12 December 2022
During an inspection looking at part of the service
St Dominic’s Nursing Home provides nursing and personal care for up to 91 people with nursing needs, such as Parkinson's, diabetes, and heart failure, many of whom were also living with dementia. The home was divided into six units, over three floors, Fern, Crocus, Dahlia, Aster, Bluebell and Elderflower. Fern and Elderflower units remain closed currently. There were 43 people living at the home on the days of our inspection.
People’s experience of using this service and what we found:
The governance systems had not supported the service to consistently improve and sustain improvement. Audit systems and processes had failed to identify risks to people's safety and other aspects of the service that required improvement.
Improvements had not been sustained since their last inspection and additional concerns were identified during this inspection in relation to staffing and person-centred care.
There was a lack of clear and accurate records regarding some people's care and support. For example, oral care, nutrition and fluid support, and peoples’ mental health. Some people’s care records were inaccurate and did not reflect their actual needs. There was a lack of oversight by the provider and management team.
Risk management was an area identified as needing improvement to ensure peoples’ health and well-being was protected and promoted. We identified shortfalls in respect of the risk of choking, management of dehydration, mental health guidance and the management of specific health problems. Staff practices regarding medicines needed to be further developed to ensure that staff follow the organisational policy for safe administration and recording of medicines. Peoples’ oral health was not consistently monitored to ensure good practice was consistently followed.
Staffing levels were not sufficient at this time to meet people’s individual needs to keep them safe and ensure their well-being.
We have made a recommendation about the mental capacity assessments for people who live at St Dominic’s Nursing Home.
People received care and support from staff who had been appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible.
There were COVID-19 policies in place for visiting that was in line with government guidance. Families told us that they were welcomed into the home and followed the guidance currently in place. We signposted the provider to resources to develop their approach.
Referrals were made appropriately to outside agencies when required. For example, GPs, community nurses and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred.
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 17 December 2021)
Why we inspected
This inspection was prompted due to information of risk and concern in relation to staffing levels, communication and safeguarding concerns which had impacted on care delivery. We also used this opportunity to look at the breaches of Regulation 12 and 17 from the last inspection in November 2021. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
The concerns raised were looked at during this inspection and have been reflected in the report.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led questions of this full report.
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.
Enforcement
We have identified continued breaches in relation to safe care and treatment, staffing and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.