Archived: Spring Bank Nursing Home

Updated 24 August 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 inspection started on 9 June 2015 with an unannounced visit to the service, the inspection continued on 10 June 2015.

The inspection team was made up of two inspectors, a specialist advisor in nutrition and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service, in this case, the care of older people.

We looked at 15 people’s medication records, four people’s care plans and seven people’s nutritional records. We also looked at staff records, a selection of maintenance records and records relating to the management of the service. We spoke with eight people who lived in the home and two people’s relatives. We spoke with the manager, the provider, two nurses, three care workers, the maintenance man, the cook and a kitchen assistant. We observed how people were cared for and supported in the communal areas and looked around the home.

Before the inspection we reviewed the information we held about the home. This included information from the provider, notifications and speaking with the local authority contracts and safeguarding teams. Before our inspections we usually ask the provider to send us a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. On this occasion we did not ask for a PIR.

Updated 24 August 2015

The inspection took place over two days on 9 and 10 June 2015, the first day was unannounced.

Spring Bank Nursing Home provides accommodation for up to 31 people, predominantly older people. It is situated in the town of Silsden and is close to local shops and amenities. The accommodation is on two floors and is made up of single and shared rooms. There are two lounges and a dining room on the ground floor and there is a passenger lift. The home is set in its own grounds and there is parking by the side of the building.

The service has not had a registered manager since November 2013. 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 last inspection was in November 2014 and at that time we found there were ten breaches of the regulations. We issued warning notices for three of the breaches of regulations, there were in relation to nutrition, record keeping and monitoring the quality of the services provided. We told the provider they had to make improvements by 23 March 2015. The other breaches related to safeguarding, the safe management of medicines, the safety and suitability of the premises, consent to care and treatment, staff training and development and respect and involvement.

We told the provider they must submit an action plan with details of how they were going to make improvements in these areas. The provider sent us an action plan. During this inspection we followed up all these areas to check if the required improvements had been made.

We found the provider had not taken adequate measures to meet the requirements of the warning notices in relation to nutrition, record keeping and monitoring the quality of the service which meant there was a continued breach of regulation in these areas. In addition we found the provider was still in breach of the regulations relating to medicines, the safety and suitability of the premises, consent to care and treatment and staff training and development. In addition to the on-going breaches of regulation we identified new breaches of the regulations. They were in relation to staffing, staff recruitment, person centred care and safe care and treatment.

People who used the service and their relatives told us they felt safe. However, we identified a number of concerns which led us to conclude the service was not safe. We found people’s medicines were not managed properly and people did not always get their medicines in the way they were prescribed. This was an on-going breach of regulation. The home was not clean and there were unpleasant odours in some areas including people’s bedrooms. The home décor and furnishings were showing signs of wear and tear and the home was not well maintained. The standards of cleanliness had deteriorated since the last inspection.

There were usually enough staff on duty but the home did not have enough nurses and relied on a mixture of part time and agency nurses which risked a lack of continuity of care. This was a new area of concern.

We found people did not always receive care and treatment which was appropriate, met their needs and reflected their preferences. This was a new breach or regulation. People were supported to meet their health care needs and had access to NHS services via their GPs.

Some improvements had been made to the way people were supported to eat and drink however there were still areas of concern. For example, when people had food and fluid charts to monitor what they were eating and drinking there was no system in place for checking the charts to make sure they had in fact had enough to eat and drink.

People told us staff were kind and caring and we saw staff were respectful and attentive to people’s needs. However, there were some aspects of the service which could compromise people’s privacy and dignity, for example there was no lock on one of the communal toilet doors.

There were no restrictions on visiting and people were able to receive their visitors at times that suited them and in private. There was a programme of activities. Opportunities to take part in social activities outside of the home were limited and for the most part people relied on family and/or friends to take them out.

People told us they had no reason to complain. Information about how to make a complaint was displayed in the home.

The required recruitment checks were not always done before new staff started work. This meant people could be at risk of being supported by staff unsuitable to work in a care setting. This was a new breach of regulation. When new staff started work they did not always get any induction training to make sure they were competent to work safety and deliver appropriate care. Staff had received some training on safe working practices but it was difficult to get accurate information about what training staff had received. This risked people being cared for by staff who were not properly training to deliver appropriate and safe care. This was an on-going area of concern and had been identified as a breach of regulation at previous inspections.

Staff did not have a clear understanding of the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards which meant there was a risk they were not always acting within the law. This was an on-going breach of regulations.

There was no registered manager and there was a lack of consistency and leadership. There were some systems in place to monitor the quality of the services provided but there were not working well. This meant that potential problems or shortfalls in the service were not always identified and acted on which in turn could have a negative impact on the experiences of people who lived in the home.

People who lived in the home and others were potentially at risk because the provider did not have effective systems in place to identify, assess and manage risks to their safety and welfare.

We found the provider was not meeting nine regulations and many of these were on-going. CQC is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

On 07 September 2015 we issued a Notice of Proposal to cancel the provider’s registration to carry on the regulated activities accommodation for persons who require nursing or personal care, treatment of disease disorder or injury and diagnostic and screening procedures at the location Spring Bank Nursing Home.  The provider took the decision to close the home.