Archived: Collamere Nursing Home

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

This inspection was carried out to check on any action taken by the provider. 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. At the time of the inspection 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 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. An application for the post of registered manager had not been submitted to the commission.

We looked at how medicines were managed and administered. We found it was not always possible to establish if people had received their medicines as prescribed. There were gaps in the medicine administration records (MAR). Handwritten entries on the MAR had not been signed by two people to help ensure the risk of errors was reduced. Prescribed creams were not always recorded when applied. Creams were not dated when opened. This meant staff were not clear on when the item might no longer be safe to use. The medicines refrigerator stored prescribed medicines that required cold storage. However, the refrigerator temperature was not recorded daily. This meant that any fault or increase in the temperature within the refrigerator would not be noticed in a timely manner and the safe storage of medicines inside could not be assured. Regular medicines audits were not consistently identifying when errors occurred.

Records were not always completed by care staff when care and support had been carried out. There were gaps in the daily care and nursing records. Care plans contained a great deal of information. Not all care plans had been updated to take account of any changes that had taken place. This made it difficult for staff to find the current accurate plan of care for each person. This meant that appropriate care was not always carried out by staff, such as regular weights being taken and observations carried out.

People’s personal information and care plans were held in the nurses office. The door to this room was found open regularly throughout the day of our inspection with no one present in the room. This meant people’s care records were not held securely. Care planning was reviewed and people’s changing needs recorded, although not always in a timely manner. Where appropriate, relatives were included in the reviews.

Some people had been assessed as requiring pressure relieving mattresses when cared for in bed. These mattresses were not regularly checked to ensure they were correctly set for each person. People were regularly re-positioned by staff and this was mostly recorded.

Staff were supported by a system of induction training, although this was not always recorded. The Care Certificate was not being used by the service to support the induction of care staff new to the role. Care staff supervision had increased since the new manager had been in post. Staff told us they did not have this support regularly.The nurses reported not having been provided with supervision recently. The manager did not have a system or process in place to monitor when each staff member was due to have supervision. Appraisals were not taking place at the time of this inspection.

Staff knew how to recognise and report the signs of abuse. However, not all staff had received annual updates in safeguarding adults training. Staff training had not been updated in line with the guidance stated on the service's training matrix, with many subjects requiring updating. Staff had not had annual fire training. Nurses training did not appear on the training matrix. The kitchen porter prepared food each day for people. However, they had not completed training in safe food management. This meant that staff were not always provided with appropriate training and updates to enable them to safely carry out their roles.

Staff meetings were held. These allowed staff to air any concerns or suggestions they had regarding the running of the service. However, staff told us they had raised issues at meetings and at supervision which they felt had not always been addressed.

The manager used a dependency assessment tool to identify the minimum number of staff required to meet people’s needs. However, people and staff told us that there were not enough staff. Comments included, “Staff are always running for the bells” and “People are getting upset and are not getting the standard of care they should.” The service had staff vacancies and was actively recruiting at the time of this inspection. Bank and agency staff were being used to cover shifts. However, the service was one carer short on the day of this inspection and the bank carer did not arrive to cover this shift. Some people reported having to wait for care and support to be provided. All staff told us they were rushed, stressed and did not feel they were able to carry out their role to the best of their ability. Staff told us they did not have time to spend time with people and provide activities. Activites did not take place each day, were not planned and did not reflect people’s choices and preferences.

Staff reported that there were concerns about the laundry service at Collamere. Comments included, “People have run out of clean clothes and needed to wear our gowns” and “The bed linen is often not ironed, and people’s clothes are just bundled into drawers, even dresses. It just looks so poor and doesn’t show any respect.”

There was a planned menu which showed two choices were offered to people at mealtimes. On the day of this inspection each person in the dining room, and several people in their rooms were all having the same meal. People’s comments included, “The meat in the sandwiches is so thin you can see through it” and “I don’t like the food here, although the deserts are not bad.” Staff comments included, “We are limited on food, we cant always provide a choice for people” and “The food here is terrible, very poor quality, I see it every day.” Staff told us the service had run out of milk, tea and juice on a few occasions in the last month with staff needing to go out to the shop to buy items. The kitchen staff were aware of people’s dietary requirements and preferences.Two people had specific foods prepared for them on the day of this inspection, one person had sausages and another had an egg. Some people required nutritional supplements to their diet. Staff did not always record when these prescribed items had been provided.

Accidents and incidents that occurred at the service were mostly reported by staff and recorded in people’s care files. However, the manager did not audit such events to help ensure the risk of reoccurrence was reduced.

The manager and staff were aware of their legal responsibilities under the Mental Capacity Act 2005 and told us how they ensured people’s rights were protected. However, consent to care and photographs had in some instances been signed by the manager of the service and not the person or their legal representative. Applications had been made appropriately to the local authority for authorisation of potentially restrictive care plans. One authorisation had been granted. The manager was asked to ensure that the Care Quality Commission were notified of this authorisation as they are legally required to do.

