Archived: Collamere Nursing Home

Updated 29 November 2016

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 is 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 first inspection visit took place on 10 October 2016. This inspection visit was carried out by two adult social care inspectors, a pharmacy inspector, and an expert by experience. The expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was in older people’s care. We received additional concerns following the inspection and undertook a further inspection visit to the service on the 4 November 2016, carried out by two adult social care inspectors.

Before the inspection, we reviewed the information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.

We spoke with seven people who lived at the service. Not everyone we met who was living at Collamere was able to give us their verbal views of the care and support they received due to their health needs. We also spoke to four relatives to share their views on the service. We looked around the premises and observed care practices.

We looked at care documentation for seven people living at Collamere, medicines records for 31 people (included some people who were no longer at the service), three staff files, training records and other records relating to the management of the service. We spoke with the deputy manager, manager, head of operations and the registered provider during the inspection. We spoke with nine staff during the inspection visits and one staff member following our visit.

Updated 29 November 2016

We carried out an unannounced focused inspection of Collamere nursing home on 10 October 2016. We undertook this visit as we had received concerns in respect of a person’s care at the service. Following this inspection visit we received further concerns in respect of the care and welfare of people using the service. We therefore undertook a further inspection visit to the service on the 4 November 2016 to widen our inspection to become Comprehensive. We also checked what action the provider had taken in relation to concerns raised at our last inspection in August 2106. At that time we found breaches of the legal requirements related to: medicines management, diet and nutrition, staffing levels, a lack of training and supervision for staff, not ensuring that care plans were in place or up to date, and ineffective auditing systems. We told the provider to take action to meet the legal requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Collamere nursing Home on our website at www.cqc.org.uk. The provider for this location is registered under the legal entity of Pinerace Limited. Pinerace Limited is part of the Morleigh group of nursing and residential care homes.

Collamere is a care home which provides nursing care and support for up to 46 predominantly older people. On both days we visited there were 27 people living at the service. Some of these people were living with dementia.

The service is required to have a registered manager in post. At the time of our inspection visits there was not a registered manager in post. 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. A manager had been working in the service since April 2016. However, an application for the post of registered manager had not been submitted to the commission.

The provider has overall responsibility for the quality of management of the service and the delivery of care to people using the service. The provider has repeatedly not achieved this at Collamere Nursing Home and whilst it had a rating of Good on the first rated inspection in April 2015, it still had a legal breach in the area of management. Since October 2015 the Care Quality Commission has carried out a further four inspections (including this one) of the service and all have been rated as Requires Improvement. At each inspection there have been breaches of the regulations. The service has not met the requirements of enforcement action which they are required to do by law.

At the previous inspection in August 2016 we found that the temperature of the medicine fridge was not recorded as they did not have a thermometer. During this inspection, we found that medicines that required cold storage were kept in a medicines refrigerator in the nurses’ office but a record of the fridges temperature was still not kept. Not checking the fridge temperature daily means that any fault with the fridge would not be identified in a timely manner and medicines might be stored at a temperature that makes them unsafe or ineffective.

We also looked at how medicines were managed and administered. Records showed people were administered their medicines correctly. However, there were some improvements needed in the recording of medicines administration. For example, handwritten entries on the medicines records had not been signed by two people to help ensure the risk of errors was reduced and body maps were not used consistently when creams and pain relieving patches were applied. These issues had been identified at the August 2016 inspection and no progress to address them was evident.

Records were not up to date at the August 2016 inspection and we found continued evidence of this at this inspection. For example staff told us how they needed to approach a person in a particular way or the person may bite or scratch them. This was not reflected in their care plan. There was no risk assessment to help protect staff from injury. We found staff did not have the information, guidance or direction about when to provide certain elements of care to a person or what action to take if a person’s health needs changed.

Records were not always completed by care staff when care and support had been carried out. For example, weight charts and food and fluid charts were not being recorded consistently. This did not allow staff to monitor people’s health in a consistent manner and enable them to identify if any changes to their care were needed. This meant that appropriate care was not always carried out by staff.

At our previous and current inspection visits we found systems were not being operated effectively to assess and monitor the quality of the service provided. This meant the provider and manager were unable to identify or address any areas of concern. For example, at the August 2016 inspection we found that pressure mattresses were not at the correct setting for people’s weight. The manager said they completed their own audit and confirmed that some settings were incorrectly set. However, they had not kept records of when they checked the pressure mattresses, when this was needed to be repeated or what action they had taken to help ensure they were correctly set in future. On this visit we again found that pressure mattresses were not at the correct settings. This meant that people were not protected from the risks associated with pressure damage to their skin.

We received concerns from a health professional regarding a lack of communication with the service. The impact of this was difficulties in the working relationships between the health professional and the service which could impact on the care people received at the service.

We found staff were supported by a system of induction, supervision and training, although this was not always recorded by the management team. The Care Certificate was not being used by the service to support the induction of care staff new to the role. This meant there was no evidence that they had completed the induction and had been deemed to be competent to carry out their role. Staff told us they had attended supervision and we noted that some training courses were being provided. Appraisals were now taking place. However, we concluded that there was insufficient evidence that induction had been improved or that all relevant training was being provided.

The service calculated staffing levels using their own assessment tool and we saw these numbers of staff were usually working at the home. Staff felt that staffing levels had ‘improved’ since the previous inspection and that they had more time to be with people. However, we were told by staff, and observed, that when people became anxious, staff did not have the time to be able to stay with the person until their anxiety levels had lessened. For example we observed a person not being provided with staff support at a meal time which meant that the person could not access their meal. We concluded that sufficient staff were employed at the service to care for people’s physical care needs. However peoples’ emotional or psychological needs were not adequately met.

We found that people did not receive care and treatment that was responsive to their individual needs. For example when people called out for assistance continually staff were not able to spend the time needed until the person’s anxiety had reduced. We found that the care provided to people was often task orientated rather than in response to each person’s individual needs.

Staff reported continued concerns about the laundry service at Collamere. Comments included, “It’s awful. We come in early to get the laundry done otherwise we would not have enough clean bedding”. We took a sample of linen and towels which were worn, frayed and discoloured due to extensive laundering and a torn bed sheet to show the management team. Their response was to place blame on staff for drying pillows in the tumble drier and for staff taking new towels for their own use. The management team told us on the 4 November 2016 that they had ordered some bed linen. However, it is a concern that we needed to raise this as an issue in the August inspection and also on the 10 October 2016 before any action was taken.

At this inspection we found that recruitment processes were not followed consistently. For example, a member of staff who had been working unsupervised at the service, had not had their full Disclosure and Barring System (DBS) check before commencing work. The failure to complete necessary checks before allowing staff to provide care exposed people to unnecessary risk.

We identified there were difficulties in communication within the management team. For example following the August 2016 inspection, the head of operations had come to the service and commenced their own care plan audit. The manager had also introduced their own care plan auditing system which they had shared with nursing staff about how they wanted it to be completed. This demonstrated that there was no agreement between the head of operations and the manager as to how they would respond to an issue. This created confusion.

The manager had designed a new handover recording sheet to improve communication between staff. This sheet was used at shift handover, so that any changes to the person’s care or any actions needed to be taken were recorded. This was to reduce the error of miscommunication between staff. However, we found that staff were not completing the handover sheet as instructed, which could lead to information not being shared effectively.

People’s personal confidential information was not always stored securely. This meant that people co