You are here

Archived: Ainsworth Nursing Home Requires improvement

Reports


Inspection carried out on 20 February 2018

During a routine inspection

We carried out an unannounced inspection of Ainsworth Nursing Home on 20 and 22 February 2018.

At the last comprehensive inspection on 5 and 6 December 2016 the service was rated requires improvement. Whilst no breaches of the regulations were found the provider was asked to develop support systems for staff and checks to monitor and review the service needed embedding. At this inspection we found some improvements had been made, however monitoring of the service provision needed expanding upon.

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

Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. The building is a large, converted former hospital, based in the Ainsworth area of Bury, Greater Manchester. Accommodation is separated into two units; one providing general nursing and residential care and the second provides nursing care for people living with dementia. All rooms are situated on the ground floor and are easily accessible. At the time of the inspection there were 25 people living at the home.

The registered manager had recently left the service. Therefore there was no registered manager at the time of this inspection. However the provider had taken prompt action to appoint a new manager to the position. 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.

During this inspection we identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Effective systems to monitor, review and assess the quality of service were not in place to help protected people from the risks of unsafe or inappropriate care.

Robust systems were not in place to ensure people received their prescribed medicines safely.

Assessments and management of the environment need to be put in place so that potential risks to people are minimised.

Robust recruitment procedures were not in place to ensure the suitability of staff employed to work at the home. Sufficient numbers of staff were not always available at core times. Further recruitment was taking place so that better flexibility of support could be provided.

Further training opportunities were needed so that staff have the necessary skills and competencies needed to safely and effectively meet the needs of people living at the home.

We recommend the provider seeks advice from the Greater Manchester Fire and Rescue Service (GMFRS) about the safety and suitability of locks being used at the home particularly as some people were restricted from leaving the building alone. Relevant checks were completed with regards to fire safety. Arrangements had been arranged for an up to date fire drill to be completed.

Activities and opportunities were offered to people to help promote their health and wellbeing as well as maintain community links. Information in people’s ‘life story’ books were to be considered so that other opportunities could be introduced around people’s individual hobbies and interests. We recommend the provider also refers to current guidance when developing opportunities for people.

Suitable arrangements were in place for the recording and responding to any complaints or concerns. People and their visitors were not aware of the procedure in place but said they would speak with the manager or staff and felt confident their concerns would be li

Inspection carried out on 5 December 2016

During a routine inspection

This was an unannounced comprehensive inspection which took place on 5 and 6 December 2016. We last inspected Ainsworth Nursing Home on the 6, 7 and 8 June 2016. At that time the service was rated ‘Inadequate’ and placed in ‘Special measures’. Services placed in special measures are inspected again within six months, providing a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action. During this inspection we reviewed what progress had been made since our last inspection. We found the provider had made sufficient improvements to the service and had addressed the breaches in regulation. Therefore it was agreed that the ‘Special Measures’ would be removed.

Ainsworth Nursing Home is situated in the village of Ainsworth, in a rural position. Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. There were 20 people living there on the day of our inspection.

The manager of the service was registered with the Care Quality Commission (CQC). A registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

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

Some checks were being completed to monitor and review the service provided. Thorough oversight of the service and effective communication between the management team will help to ensure that robust systems are in place to sustain the improvements made so that people who use the service are protected.

Opportunities for staff training and development were in place. Staff we spoke with said they felt supported in their role. Through our discussion with the registered manager it was acknowledged that systems to support staff needed formalising. We have made a recommendation that opportunities for staff so that good practice is followed as well as promoting team building so that morale is improved.

Checks were being completed for newly appointed. The registered manager was aware all checks were required prior to staff commencing work ensuring their suitability for the position so that people were kept safe. Adequate numbers of staff were available.

We received lots of positive comments from people about their experiences and the care and support they received. Staff were described as being compassionate, caring and respectful towards people.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where people lacked mental capacity steps were taken to ensure decisions were made in their best interests.

Improvements had been made to ensure staff were aware of their responsibilities in protecting people from abuse. Staff spoken with demonstrated their understanding of the procedures and confirmed they had completed relevant training.

The management and administration of people’s medicines was safe and demonstrated people received their medicines as prescribed.