Collamere provided accommodation on the ground floor only of the building. The upper floor was in the process of being refurbished and was not in use at the time of this inspection. The lift to the upper floor was not in working order. Fire escape doors led from main corridors and communal areas such as the dining room. The dining room fire doors were locked. No key was present in the immediate vicinity. One exit door opened with a simple turn knob to the outside. This door was not alarmed. Another exit door had an alarm which sounded when the door was approached. The alarm sounded as we approached the door, there was no response from staff. We were told by the manager that this door was used regularly by staff to take out rubbish and the alarm went off all the time, so staff no longer responded to the alarm. A further fire exit door was unlocked with the key hanging nearby but no alarm sounded when it was opened. There were people living at the service who were living with dementia and independently mobile. This meant there was a potential risk that people could leave the service through these exits without staff noticing.

In the entrance hall of the service there were family and staff questionnaires available for people to fill in. Families told us they had completed these forms in the past. We asked the manager about any recent quality assurance survey reponses. We were told there was no information available regarding the views of people and their families about the service. No residents meetings had taken place. This meant that the service was not effectively seeking people’s views and experiences of

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.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. However, the registered manager had been working in different roles within the Morleigh group since March 2015. Temporary managers had been in post to manage the day-to-day running of the service, with the support of the registered manager, since that time.

We carried out this unannounced inspection of Collamere Nursing Home on 15 January 2016. At this focused inspection we checked to see if the service had made the required improvements identified at the inspection on 21 October 2015. In October 2015 we had concerns about the lack of consistent management, leadership and oversight of the day-to-day running of the service. This had resulted in quality monitoring systems not being operated effectively and areas of the service that required improvement had not been identified. These areas included; the service using an incorrect form to record people’s food and fluid intake, identify and action faulty equipment and ensure the environment was suitable for service user’s needs. We also found people had limited access to snacks when kitchen staff left at 6pm and there was a lack of meaningful activities in line with people’s interests and preferences. Staff were not consistently supervised, supported and trained to carry out their roles.

This report only covers our findings in relation to these topics. 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.

At this inspection we found improvements had been made to the environment, auditing systems and staffing training and supervision. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Staff were supervised, supported and trained to carry out their roles. The premises and equipment were fit for purpose and were mostly well maintained. The environment had been adapted to assist people with dementia to orientate around the premises. Care staff had access to the kitchen during the evening and overnight, so people could have snacks of their choosing at any time.

An activities co-ordinator had been appointed and a programme had started to be developed. However, until an activity programme was developed, that could demonstrate that each person’s individual social and emotional needs had been considered, people did not have access to meaningful activities.

There had been an acting manager in post for the last three months and they, together with the clinical lead, had provided stable management and leadership for the service. However, staff were worried about the prospect of another change of manager because the acting manager left the organisation on 15 January 2015.

People told us they felt safe living at the service and with the staff who supported them. One person told us, “I feel well looked after and safe.”

People’s individual health needs were well managed and staff had the skills to recognise when people may be a risk of their health deteriorating. People had access to healthcare professionals such as a GP, chiropodist, dentist or optician.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. We observed the support people received during the lunchtime period and staff supported people appropriately and sensitively.

Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. Any risks concerning people’s care and support were identified and appropriately managed.

Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

There were enough skilled and experienced staff on duty to keep people safe and meet their needs. Staff had a good knowledge of each person and how to meet their needs. Staff knew how to recognise and report the signs of abuse.

We identified one breach of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.

Information we gathered during the inspection helped answer our five questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

From the outcomes we looked at during this inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was safe.

People were treated with dignity and respect by the staff. During our inspection we spoke with three people living in the home and two visiting relatives. People told us they were happy living in the home and they felt safe.

We found there were enough qualified, skilled and experienced staff to meet people's needs. The service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. There were robust recruitment procedures in place that included a Disclosure and Barring Service (DBS) check.

Is the service effective?

From the outcomes we looked at during this inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff training in moving and handing was up to date and staff told us they always worked in pairs when using equipment. Staff we spoke with and observed showed they had good knowledge of the people they supported.

We spoke with two visitors and they told us they visited the home every day and were always made to feel welcome.

Is the service caring?

From the outcomes we looked at during this inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was caring.

We spent time in the communal lounge and dining room to observe how staff responded to people's needs. We observed staff responded to people in a kind and sensitive manner. For example we observed staff assisting one person to eat their lunch. We saw the care worker assisted the person in a relaxed and unrushed way, talking with the person throughout to reassure them and explain what was happening.

Is the service responsive?

From the outcomes we looked at during this inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was responsive.

People were given the opportunity to take part in a range of group activities each afternoon. Some people told us they did not want to take part in any activities. The home kept records of activities people had taken part in each day. However, records we looked did not evidence that people had either taken part in an activity each day or had declined to take part.

