Archived: Village Green Care Home Also known as The Old Village School Nursing Home

We carried out an unannounced comprehensive inspection of this service on 08 and 10 June 2015. After that inspection we received concerns in relation to the provider’s ability to meet the needs of the people who lived at the home, particularly with regard to their safety, nursing requirements and the management of their medicines. As a result we undertook a focused inspection to look into those concerns. However due to the level of concerns identified during the inspection process we also looked at 'caring' and if the service was being well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old Village School Nursing Home on our website at www.cqc.org.uk

Following our inspection in June 2015 the overall rating for this provider was ‘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.

During this inspection we found that there had been no improvement in the areas that we looked at and we are taking enforcement action.

The Old Village School Nursing Home provides a service for up to 60 people. The home is divided into three units providing personal and nursing care to older people and younger adults; including those with high care needs as a result of neurological conditions and those who need care at the end of their life. An on-site physiotherapy department provides some people with individual physiotherapy and rehabilitation programmes. At the time of the inspection there were 50 people who lived at the home.

The home had a registered manager. However, the registered manager had been absent from the home for three months at the time of the inspection. 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 was being managed by the provider’s operational manager at the time of the inspection.

People did not always feel safe at the home nor did they always receive care at the time that they needed or wanted it. Staff did not always respond to people’s needs or calls for assistance. People were fearful and felt degraded by some of their experiences.

People were at serious risk of harm. Personalised risk assessments were not always sufficiently detailed or accurate and had not been reviewed regularly to ensure that no changes had occurred. Not all risks people encountered had been identified or recognised so that action could be taken to minimise them. People’s medicines were not managed, stored or administered safely.

People were not always assisted to eat their meals, and people who received nutrition and hydration by way of percutaneous endoscopic gastrostomy (PEG) tube did not always receive this in the correct volumes.

People’s capacity to make and understand decisions was not always assessed and documented appropriately. Decisions made on people’s behalf in their best interests were not always documented so there were risks that they would not be protected within the legal framework to protect their rights and best interest.

Care plans did not always reflect the care provided and had not been updated when people’s needs had changed. So there was a serious risk that their needs would not be provided in a consistent way that had been planned for.

People’s dignity and privacy was not respected and they were often left for unacceptable periods without receiving the care they needed. Their dignity was compromised and they did not receive the care that they required.

We were so concerned about the poor quality of the care being provided that we immediately notified the local authority and clinical commissioning groups. Due to the number of safeguard referrals other professionals started to review the care for all those using the service. These reviews identified serious levels of staff incompetency, poor attitudes to people and a lack of care.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 

We took enforcement action and there are currently no people living at the home.

The enforcement action that we took was subject to an appeals process. The provider was not entitled to carry on Regulated Activities during this process. The appeal was allowed by the First Tier Tribunal (Care Standards) and the Regulated Activities are now subject to the following conditions imposed by the tribunal:

1. It shall be a condition of the registration of the provider in respect of the Home with immediate effect that the provider shall not admit as a service user to the Home more than two service users in any period of 7 calendar days computed consecutively from 1 March 2016 for the first four weeks.
2. After this initial four week period the number of admissions will be increased to a maximum of three service users per week for the next 20 week period.
3. A named consultancy company is appointed by the provider under a management agreement to provide professional management services for the purpose of carrying out the accommodation together with nursing or personal care and treatment for disease, disorder or injury (as defined under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014) for a minimum period of 18 months.
4. A named person will undertake the day to day management of the Home for at least the first 18 months of operations and apply to become registered with the Respondent. Any subsequent person who is identified to become the registered manager will not be appointed as such until the CQC has registered that person in respect of the Home.
5. A named member of the consultancy company is appointed by the provider as a manager of the provider under a management consultancy agreement to oversee the day to day management of the Home and provide the role of Nominated Individual for a minimum of 18 months. They will visit the Home for a minimum of five days per week in the first four weeks of operation and a minimum of two days a week for the next two months and one day per week thereafter; and in each such month prepare and provide a report to the Board of Directors of Old Village Care Limited with a copy to the CQC.
6. Before the admission of the first service user to the Home upon reopening, the Home shall have in place sufficient numbers of suitably qualified, competent, skilled and experienced staff who are permanent employees of the provider so that there are on duty at the Home between the hours of 8am and 8pm not less than four staff and between the hours of 8pm and 8am three such staff dedicated to direct service user care of whom one on each “shift” is a first level registered nurse.
7. When further admissions are made that would require an increase in staffing levels, admissions will pause whilst suitable additional suitably qualified trained care staff are recruited.
8. Temporary staff engaged by an agency shall only be used in cases of necessary absence of permanent staff due to sickness, leave or sudden and unexpected absence or departure.
9. Any service user to be admitted to the Home will be admitted after a pre-admission acceptance by the Home manager, on a pre-arranged date and time with a member of the care team allocated to complete all admission paperwork upon their arrival. A 72 hour care plan will be created to bridge the gap between admission and the completion of a full care file. Following 72 hours after admission the Home manager will verify in written form to the named consultancy company that all required documentation is in place (for the period for which their management agreement is in place).
10. Service users will be admitted to locations within the Home in the following order:

