Fleetwood Nursing Home

Fleetwood Nursing Home provides accommodation for persons who require nursing or personal care or treatment of disease, disorder, or injury. The service can support up to 30 older people, including those with mental health conditions. At the time of our inspection there were 20 people using the service. The property is set over 2 floors with lift access to the upper floor. There were several communal areas and a large rear garden for people to enjoy. Aids and adaptations were in place to meet people’s individual needs.

People’s experience of using this service and what we found

Relatives felt people were safe and the registered manager was responsive to concerns. However, fire safety measures were not always in line with guidance and some information conflicted. Potential environmental hazards also needed consideration. Records identified low levels of training in subjects required to keep people safe or meet individual needs. Whilst care records were detailed and risk assessments in place, appropriate mitigation was not always considered. The home had systems for the safe handling, storage and disposal of medicines and we saw good infection prevention and control practices.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We have made a recommendation around this.

Though audits and checks were in place, these were not always effective. A number of concerns around quality assurance, risks and regulatory requirements were identified during inspection and management monitoring had not picked this up. From observations, people seemed happy and relaxed. When asked what they thought of the staff, 1 person said, “I love them all, they are caring and look after me.” A relative told us they hoped to move into the home because their loved one was so happy and well looked after. People, relatives and staff were engaged through regular conversations, meetings and surveys. The team worked together or in partnership with others to achieve good outcomes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 16 January 2020). The service remains rated requires improvement. This service has been rated requires improvement for 3 consecutive inspections.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fleetwood Nursing Home on our website at www.cqc.org.uk.

Previous recommendations

At our last inspection we recommended that the provider improved deployment of staff and worked within guidance and best practice to improve quality monitoring systems. At this inspection staffing levels were better, but we still had concerns that best practice guidance was not always followed, and quality monitoring systems needed improving.

Why we inspected

This inspection was prompted by a review of the information we held about this service; to check if sufficient improvements had been made. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to risk management, staff training and monitoring and improving quality at this inspection. A recommendation has been made around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fleetwood Nursing Home is a care home providing personal care to 22 people at the time of our inspection. The service can support up to 30 older adults, some of whom may have mental health conditions. Bedrooms are of single occupancy over two floors, with passenger lift access. There are various communal spaces for people’s comfort.

We found the following examples of good practice.

¿ The registered manager implemented enhanced infection control procedures to maintain people’s safety during the pandemic. Staff had additional training and demonstrated a good awareness of practices, procedures and available guidance.

¿ Staff had access to good stocks of personal protective equipment (PPE) and were effectively trained in its use and disposal. Designated housekeepers worked very well with the care team in maintaining high standards in cleanliness and infection control.

¿ The registered manager reinstated visiting because they found lack of contact with relatives had a negative impact on people. The system was secure to retain everyone’s safety. A relative said, “[My relative] deteriorated in hospital without that family contact. Now she’s at Fleetwood Nursing Home we can see her and she has come on leaps and bounds. It’s wonderful.”

¿ Staffing levels were increased to ensure people were safe and their wellbeing was optimised. A staff member stated, “We have extra staff on so we’re not compromising the residents’ needs.”

¿ The management team completed multiple audits to oversee everyone’s safety and welfare. Staff and relatives spoke highly of the registered manager. A relative told us, “[The registered manager] is wonderful. I’m so grateful she’s there, I feel incredibly reassured.”

¿ When people were newly admitted to the home, staff and the management team followed national guidance. They created risk assessments to guide staff to people’s support needs.

Further information is in the detailed findings below.

Fleetwood Nursing Home provides support for people who require residential or nursing care. The home has two floors, a lift is available for access to both floors; some rooms are en-suite.

People’s experience of using this service and what we found

Systems were in place to monitor the quality and care people received. The management strove to be open and constantly develop and improve the support people received. However, some concerns identified on the inspection had not been recognised by the management. Additionally, there were some inconsistencies in documentation. We have made a recommendation around this.

People and staff told us there could be more staff to better meet people’s needs. We discussed this with the registered manager. We were assured staffing was under review and changes would be made where they are required. We have made a recommendation around this.

People appeared happy and comfortable around staff and their relatives told us they were happy and safe. Management had completed risk assessments to ensure people were protected from risks associated with their care. Where concerns were found during the inspection, the management was responsive and took immediate action to mitigate these. Systems were in place to show people's medicines were managed safely. We did find there were some areas of improvement in the paper work. Staff recruitment was safe. Staff were aware of their responsibilities in relation to infection control.