Care plans were person centred and contained good information about the current needs, wishes and preferences of people. Where risks had been identified, additional plans and monitoring had been put in place so that staff could quickly respond to people’s changing needs.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Where people’s health and well-being were at risk, relevant health care advice had been sought so that people received the t

Inspection carried out on 6 June 2016

During a routine inspection

Ainsworth Nursing Home was inspected on the 12 May 2015. The overall rating for this provider was ‘Inadequate’. This meant that it was placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use of enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The service was inspected again on 5 and 6 January 2016 when we undertook a further comprehensive inspection to see if improvements had been made since the service was placed in ‘special measures’. Multiple breaches of the regulations were found again and the condition to restrict further admissions to Ainsworth Nursing Home on the 14 September 2015, remained in situ. The service was rated as “requires improvement” with one domain rated “inadequate” and therefore remained in ‘special measures’.

This was an unannounced comprehensive inspection which took place on 6, 7 and 8 June 2016. We have rated the service as “inadequate” and therefore the provider remains in ‘special measures’. This inspection found that there was not enough improvement to take the provider out of ‘special measures’. CQC is now considering the appropriate regulatory response.

Ainsworth Nursing Home is situated in the village of Ainsworth, in a rural position. Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. There were 23 people living there on the day of our inspection.

The service did not have a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service has been without a registered manager since 1 February 2016 when we cancelled the previous registered manager due to their unfitness. The provider had promoted the deputy manager but they withdrew their application to register as the manager. A new manager had been appointed, however they had only been in post three weeks.

During this inspection we found continued and new breaches of the regulations. You can see what action we told the provider to take at the back of this report.

Staff members did not understand their responsibilities in relation to safeguarding people who used the service. During our inspection we found issues relating to the safe care and treatment of people that required a safeguarding alert to be raised with the local authority.

Staffing levels were not consistent with what we had been told by the manager. We found occasions when there were not the amount of qualified

Inspection carried out on 5 January 2016

During a routine inspection

This was an unannounced comprehensive inspection which took place on 05 and 06 January 2016. The service was last inspected on 12 May 2015 when we undertook a comprehensive inspection. Multiple breaches of the regulations were found and a condition was imposed on the provider’s registration to restrict any further admissions to Ainsworth Nursing Home. The service was rated as “inadequate” and placed into ‘special measures’. The condition to restrict admissions to the home remains in place and due to one domain being rated as inadequate from this inspection the service remains in ‘special measures’.

Ainsworth Nursing Home is situated in the village of Ainsworth, in a rural position. Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. There were 25 people living there on the day of our inspection.

The service did not have a registered manager in place at the time of our inspection. 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. There was a manager in place who had applied to CQC to register and their application was in progress.

During this inspection we found some improvements had been made to meet the relevant requirements, however continued breaches of the regulations were found. You can see what action we told the provider to take at the back of this report.

We found people’s care records were not as up to date or as accurate as they should have been, reflecting the current and changing needs of people so that staff were clearly directed in the delivery of people’s care.

Robust recruitment procedures had not been followed to check the suitability of people applying to work at the service.

Insufficient improvements had been made in relation to risk assessments. One risk assessment we looked at did not reflect the person had sustained four falls in recent times.

We saw there was no readily accessible guidance for staff in relation to the amount of thickener to be added to drinks for those people who required it. It was also identified that the majority of the prescribed thickeners were given by the care staff and not by the nurses who had signed on the MAR that they had given them.

We have made a recommendation in relation to water temperature checks and the frequency at which these are conducted.

We found improvements had been made in relation to fire safety, including the replacement of windows, staff training and fire drills.

We have made a recommendation in relation to the competencies of persons undertaking Portable Appliance Testing (PAT).

Records needed improving where ‘best interest’ meetings and decisions had been made for people who lacked the capacity to make decisions for themselves.

Records we looked at showed the confidentiality policy had been discussed with staff; however this was not adhered to by one member of staff who was overheard discussing the care and treatment of a person who used the service with another person’s visitor.

We saw some language used in care records was derogatory. We saw that people were sometimes referred to as ‘wandering’ or ‘wander some’. We also saw there was a ‘wandering’ policy in place.

We saw a range of activities were provided however, these were all condensed to the two days when the activities coordinator was on duty. We have made a recommendation in relation to the expertise of care staff in order to keep people who use the service stimulated and engaged.

We found that two specific incidents that should have been reported to us. We checked our records and found that we had not received any notification from the service to inform us of these.

Appropriate action had been taken to p

Inspection carried out on 12 May 2015

During a routine inspection

This was an unannounced comprehensive inspection which took place on 12 May 2015. The service was last inspected on 12 March 2015 when we undertook a focussed inspection to see if the provider had taken action against warning notices that were issued. We found some improvements had been made to meet the relevant requirements.

Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. There were 25 people living there on the day of our inspection.

The service had a registered manager in place at the time of our inspection. 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.

During this inspection we found risk assessments did not contain sufficient information to help guide staff in order to minimise the risks to people who used the service.

