Background to this inspection
Updated
13 October 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 12, 13 and 14 August 2015 and was carried out by four adult social care inspectors, an inspection manager and two specialist pharmacy inspectors. The first day of the inspection was unannounced.
Before and during the inspection we sought information from representatives of the local authority, the Midlands and Lancashire Commissioning Support Unit and Chorley, South Ribble and Greater Preston Clinical Commissioning Groups. We also reviewed the information we held about the service, including notifications. A statutory notification is information about important events which the provider is required to send to us by law.
During the inspection, we spoke with ten people living in the home, five relatives and a visitor, two visiting healthcare professionals, five staff, the two covering managers and a director of the operating company.
We looked at 11 care files which belonged to people living in the home. We also looked at other important documentation relating to people living in the home such as 13 medication administration records. We looked at how the service used the Mental Capacity Act 2005 and Deprivation of Liberty code of practice to ensure that when people were assessed as lacking capacity to make their own decisions, actions were taken in line with the legislation.
We looked at a selection of documentation relating to the management and running of the service. This included three staff recruitment files, the training records, staff rotas, supervision records for staff, minutes of meetings with staff and people living in the home, quality assurance audits and menus.
Updated
13 October 2015
We carried out an unannounced inspection of Cuerden Developments Ltd – Cuerden Grange Nursing on 12, 13 and 14 August 2015. The first day was unannounced.
Cuerden Grange Nursing Home provides nursing care for up to 48 people with nursing needs. At the time of the inspection 33 people were accommodated in the home. The home is purpose built and accommodation is provided over two floors in single occupancy rooms. A passenger lift provides access between the floors.
There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
At the last inspection on 9 and 10 December 2014, we asked the provider to take action to improve staff recruitment and record keeping. On this inspection we found the necessary improvements had been made to staff recruitment processes, but we found there were continuing shortfalls with record keeping.
During this inspection we found the provider was in breach of eight regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. These were in relation to person centred care, dignity and respect, safe care and treatment, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing. You can see what action we have asked the provider to take at the back of the full version of the report. We also found a breach of one regulation of the Care Quality Commission (Registration) Regulations 2009 for non-notification of incidents. We are dealing with this issue separately.
People’s safety was compromised in many areas. We found risks to people’s health, safety and well-being had not been mitigated, and staff had not followed risk management strategies set out in people’s care plans. This meant people were at high risk of unsafe care. The majority of the staff had not received recent vulnerable adults safeguarding training and lacked insight into institutional abuse and neglect by omission of care. We also found shortfalls in the management of people’s medication.
Whilst staff were safely recruited there were not enough staff to meet people’s needs. We found the majority of the staff had not completed training in many key areas. This meant staff did not have updated knowledge to ensure they carried out their role effectively. Staff told us morale was very low in the home and they felt stressed. We noted that although some staff had received an appraisal of their work performance, none of the staff had received a supervision during 2015.
People were not given appropriate support at mealtimes and staff focussed on tasks rather than interacting with people they were supporting. We witnessed unsafe practices at meal times and throughout the inspection, which left people at risk of choking. People told us they felt rushed.
Staff were not responsive to people’s healthcare needs and did not act promptly on advice given by external healthcare professionals.
We found the majority of the staff had not completed training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Whilst we saw applications had been made to the local authority for DoLS and some assessments had been carried out of people’s mental capacity, we found some information in people’s care plans was out of date.
We observed some staff practices which showed a lack of respect for people and did not promote their privacy and dignity. We had to intervene on several occasions to ensure people received safe and appropriate care. There were few opportunities to engage in activities and people were seen sitting in the lounges or their bedroom with no meaningful activity or positive interaction taking place.
Whilst people had an individual care plan there was no evidence people or their families had been involved in reviews of their care. We also found care plans had not always been updated in line with changing needs and staff did not follow the plans when delivering care. This meant people were at risk of harm because the service failed to respond promptly and appropriately to their care needs.
The management of the service was inconsistent and lacked continuity. There were no effective systems or processes in the home to ensure that the service provided was safe, effective, caring, responsive or well led.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. 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 take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Within a few minutes of arrival at the service a director of the Company operating the home contacted us to inform us of the intention to close the home. He told us that he was unable to recruit nursing staff and the service was unsafe. He submitted an application to remove the location from the provider’s registration the next day. During the inspection the director and the covering managers worked closely with relatives and external organisations to support people’s transfer to their new homes. The home is now closed and the service provider is no longer admitting people.