Newquay Nursing and Residential Home

Updated 8 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the registered manager was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by two inspectors and a pharmacy inspector.

Service and service type

Newquay Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Newquay Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the registered manager are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the registered manager sent us in the registered manager information return (PIR). This is information registered managers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We reviewed information we had received about the service since the last inspection. We sought feedback from professionals who worked with the service.

We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We were unable to speak with most people who used the service about their experience of the care provided due to their reduced mental capacity. We therefore made observations of interactions with staff throughout the inspection visit. We received information from five members of the staff team. We spoke with one relative and received information from one professional.

Updated 8 September 2022

About the service

Newquay Nursing and Residential Home is a residential care home providing personal and nursing care for up to 41 people. Some people were living with dementia. At the time of our inspection there were 20 people using the service.

Newquay Nursing and Residential Home is a detached property on the edge of the town of Newquay. It has two floors. The service is adapted to support people with mobility issues and has a range of aids and equipment to support people.

People’s experience of using this service and what we found

At the previous inspection the registered manager had failed to demonstrate systems to evaluate safety were being managed effectively to provide oversight of the service. This had the potential to place people at risk of harm. At this inspection not enough improvement had been made to meet the regulation.

The registered manager had not been aware records to mitigate risks had been missing since March 2022. For example, people’s records reporting their weights, had not been in place since March 2022. Staff told us they were continuing to weigh people monthly or when required and this information was passed to the deputy manager for recording and acting on. Those records were not available at the time of the inspection visit. Staff did not have the necessary detail where changes had occurred. Following the inspection visit we were assured by the provider the records had been moved off site for a short timeframe but were now in place and available to staff.

Records to report staff appraisals and supervisions were not available from March 2022. This meant there was no record of staff development, training and wellbeing. However, five staff members told us they felt well supported and individual support sessions were taking place. Following the inspection, we were assured by the registered manager that missing records had been returned and were now in place. The registered manager was monitoring future recordings of supervision sessions with the deputy manager.

The registered manager did not have effective systems to monitor equipment and utilities. For example, two air flow mattresses did not have the correct pressure set against people’s weight. There was no evidence skin damage had occurred. They had not been serviced since 2019. The services electrical wiring certificate was out of date. There were no systems in place to monitor the pressure of the air flow mattresses. This demonstrated the registered manager was not meeting governance requirements in overseeing the services systems.

There was no evidence of the service analysing incidents or accidents which would identify patterns and trends and action taken to mitigate risks. For example, times and places where falls occurred.

Fire systems were being regularly checked and action taken if required. Staff fire drill training was occurring as confirmed by five staff members. However, there were no records in place to record these.

People did not have Personal Emergency Evacuation Procedures [PEEP’s] plans in place for supporting emergency services and staff in the event of an incident occurring where evacuation would be necessary.

The registered manager told us staff recruitment especially for nurses was posing significant difficulties. This had resulted in the registered manager employing overseas staff to maintain safe numbers. The registered manager was working additional hours at the service to fill gaps where nurses would normally be rostered. This was having a direct impact on time available to carry out a governance role. Staffing numbers were based on minimum levels. The registered manager had reduced occupancy by half and was not admitting people, to enable staff to safely manage people’s needs.

The management of people’s medicines had improved since the previous inspection. However, more improvement in governance and oversight of medicines was required.

The homes environment required attention. For example, there were a number of double-glazing failures meaning glass was affected by condensation and could not be looked through. Some people’s rooms had damaged overhead lights. For example, three had the shade and bulbs missing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 21 February 2020).

The registered manager completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the registered manager remained in breach of regulations.

At our last inspection we recommended that the registered manager ensure cleaning materials were kept in a locked and secure environment. At this inspection we found the registered manager had taken action to ensure cleaning materials were stored safely.

Why we inspected

We carried out an unannounced inspection of this service on 09 January 2020. Breaches of legal requirements were found. This inspection was carried out to follow up on action we told the registered manager to take at the last inspection. In addition, we carried out a direct monitoring assessment of the service in May 2022. We were not assured by the responses from the registered manager and an on-site inspection was recommended.

This report covers our findings in relation to the key questions Safe, Effective and Well-led.

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 registered manager needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the registered manager to take at the end of this full report.

Follow up

We will request an action plan from the registered manager to understand what they will do to improve the standards of quality and safety. We will work alongside the registered manager and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.