People we spoke with expressed their confidence in the staff and felt they knew their needs. People’s needs for nutrition and fluids had been considered. People were supported by staff to live healthier lives. The staff received training to help them in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We received positive feedback about care provided at Fleetwood Nursing Home from people who lived at the home and their relatives. We saw staff speaking with people in a respectful and dignified manner. People we spoke with told us they were offered a variety of choices, which promoted their independence.

People told us they felt staff were responsive to their needs. We saw people and their relatives had been involved in the planning and review of their care. People told us they were encouraged to give their views and raise concerns or complaints. Staff understood the importance of supporting people to have a good end of life, as well as living life to the full whilst they were fit and able to do so. People told us they were provided with stimulation and opportunities to join in activities.

There was a positive staff culture. We found the management team receptive to feedback and keen to improve the home. The registered manager worked with us in a positive manner and provided all the information we requested.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 19 December 2018). We found no breaches of regulation at the last inspection and we made no recommendations. However, we needed to see improved practice, sustained over time, in order to award a rating of 'Good'. The service has had a continued period of management instability. However, at this inspection we saw notable improvements had been made. At this inspection the service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will ask the provider for an action plan following this report being published to document how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fleetwood 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.

The service had a registered manager. 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.

This inspection took place on 02 and 04 October 2018 and was unannounced on the first day.

The last inspection of this service took place in January 2018. During that inspection, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), and Regulation 17 (Good governance). We also found a breach of Regulation 18 (Notification of other incidents) CQC (Registration) Regulations 2009, because the provider had not notified CQC of important events which affected the health and safety of people who lived at the home.

Following the last inspection, we met with the provider to discuss our concerns and asked them to complete an action plan to show what they would do and by when to improve the all the key questions to at least good. At this inspection we found the provider had made improvements in all areas. You can see more information about this in the detailed findings of the report.

However, as some key questions were rated as ‘Inadequate’ at the last inspection, although the provider has made improvements, we need to see improved practice, sustained over time, in order to award a rating of ‘Good’ for these key questions.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Staff assessed risks to the health and well-being of people who lived at the home and plans were put in place to lessen these risks. Environmental risk, for example around fire safety, had been assessed and appropriate plans put in place to lessen risks. The service promoted positive risk taking in order to help people maintain as much independence as possible.

The provider had systems to safeguard people against abuse or improper treatment. Staff had received training to spot abusive or inappropriate practices and knew how to report them. The service followed a robust recruitment process to ensure only suitable candidates were employed.

The service ensured a sufficient number of staff were deployed at all times. Staff recruitment and retention had improved and use of agency staff had decreased significantly. The registered manager reviewed staffing levels against people’s needs to ensure there were always enough staff.

The provider had systems which recorded any adverse incidents or events. We saw analysis of accidents and incidents was undertaken in order to make positive changes to reduce the risk of recurrence.

The service followed best practice in relation to the safe and proper management of medicines.

Staff had received training to reduce the risks related to the spread of infection. We observed staff follow good practice guidance whilst undertaking their duties. The home was clean and tidy during our inspection.

The service ensured staff had the skills, knowledge and a good level of support in order to meet people’s needs effectively. Staff received a thorough induction when they began working at the home, alongside additional training and regular supervision form senior staff.

People’s nutritional needs had been assessed and care planned in order to meet them. People’s specific dietary needs were monitored and catered for appropriately.

People’s needs and choices were assessed and care and treatment provided in line with current legislation and guidance in order to achieve effective outcomes for people who lived at the home. This included planning for end of life care.

Staff supported people to live healthier lives and to receive ongoing healthcare support. People were supported to attend appointments and healthcare professionals visited the home when required.

The service followed good practice guidance in relation to obtaining consent from people. Where people lacked capacity to consent, the service followed best interests processes, as outlined by the Mental Capacity Act 2005 code of practice.

We received consistently positive feedback about how caring the service was, including staff and management. People were able to make their own choices and express their views. People, their relatives and staff were actively involved in shaping the service delivered.

People who lived at the home enjoyed a variety of activities and trips out which were organised for their entertainment.