We observed staff spending one-to-one time chatting to people and staff checked people regularly in their rooms and communal areas to ask if they needed any assistance.

Is the service well-led?

From the outcomes we looked at during this inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was well-led.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians, occupational therapists and tissue viability nurses.

The two visitors we spoke with told us they were satisfied with the care their relative received and would feel confident raising concerns if they needed to.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

During our inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was safe.

People were treated with dignity and respect by the staff. During our inspection we spoke with six people living in the home and three visiting relatives. Most people told us they liked living in the home and everyone we spoke with told us they felt safe. One person told us 'I like living here and my room is nice'. A relative told us 'X is fine, likes it here and they look much better than when they first moved in'.

Care plans were personalised to the individual and gave clear guidance for staff to follow to meet people's needs. This included how staff should provide care to people who had complex needs and were not always orientated to their surroundings.

People were safe because staff knew what to do when safeguarding concerns were raised and they followed guidance. Where concerns had been raised by people, and other staff, about how some staff had treated people we found the home had taken appropriate action to ensure people were safe from harm.

We saw Collamere Nursing Home understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there were enough qualified, skilled and experienced staff to meet people's needs. However, some people we spoke with commented that they did not think there were sufficient staff and there were often agency staff used at weekends. The service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.

Is the service effective?

During our inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with three visitors and they all confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was caring.

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people's families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people's wishes.

Most people we spoke with told us they were happy living in the home and most staff were caring and attentive to their needs. People told us 'some of them [staff] are very good and others are not', 'they[staff] are very good' and 'staff look after you'. We observed staff responded to people in a kind and sensitive manner.

Is the service responsive?

During our inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was responsive.

People were able to take part in a range of group and individual activities such as card games, listening to music and craft work. Some people told us the activities on offer were not to their liking and they preferred to stay in their rooms.

Collamere Nursing Home gave clear information to people about how to complain. We saw the home responded appropriately when complaints were made and took prompt action to resolve the concerns raised.

Is the service well-led?

During our inspection of Collamere Nursing Home we saw evidence to support a judgement that this service was well-led.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

Quality assurance systems were in place to monitor the service being provided. Care review meetings had been held to ensure the care and support provided was still meeting the needs of the person.

People who used the service and their representatives were asked for their views about their care and treatment. The results from the most recent survey, completed a week before this inspection, had raised concerns about several areas of the service provided. However, we found the home had already responded to these concerns and had put measures in place to monitor staff interaction, improve the cleaning schedule and review the menus.

We saw people's privacy and dignity were being maintained. People we spoke with told us their dignity and privacy was maintained by the closing of doors and curtains when being assisted by staff.

We saw care plans were detailed and gave direction as to the care and support people needed. They had been regularly reviewed.

We saw the home was clean. There was information about infection control readily available throughout the home. We noted some environmental issues such as lack of a suitable clinical waste bin, cracked tiles and a toilet without a sink. The provider had dealt with all the issues we bought to her attention shortly after the inspection.

Staffing levels were satisfactory to meet the needs of the people who lived at Collamere on the day of the inspection.

People who used the service were protected against the risks of unsafe or inappropriate care and treatment as records were updated and stored securely in order to protect people's confidentiality.

We carried out this inspection from 4.30pm until 9.15 pm as concerns had been raised about the quality and quantity of the food at tea time, as well as the kitchen being locked and that people did not have access to food after 5 pm.

We had received information about staffing; we were told that there were poor language skills of people whose first language was not English and that night staff were sleeping on duty. As a result of night staff sleeping on duty we had been told that night rounds were not always carried out as often as they should be. We had also been told that due the shortage of care staff people had to wait a long time to have their call bells answered.

We saw care plans were generally detailed and gave direction as to the care and support people needed. They had been regularly reviewed but in at least one care plan detail about how to manage weight loss was not detailed or individual to the person using the service.

We saw there was food available to make snacks for people, once the kitchen staff had left at 5.30pm. Most people told us they liked the meals they were offered and the portion sizes were adequate for them. However, one person told us the portions were too small and sometimes there was no choice offered.

We saw staff were always busy. Staff told us they were currently managing to meet people's needs but as more people moved into the home staffing levels would need to increase. Staffing levels at tea time were currently under review due to the increase in the number of people who needed help with their meals and drinks.

We saw care records were kept securely but accessible to staff at all times. We found that records were not always accurately maintained.

One care worker took a person who used the service to the toilet asking them to ring the bell when they had finished, the care worker said 'I like to give X dignity'. We heard care workers asking people where they would like to sit and where they would like to spend their time.

The care records seen were well maintained and updated daily. This meant they were accurate and directed staff in how to provide care and support for people who used the service.

We were shown there was a robust system in place to order, store and dispense people's prescribed medicines.

We saw systems in place to support staff. Staff told us they currently felt well supported.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.