a. Woburn Unit – Ground Floor

b. Knebworth Unit – First Floor

c. Old School Unit – Ground Floor

11 Before any service user is admitted to the Home, the Director of Old Village Care Limited will undertake the following training:

a. Safeguarding;

b. dignity in care;

c. moving and handling;

d. dementia;

e. infection control; and

f. COSHH

12 For the period that the named person is appointed Nominated Individual, the Director of Old Village Care Limited shall also attend the Home with the Nominated Individual at least three times per month to observe and learn from her the skills of supervising day to day management.

This service will remain in special measures. Services in special measures will be kept under review. The expectation is that providers found to have been providing inadequate care should have made significant improvements within a timeframe of six months. 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 unannounced inspection took place over two days, on 08 and 10 June 2015. The service had been inspected using our ratings methodology on 22 July 2014 and had been rated as ‘Good’ in all of the five questions that we ask. Is it safe? Is it effective? Is it caring? Is it responsive? Is it well led? However, we had received information that had raised concern about the care that was being provided at the home and we determined that a further comprehensive review of the service was necessary.

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

The Old Village School Nursing Home provides a service for up to 60 people. The home is divided into three units providing personal and nursing care to older people and younger adults; including those with high care needs as a result of neurological conditions and those with end of life care needs. An on-site physiotherapy department provides some people with individual physiotherapy and rehabilitation programmes. At the time of the inspection there were 57 people who lived at the home.

The home had a registered manager. However, the registered manager had been absent from the home for more than a month at the time of the inspection. 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.

People felt safe at the home and staff had received training on safeguarding of people. However, staff did not always know who to report any concerns to and appropriate referrals had not been made to the safeguarding authority.

Robust recruitment procedures were not always followed when recruiting permanent staff. Checks on the suitability of staff provided by agency services to care for and support people with highly complex needs was not checked. There were insufficient numbers of suitably qualified, competent staff at all times to provide appropriate care and support to people. Duty rotas did not accurately reflect the staff working on the day of the inspection.

There was induction programme provided for new permanent staff at the home, but agency staff were not given an induction. The effectiveness of the training provided was not monitored and there were language barriers between staff and the people they cared for.

Staff were not supported by way of regular supervision with their manager, although annual appraisals had taken place. The interaction between staff and people was caring and friendly, although people had mixed feelings about the care that they received. People’s privacy and dignity were not always protected. People did not always receive the care they needed at the time that they needed or wanted it.

Personalised risk assessments were not always sufficiently detailed or accurate. Staff did not always know how to interpret them. Assistive technology designed to reduce the risk of harm to people was not always used when it was in place. People’s medicines were not managed, stored or administered safely.

People received sufficient food to maintain their health and well-being, although staff did not always have time to ensure that people had drank sufficient fluids. People’s food preferences were not always catered for. People’s weight was monitored and referrals made to a dietitian when appropriate but these were not always made in a timely manner. People who received nutrition and hydration by way of percutaneous endoscopic gastrostomy (PEG) tube did not always receive this in the correct volumes or at the correct rate.

People’s capacity to make and understand decisions was not always assessed and documented appropriately. Decisions made on people’s behalf in their best interests were not always documented.

People were not supported to pursue their interests and hobbies. People and their relatives had been involved in the initial planning of their care, but were not involved in any reviews. Care plans had not been updated when people’s needs had changed.

There was a system in place for people to make a complaint should they need to. People and relatives had been asked for their opinion as to the quality of the care provision and were encouraged to make suggestions for improvements.

There was no effective quality monitoring system in place.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.