Archived: Ennerdale Nursing Centre

A registered manager was not in post at the time of inspection since approximately September 2015. ‘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.

We found people were not safe in the care home. We were concerned people who were prescribed thickeners for their drinks were not being given the appropriate amount of thickener. As a result of this we were concerned people were at extreme risk of choking or not being able to consume the drink and at risk of dehydration.

We spoke to the managers about our concerns and sent safeguarding referrals to the local authority to ensure all the people who were prescribed thickeners in their drinks were safeguarded.

The service lacked good governance as we found systems were failing to monitor care and encourage improvement. We met with the managers of Bupa following our inspection and expressed our concerns and that improvements were required to ensure people were safe. We returned to the care home on 28 January 2016 to monitor any progress made since our inspection on 14 and 15 January 2016 and found the system of administering prescribed thickeners was still failing people. The service had demonstrated a failing to robustly reassess their systems in place in order to determine what the failings were to correct them and improve. We found the service was unable to mitigate the risks for people when we pointed them out. We were concerned that the service did not have adequately skilled staff to effectively implement a safe system and the lack of improvement was continuing to place people at risk of harm or death. Concerns raised at the inspection should have been highlighted within the service itself through quality assurance checks and audits of systems, however they were not. Therefore, the service demonstrated an inability to identify risks which were placing people at risk of harm, neglect or death through inadequate governance.

We looked at people’s care plans and found that information pertaining to the individual person didn’t include their background, interests or preferences and so information about the person was incomplete and not person centred. We observed people’s needs were not always being considered with one person lying on their left side despite written instructions above the person’s bed stating ‘do not turn me onto my left side whilst I am in bed’. People who had suffered a stroke and were unable to move themselves in bed, were reliant on staff to position them on their unaffected side. By staff not adhering to this, there was a risk of people sustaining further injury.

We couldn’t ascertain when the care plans had last been reviewed or if the information had been updated in accordance with the changing health needs of people receiving care. Therefore, we could not be sure the information in the care plans was either current or accurate. This meant that staff may not have the required information to meet people’s needs. We looked at positioning and weight charts and found that people were not always being turned or weighed as advised by health care professionals. One person had the incorrect positioning chart in their room which belonged to another person. This was brought to the attention of the manager and the quality assurance manager. Another person had been assessed by a health professional dated 23 October 2015 advising that the person requires a weight recording every second week. We could only see one weight recorded since then documented on 22 November 2015. This led us to believe that advice given by health care professionals was not always being followed which may then lead to people not being cared for effectively placing people at risk of harm.

There were systems in place to try to ensure that medicines were given appropriately but these systems were not being followed or being monitored. This raised concern whether the systems in place were fully effective in ensuring people requiring medicines were receiving their prescribed medication at the appropriate times or at the appropriate dosages. There were inconsistencies in the systems of administering creams on both floors within the care home. We found creams in people’s bedrooms which were not labelled and therefore we couldn’t be sure who the cream was for. This presented a risk of creams being contaminated if staff were applying the same cream to more than one person or of applying a cream to the wrong person. Staff were unable to locate creams for people and did not have a system in place to ensure people’s prescribed creams were securely stored. In one person’s room we observed a tin of prescribed thickener with the lid open which posed an infection control/contamination risk to the person who it was prescribed for.

There was not enough staff at the home to meet people’s needs. We spoke with qualified and unqualified staff as part of our inspection. All the staff we spoke to demonstrated during conversation that they had a caring nature and manner. However, some staff said they were short staffed and were unable to provide the care people required all of the time.

We looked at staff recruitment files and found an induction process had been followed. Staff had not received regular supervision or appraisals. Staff told us they had received training on the Mental Capacity Act but the staff we spoke to were unable to articulate what the mental capacity act is. The care plans included a mental capacity form related to consent to care and treatment which had tick boxes for staff to tick if a person had capacity or not or whether it was variable. We found inconsistencies in the documentation we looked at regarding a person’s mental capacity and we only found one person with a decision specific mental capacity assessment and evidence that the best interest’s process had been followed.