We found some bed rails did not have the correct protectors on to prevent people injuring themselves.

The provider did not have robust recruitment processes in place to ensure people using the service were kept safe.

We found that people who used the service did not have a Personal Emergency Evacuation Plan (PEEP) in place to ensure they were safely evacuated in an emergency situation.

A number of windows we checked throughout the service could not be opened as they had been painted shut.

The management, assessment and recording of medicines were not accurate and complete.

We found commodes were dirty, carpets were badly stained and linoleum was dirty and ripped.

We checked a number of taps throughout the service and found in one toilet there was no running water coming out of the hot tap. We also found that some bedrooms, a bathroom and a toilet did not have hot water.

Staff had not received all necessary training and support to carry out their roles.

Water/juice was not readily available for people who used the service to help themselves to.

There was a lack of signage to support people with dementia to orientate themselves to their surroundings.

One relative told us the environment was poor and in need of refurbishment.

Language used by staff when recording notes in care files was negative and not respectful of people who used the service.

There was a lack of meaningful activities within the service, in particular for people with dementia. One relative told us “we feel [relative] gets very little stimulation”.

People’s religious needs were not always met.

Complaints were not always documented or dealt with satisfactorily.

Care records were not accurate and did not reflect the care and treatment that was required or provided.

The registered manager had been practising as a registered nurse without legally being registered with the Nursing and Midwifery Council (NMC).

One person told us “I do not see eye to eye with the registered manager, they make me feel uncomfortable”. A relative also told us the registered manager was not easy to talk to and could be “very frosty” about people voicing concerns.

One staff member told us there was a significant lack of leadership within the home.

There was a lack of robust systems and processes in place to effectively monitor and improve the quality of the service.

Policies and procedures were inaccurate or out of date.

Records we looked at showed that staff had undertaken safeguarding training and were able to tell us how they would respond should they have any concerns.

Staff showed a good understanding of the needs of people they were supporting.

A new staff member spoke to us about their induction. They told us “It’s been good really, I’ve learned a lot”.

One person who used the service told us the staff were friendly and cheerful.

We observed people who used the service were treated with kindness and compassion.

Relatives we spoke with told us the staff made them feel welcome.

Service users we spoke with told us they knew who to approach should they wish to make a complaint.

Survey’s we looked at showed that most people were happy with the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve.
  • Provide a framework within which we use of enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Inspection carried out on 12 March 2015

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 12 November 2014. A breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 was found, which corresponds to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We served a warning notice because service users were not protected against the risks of inappropriate or unsafe care and treatment, by means of the effective operation of systems to regularly assess and monitor the quality of the services provided instructing the provider where improvements were needed.

As a result we undertook a focussed inspection on 12 March 2015 to follow up on whether action had been taken to address the warning notice.

Focused inspection of 12 March 2015.

The warning notice stated that the provider and manager must become compliant with this regulation by 16 February 2015. We undertook a focused inspection to check that they had met these legal requirements and found that they had made improvements, however the requirements were not fully met.

During this inspection we continued to have concerns in the following areas.

We looked at care records and found that there continued to be a lack of evidence to show the service involved people in the planning and reviewing of the care they received at Ainsworth Nursing Home.

We found that the manager lacked knowledge on issues around the Mental Capacity Act 2005 and involvement of people in the consent to their care and treatment.

We found that people who required positional changes due to the risk of pressure sores were not being repositioned as frequently as identified in their care records. We had previously raised our concerns regarding this in our warning notice. Due to our findings we raised a safeguarding alert with the local authority.

We found that the registered manager was continuing to address low staffing levels and had been advertising for registered nurses. We saw that two people were interviewed for vacant post during our inspection.

We found the care records on the general nursing unit were stored securely. However we noted that the care records on the dementia unit were in an unlocked filing cabinet in a communal reception area.

The registered manager had a new system in place for ensuring nursing staff employed by the service were currently registered to practice with the Nursing and Midwifery Council.

We found that people were being weighed on a regular basis and weights were documented in care records.

During our inspection we noted that most of the bedroom doors were closed to ensure privacy and dignity for people who used the service.

The registered manager had implemented a system for the recording of complaints and concerns brought to their attention.

We looked at the quality assurance systems that were in place in the service and found that these were being completed. However we found that medicine audits were not sufficiently robust to identify when errors had occurred and infection control audits were not being completed in full.

Inspection carried out on 12 November 2014

During a routine inspection

This was an unannounced inspection which took place on 12 November 2014. The service was last inspected in February 2014 when we found it to be meeting all the regulations we reviewed.

