Archived: Nydsley Residential Home

Updated 19 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, looked at the

overall quality of the service, and provided a rating for the service under the Care Act 2014.

You can find full information in the detailed findings sections of this report.

We carried out an unannounced comprehensive inspection on 17 December 2015. This inspection was completed to check that improvements had been made to meet the legal requirements identified at the inspection of 4 June 2015 and the previous inspection of 11 November 2014.

Prior to our inspection we reviewed the information we held about the service. This included any safeguarding alerts and outcomes, complaints, previous inspection reports and notifications that the provider had sent to CQC. Notifications are information about important events which the service is required to tell us about by law.

Before the inspection we had attended or received minutes of meetings arranged by the local authority and attended by representatives of the local authority safeguarding team, the local authority contract and commissioning team and the local Clinical Commissioning Group (CCG)

The inspection was carried out by two inspectors.

We spoke with four people who used the service, two relatives, a visiting professional, the registered manager, and two members of staff during the course of our visit.

We looked at ten people’s care records, three people’s in detail to see how their care was assessed and planned. We reviewed how medicines were managed and the records relating to this. We checked three staff recruitment files and the records kept for staffing rotas, training and supervision. We looked at records for the management of the service including quality assurance audits, action plans and health and safety records.

Updated 19 April 2016

We last inspected this service on 4 June 2015 where we found continued breaches relating to:

Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2014 – Staffing. The provider had failed to protect people against the risk associated with not providing appropriate training, supervision and appraisal for staff working at the home.

Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2014 – Good Governance. The provider failed to protect people against the risks of inappropriate care and treatment by not having systems in place to regularly assess and monitor the quality of the service and to identify, assess and manage risks.

We used our enforcement powers and served warning notices against the provider in respect of Regulations 18 and 17.

We also asked the provider to take action to make improvements to the shortfalls identified. The provider sent us an action plan telling us about the actions to be taken and that the improvements would be completed by 1 November 2015.

This inspection took place on 14 December 2015 and was unannounced. This inspection was carried out to look at the five questions, is the service safe, effective, caring, responsive and well-led and to follow up on whether action had been taken to deal with the breaches. At this inspection we found some improvements had been made but found further breaches in regulations.

Nydsley Residential Home provides personal care and accommodation for up to 14 people. The home is owned by Mr and Mrs Hall. Mrs Hall is the registered manager of this service. 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. Nydsley Residential Home is a large detached property in its own grounds. Accommodation is provided on two floors with a stair lift for people to use to get to the upper floors. There is a small car park for visitors to use.

The feedback we received from relatives of people who used the service was positive. They were very satisfied with the quality of the service their relatives received. This view did not correspond to our findings in a number of areas.

At times during the day there were insufficient staff on duty to ensure people’s safety and welfare. This is a breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staffing.

There were general risk assessments in place relating to the safe running of the service and also individual risk assessments for some people who used the service. However, the risk assessments relating to people lacked detail about mitigating against risk and failed to assess the balance between risk and people’s independence. For some people there was no risk assessment completed where risks had been identified. This is a breach of Regulation 12. Safe care and treatment. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People received their medicines at the times they needed them, however, some aspects of the storage, recording and administration of medication placed people at risk. We observed people’s medicines were left unattended and there were insufficient checks recorded where people were prescribed medicines outside of the usual medicines cycle. This is a breach of Regulation 12. Safe care and treatment. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some staff had received training with regard to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. However, where people lacked capacity, the restrictions that staff and the provider had put in place may amount to depriving some people of their liberty but an application under the Mental Capacity Act Deprivation of Liberty Safeguards had not been made as required. This is a breach of Regulation 11 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Need for Consent.

Although we observed staff demonstrating kindness and respect during the inspection, we found derogatory and judgemental language used in people’s care records and were concerned how this reflected on the culture and atmosphere at the service. We observed that, although people did not express any concern, there was little choice offered throughout the day. The culture we observed did not enhance opportunities for people to have their emotional social needs and enjoyment of life addressed. This is a breach of Regulation 10. (Dignity and respect) of the Health and Social Care Act 2008 (regulated activities) Regulations 2014.

Prior to people being admitted to the service a preadmission assessment was completed to ensure the service was able to meet the person’s needs. There was a new care planning format in place and we saw some good detail about people’s needs, their likes and dislikes and their social history. However, these were not sufficiently personalised and were not always being met in practice. Care plans lacked evidence of people being involved in determining how they wished their care and support to be provided. They related more to tasks to be completed rather than how to meet people’s individual needs, and choices and their well-being and enjoyment of life. This is a breach of Regulation 9 (Person centred care) of the Health and Social Care Act 2008 (regulated activities) Regulations 2014.

We found some improvements to auditing and monitoring systems of the service. However, they were not sufficiently detailed to facilitate an analysis of the findings and the development of improvements. The registered manager worked alongside staff and as such worked ‘hands on’. This gave them little time to concentrate on management tasks and keeping up to date with new legislation and good practice. This meant the service failed to have a culture of continuous improvement. This is a (continuing) breach of Regulation 17 (Good Governance) The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 from the inspection carried out on 11 November 2014.

The overall rating for this provider is ‘Inadequate’. The means the service has been placed into ‘Special Measures.’ The purpose of special measures is to:

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

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

3. 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.

Although staff had received training with regard to safeguarding adults and were able to demonstrate an understanding of the issues, the policies and procedures available did not reflect up to date legislation and guidelines.

The provider had systems in place to ensure new staff were recruited safely, this included carrying out appropriate checks to ensure people had not been barred from working with some groups of people. No new staff had been recruited since the previous inspection.

The service was clean and staff had access to personal protective equipment such as gloves and aprons.

Since the previous inspection a training programme had been put in place and all staff had received updated training. Although we were told the content of training had been discussed in the staff team, more formal systems to monitor competency and understanding of training would be beneficial in ensuring staff could demonstrate appropriate skills and knowledge in relation to the people they cared for.

Although there was no choice of menu people’s food preferences were known and accommodated. People were very positive about the food provided with particular reference to everything being ‘home cooked’. However, identified nutritional risks were not always appropriately managed.

The service is an older, adapted property with a purpose built extension and as such some areas of the home were not as easily accessible as others. We were told by the registered manager that this was considered when people expressed an interest in coming to live at the home. We discussed the increasing number of people living at the home who lived with dementia and the need to improve the environment to make it more dementia friendly, with the use of signage for example.

People’s bedrooms were personalised and visitors to the home were encouraged and welcomed. The provider arranged for entertainers in the home but there was a lack of daily activities provided by the staff team, either for a group of people or for individual interests.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is considering the appropriate regulatory response to resolve the problems we found.