Nower House is a residential care home providing personal care to up to 50 people aged 65 and over, some of whom live with dementia. At the time of the inspection they were supporting 35 people. The care home is one adapted building and at the time of the inspection people were only residing on one floor, the ground floor. The lower ground floor was only being used for the kitchen and domestic purposes.
People’s experience of using this service and what we found
People were not always kept safe from risks. Risk assessments were not always completed and care plans did not always adequately detail risks.
The home did not have enough staff to meet people’s needs. We saw staff did not have time to support in a personalised way and people and staff told us there were not enough staff working at the home. This had impacted the ability of staff to meet basic bathing choices of people, such as more than one shower a week.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
The environment of the home did not always meet the needs of the people living there. For example, it was not a dementia friendly environment.
There was not always full oversight of the quality and safety of the home. There were some essential audits not being completed, these included quality assurance audits. This meant that shortfalls in practices were not being identified and action could not be taken to drive improvement in the home.
For the last two inspections the provider had failed to make adequate improvements to ensure people were kept safe and the home was effectively monitored. As a result, in certain areas the home had deteriorated.
People told us they felt safe and staff were caring towards them. However, the level of care people received had been directly impacted by the shortage of staff. Staff were knowledgeable in safeguarding procedures they needed to follow.
People told us they felt comfortable to raise complaints and they felt they could talk to the registered manager.
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 03 August 2021) and there were multiple breaches of regulation. The provider had a condition placed on their registration to complete monthly audits specific to the concerns found at the last inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns received about training and staffing. A decision was made for us to inspect and examine those risks.
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.
We have found evidence that the provider needs to make improvements. Please see all sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.