Ainsworth Nursing Home provides accommodation for up to 37 people who have nursing or personal care needs. There is a dedicated unit for people with dementia care needs. There were 33 people living in the home at the time of our inspection, 16 of whom were living in the unit for people with dementia care needs.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We were told by staff, people who used the service and relatives that there was a general lack of staff on the unit for people with a dementia. This was confirmed by our observations on the day of our inspection when we found staffing levels were insufficient to ensure people’s needs were met in a safe and appropriate manner. In addition, people on the general nursing unit did not receive their medicines as prescribed on the morning of our inspection due to a lack of nursing staff available to administer those medicines.

The systems to ensure the safe administration of medicines in the service were not sufficiently robust to ensure people who used the service were adequately protected.

All the people we spoke with who were able to express a view told us they felt safe living in Ainsworth Nursing Home. Relatives we spoke with were mostly confident that their family member was safe in the service. However, one relative was concerned about a recent fall experienced by their family member.

Staff had received some training in how to protect people who used the service from the risk of abuse. Staff were able to tell us of the correct procedure to follow should they have any concerns about the safety of a person who used the service. Staff were confident to report poor practice in the service and we found evidence that the whistleblowing policy for the service was effective.

Staff told us they enjoyed working at Ainsworth Nursing Home and considered they received the training and support they needed to effectively carry out their role. However, we found only senior staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS); these provide legal frameworks to ensure people’s rights are upheld. As a result of this lack of training care staff we spoke with showed a lack of understanding about the need to ensure inappropriate restrictions were not placed on people.

We found staff had not received adequate training or guidance in how to support people whose behaviour might challenge others. This meant there was a risk that people who used the service might be subject to unnecessary or inappropriate methods of restraint by staff.

We could not be confident from the records we reviewed that there was sufficient monitoring of people’s nutritional needs. Improvements needed to be made to ensure people who used the service could have access to drinks at times of their choice.

While people who used the service and relatives gave positive feedback about the attitude and approach of staff, on the day of our inspection we saw that not all staff interacted with people who used the service in a way which demonstrated care and compassion.

People who used the service told us they received care and support which met their needs. However, we found the information in care records needed to be improved in order to ensure people always received consistent care.

The service employed an activities coordinator. However, on the day of our inspection we observed there was a lack of meaningful activities for people who used the service. Although people who used the service did not make any comments about the activities available for them, relatives we spoke with told us they felt the level of activities provided in the service could be improved.

There were systems in place for people who used the service and their relatives to comment on the service provided at Ainsworth Nursing Home. All the people we spoke with told us they would be confident to raise any concerns with the registered manager.

Improvements needed to be made to the quality assurance systems in the service. Internal audits had not been completed for over three months. This meant there was a risk that the registered manager would not be able to identify where improvements needed to be made in order to ensure people who used the service always received safe and appropriate care.

Inspection carried out on 26 February 2014

During an inspection in response to concerns

People who use the service received care in a way that met their needs and preferences. During the inspection, we spoke with the relatives of two people who use the service. They told us they were happy with the care provided for their relatives. They also told us they visited the home regularly and the staff kept them informed if there were any changes to their relative�s care needs.

We found that the provider had processes in place to ensure people who use the service were protected from the risk of abuse. The people we spoke with told us that they had no concerns about the care they received. They told us that if they had any concerns or complaints, they would speak to the registered manager or contact external agencies such as the Care Quality Commission (CQC).

People were cared for by staff that had been through the appropriate recruitment checks. The people we spoke with told us they were happy with the staff. They told us the staff were fully aware of their relative�s needs. The comments received included �they are wonderful� and �the staff here are second to none�.

Inspection carried out on 24 September 2013

During a routine inspection

During the inspection, we spoke with four people who use the service and five visitors who were relatives of people using the service. They told us they were happy with the care being provided. The comments received included �I can�t fault the care here� and �I am satisfied with my relative�s care�.

We found that people were asked for consent and the provider acted in accordance with people�s wishes. People who use the service received care in a way that met their needs and preferences. People's care records contained enough information to show how they were to be supported and cared for.

We found the environment in the home to be clean, safe and well maintained. The people we spoke with told us they were happy with the staff. One person commented that �If I use my alarm button, they come quickly�. We found that people were cared for by staff that had been through the appropriate recruitment checks.

The people we spoke with told us they had no concerns about the care they received. The relative of one person commented that �I have no complaints; the staff do a good job�. We found there was an effective complaints system available, in case anyone wished to raise a complaint.

Reports under our old system of regulation (including those from before CQC was created)