Archived: Nada Residential and Nursing Home

Updated 21 February 2018

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.

This inspection took place on 26 and 27 June 2017 and was unannounced. The inspection was carried out by one inspector.

We did not ask the provider to complete a Provider Information Return (PIR) on this occasion. The PIR 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. We reviewed other information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law. We contacted the local authority commissioning and safeguarding teams as well as the local Healthwatch board for feedback on the service.

During the inspection we observed interactions between staff and people who used the service. We spoke with four people living at the home, the registered manager, the deputy manager, two registered nurses and four care staff. We observed the way people were supported in communal areas and looked at records relating to the service. This included four care records, two staff recruitment files, daily record notes, medication administration records (MAR), maintenance records, quality assurance systems, incidents and policies and procedures.

Updated 21 February 2018

This inspection took place on 26 and 27 June 2017 and was unannounced. Our last comprehensive inspection of the service took place in December 2016 where the home was found to be inadequate overall, with the safe, effective and well led domains being inadequate, requires improvement in responsive and good in caring. The provider was placed into special measures by the Care Quality Commission. We took enforcement action and issued three warning notices to the provider.

Following a serious safeguarding incident a focused inspection, looking at the safe and well led key questions, was carried out in March 2017. The service was rated as inadequate in both of these key questions.

After both inspections the provider sent us action plans detailing how they were going to make improvements to meet the Health and Social Care Act regulations. This inspection was carried out to check what improvements had been implemented since these inspections.

We found that whilst improvements had been made in some areas, for example staff training, the security of the building and monitoring people when they accessed the local community to help ensure they were safe, no improvements had been made in other areas. We found continued breaches in five Regulations with regard to fire safety checks, medicines management, the environment, the lack of service specific staff training for the needs of the people living at the service, staff supervisions, lack of activities for people living at the home and a lack of quality assurance systems used to improve the service provided by the home. We also found four new breaches with regard to the planning and provision of care and support to one person nearing the end of their life, staff not having the time or knowledge to provide 1:1 support around people’s anxieties and drug or alcohol use and for the registered manager retrospectively completing records for checks on the fire safety equipment. We are currently considering our options in relation to enforcement and will update the section at the back of the full version of this report once any enforcement has concluded.

We have also made a recommendation that Personal Emergency Evacuation Plans (PEEPS) should be kept in an easily accessible file that the staff can pick up in the event of an emergency so that the information in the PEEPS would be available for the emergency services.

Nada is a privately owned care home that is situated in the Cheetham Hill area of North Manchester close to a variety of local shops and other community services. The home is registered to provide nursing care and accommodation for up to 28 people who may have a combination of mental health and personal care needs. At the time of our inspection there were 20 people living at the home.

The provider was also the registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. The day to day management of the home was delegated to the deputy manager and clinical lead. However the clinical lead was the designated nurse on duty when working and so did not have time as supernumerary to the rota to complete their other tasks.

At the time of our inspection in December 2016 the deputy manager had been off work, returning shortly after our inspection. At this inspection we were told the deputy manager worked five days each week. The registered manager was available to be contacted if required but did not regularly attend the home.

The service had tried to reduce the amount of smoking that took place within the building. Staff had completed on line and taught courses in fire awareness. The fire safety checks log book had been completed each week by the registered manager up until May 2017. A note then stated a member of staff would complete the checks. None had been completed since this date and neither the registered manager nor deputy manager had checked to ensure this delegated task had been done. The registered manager had also retrospectively made entries in the fire log book for the period 7 September to 12 December which were seen to not have been completed at our inspection in December 2016.

Staff told us they had completed a range of training courses since our inspection in December 2016. More training was planned. However the service supported people with a history of drug and alcohol abuse and mental health issues. Some staff had received training in these areas in 2013, but they had not completed refresher training and so the training was not current. Additionally staff who had joined the service since 2013 had not received any training in these areas so did not have an insight into the needs of the people who used the service. Records showed care staff did not have supervisions, although some nurses and domestic staff had.

No action had been taken to improve the activities provided at the service. People told us an entertainer occasionally visited the home. The care staff member whose role was to organise activities had left the service and no one had taken over this role.

The environment required re-decorating and upgrading. We saw one bedroom with a broken radiator cover and walls with different shades of paint on them. Walls were marked and scuffed. A few pieces of furniture had been purchased since our last inspection. One room had a strong odour, due to the person’s incontinence, which affected the surrounding corridor and bedrooms. No referrals had been made for specialist continence services. Staff cleaned the room as best they could but the odour persisted.

Care plans and risk assessments were in place and had been written for people accessing the community independently. However an end of life care plan for one person had not been written for three weeks after their discharge from hospital on palliative care. The care plan was written after a safeguarding had been raised by a social worker. The person had been found to be dirty and they did not have a pressure relieving mattress in place. During our inspection the person was seen to be comfortable, clean and with a suitable mattress.

Care plans did not contain sufficient detailed guidance about what support the care staff needed to provide and what people were able to do for themselves. One to one sessions identified in people’s care plans to reduce people’s anxiety or to discuss their alcohol consumption did not take place.

Medicine Administration Records (MARs) were seen to be fully completed. Protocols for any ‘as required’ medicines had improved. They included how the person would communicate, either verbally or non-verbally that they needed the ‘as required’ medicine to be administered. However we noted one person’s Fybogel medicine had run out and had not been re-ordered for six days, meaning this person did not receive their prescribed medicines for this period. A code had been entered on the MAR stating the Fybogel had been offered but not administered, which was not possible as it was out of stock.

Since our focused inspection keypads had been fitted to the external doors. Staff knew when people were leaving the building. A record was made of where they were going and when they were due to return to the home. Staff and people we spoke with liked this system as it made them feel safer.

Staff had a clear understanding of who had capacity to access the community on their own and who required staff to support them. Contingency plans were in place in case a person did not return at the agreed time. Care plans were in place where staff held cigarettes or property on behalf of people living at the service.

The registered manager and deputy manager did not have a robust quality assurance system in place. Only three care plans had been audited since our inspection in December 2016, no spot checks on the environment had been completed, records such as the fire log book and deep clean records had not been checked.

Residents meetings were held and surveys conducted but it was not clear what action had been taken as a result of these. One person said they did not feel able to make a complaint about the service as they would be told to leave.

Incidents and accidents were recorded and reviewed by the deputy manager. People received support with their nutritional needs.

Staff files showed a system of recruitment was in place; however this had not been followed in one instance as only one reference had been obtained.

The overall rating for this service remains ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration