the standard of risk management at the service was addressed by the provider before leaving the site on both days of inspection.
We found that people’s safety was being compromised in a number of areas. This included how people were assisted to eat and drink, use of equipment during moving procedures, how well medicines were administrated and suitability of pre-employment checks for staff prior to recruitment.
Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make particular decisions. For example, the provider had not ensured that people’s rights were actively assessed under the Mental Capacity Act of Deprivation of Liberty Safeguards, even though their liberty was being significantly restricted.
We found that people’s health care needs were not appropriately assessed therefore individual risk factors had not been fully considered, placing people at risk of avoidable harm.
Although some people told us they felt safe and their privacy and dignity was respected, we saw that care was predominantly based around tasks and did not take into account people’s preferences. We were concerned that some very frail people living at the home were isolated in bedrooms with little stimulation.
The home did not consistently involve people in decisions made around the care they received. Care plans did not evidence involvement and observation of care confirmed concerns regarding standards of dignity and respect.
We received variable feedback from relatives; some expressed positive comments about the care provided whilst others were concerned about the high use of agency workers and inconsistency in effective communication between staff at the home.
We did not find evidence of robust management systems in the home and quality assurance was not effective in order to protect people living at the service from risk.
Staff were not provided with effective support, induction, supervision, appraisal or training. The home did not have any effective governance systems in place to ensure that improvements can be made.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have deemed that the overall rating for this service is inadequate.
We want to ensure that services found to be providing inadequate care do not continue to do so. Therefore we have introduced special measures.
The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to cancel their registration.
Services rated as inadequate overall will be placed straight into special measures.
You can see what action we have taken at the end of this report.