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 our 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.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager. Staff members had received training in safeguarding awareness, the Mental Capacity Act [MCA] and Deprivation of Liberty Safeguards [DoLS]. This meant staff members were trained to recognise potential abuse and safeguard people's welfare.

People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were assessed and managed.

Regular checks were carried out on the home environment and on equipment used to support people. This assured us that the provider was maintaining and a safe and well maintained home environment.

Accidents and incidents were being recorded appropriately and appropriate action was taken in response to incidents. Accidents and incidents were monitored for patterns as part of the provider's checks on the home.

Is the service effective?

People's needs were assessed prior to them moving into the home. Care was then planned and delivered in line with people's assessed needs.

People received the care and support they required to meet their needs and maintain their health and welfare. Checks were in place to constantly monitor and review the care that people received to make sure it was the right care and support which met their needs.

Is the service caring?

People who lived at the home told us staff were caring and respectful. People's comments included: 'The staff are very nice, I can't complain at all' and 'It's very good here I am well looked after.'

Staff told us they were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity. We saw that staff were respectful and warm in their interactions with people who lived at the home.

Is the service responsive?

The service worked well with other agencies and services to make sure people received their care in a joined up way. GPs and other health professionals were referred to promptly when people required support with their health care needs. A number of visiting health professionals gave us good feedback about the home and told us staff had carried out their instructions appropriately.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on practice and seeking the views of people who lived at the home.

The service was managed in a way that ensured people's health, safety and welfare were protected.

The provider held regular meetings for staff members which ensured they were kept aware of their roles and responsibilities. Supervisions and appraisals were held for staff members which enabled them to raise any issues they had.

The findings of our inspection are based on our observations and the views of people who used the service, relatives and staff. We found that staff on the nursing unit 'Stannonought' were very busy in trying to meet the needs of the people who used the service and as a result people were left unattended in the communal area for long periods of time. Therefore people who used the service were at risk of not receiving the care and support they required as staff were not readily available to observe them and meet their needs.

The findings of our inspection are based on our observations and the views of people who used the service, relatives and staff. People's views were that there were areas of the home which were not sufficiently staffed. We found that people were left unattended in communal areas for significant periods of time. Therefore people who used the service were at risk of not receiving the care and support they required as staff were not readily available to observe them and meet their needs.

We observed thorough cleaning of various parts of the nursing centre during our visit and were informed by several staff members of the robust procedure to be followed in the event of any infection outbreak.

We found robust recruitment processes were in place and all pre-employment checks had been carried out in line with requirements which ensured people were cared for by staff who were fit and qualified to carry out their roles and responsibilities.

During our visit, we saw evidence of the quality assurance systems that were in place which ensured people using services received safe, appropriate care, treatment and support which met their identified needs and requirements.

We used a number of different methods to help us understand the experiences of the people who used the service. This was because most people using the service had complex needs which meant they were not able to tell us their experiences. Three people who were using the service did however comment about their experiences, we spoke individually with nine relatives of people using the service and we spent time observing the support provided by staff.

People living at the home gave us good feedback about their care and support. People's comments included; "The staff are really good they have always looked after me well' and 'Fantastic I couldn't ask for better care'.

Relatives gave us positive feedback about the home and said they felt the standard of care had been very good. However, more than half of them told us staff had little time to sit and talk to people or to engage in activities with them because they had always been so busy attending to people's care needs.

Everybody we spoke with told us they had no concerns about the way people had been treated at the home and they told us they were confident that people were safe. They told us they knew how to complain and would do if they needed to.

A new manager had been appointed at the home approximately six weeks ago. People provided us with positive feedback about the manager including: "She is very good, fair and approachable", "I know I can talk to her about anything" and "Excellent, gets the job done".