The provider had a complaints policy. People we spoke with, and their relatives confirmed they would have no hesitation in making a complaint and felt any concerns would be dealt with appropriately.

The provider had systems in place to assess, monitor and improve the quality of the service provided to people. We saw improvements had been made in all areas since our last inspection.

Fleetwood 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.

Fleetwood Nursing home was last inspected February 2016 and received an overall rating of Good. This inspection took place on 18 January 2018 and was unannounced. A further inspection site visit to conclude the inspection took place 01 February 2017 which was announced.

There was a registered manager in place during the first inspection visit. However the registered manager was not in post from October 2017 and had stepped down and de-registered as of 31 January 2018. There was a new manager appointed who had not yet registered with us. 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 asked the registered manager how they monitored accidents within the home. We were told all accidents were reported using accident forms. We reviewed the records and found no oversight of the accidents and no action taken following these to lessen the risk of accidents happening again.

We viewed three care records to look how risks were identified and managed. We found inconsistencies in individualised risk assessments and the plans in place to mitigate these. The documentation did not always contain information to adequately mitigate the risks to individuals.

From the documentation reviewed we saw fire safety equipment audits had not been completed at the home since September 2017. Therefore we could not be assured that the fire safety equipment at the home was safe, this put people at risk.

We looked at how the service managed medicines. We found that there were gaps in peoples records. There was no documentation in the care plan to guide staff around how the medicines should be given to individuals. We found people did not have support plans to guide staff when giving medicines which are taken “as needed”. Therefore staff did not have all the relevant and necessary information to give the medicines appropriately and safely.

We found people had been assessed for the use of moving and handling equipment. However, people did not have personalised equipment such as the correct slings in place.

The above matters were in breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2008 (Safe care and treatment).

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. We found people’s capacity to consent to care had not always been assessed and information was, at times, conflicting. For example, in one person’s care file their next of kin had signed for the consent to the service where the person’s mental capacity had not been considered. In another person’s care file the next of kin had given consent to medical treatment without the legal authority to do so. The MCA stipulates that if a person lacks capacity to consent to a decision then a best interests process needs to be carried out. Therefore the correct processes had not been followed.

This failure to follow the MCA code of practice amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent.)

We spoke with the registered manager to assess their understanding of their responsibilities regarding making appropriate Deprivation of Liberty Safeguards (DoLS) applications. We noted people had bed rails in place. We asked the registered manager if DoLS applications had been made regarding the use of the rails. The registered manager told us they had not.

We found staff were able to tell us about safeguarding principles and recognised signs of possible abuse. However, they did not always put this knowledge into everyday practice. For example, we found not all safeguarding incidents had been appropriately reported to the relevant authorities, in line with current legislation and the policies and procedures of the home.

The above matters amounted in a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2008 (Safeguarding service users from abuse and improper treatment.)

We reviewed five care files and found people’s current needs were not always identified. Care plan information was not always an accurate, complete and contemporaneous record. Person centred information in care files was inconsistent.

The above concerns amounted to a breach of regulation 9 (Person centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We asked the management and registered provider to tell us how they monitored and reviewed the service to make sure people received safe, effective and appropriate care. We found the service did not have a robust quality auditing system.

The inconsistencies we found across the service also demonstrated the lack of oversight from the registered provider. From the evidence we found during the inspection it was apparent the leaders in the home lacked the knowledge to ensure the home was run effectively. The registered manager informed us that they were mainly working as a nurse on the floor.

These shortfalls in leadership and quality assurance amounted to a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Providers of health and social care services are required to inform the Care Quality Commission, (CQC), of important events that happen in their services. The registered manager of the service had not informed CQC of significant events as required. This meant we were unaware of the events and could not check appropriate action had been taken.

This was in breach of Regulation 18 (Notification of other incidents) CQC (Registration) Regulations 2009.

We found there was no staff dependency tool in place at the home. A tool such as this helps determine the amount of staff that are required to ensure people’s needs are met. We have made a recommendation about this.

We walked around the home to check it was a suitable environment for people to live. There was very little signage to orientate people in the home. We have made a recommendation around this.

You can see what action we told the provider to take at the back of the full version of the report.

People were protected by suitable procedures for the recruitment of staff. The registered provider had carried out checks to ensure staff had the required knowledge and skills, and were of good character before they were employed at the home.

During the inspection visit we observed staff as they went about their duties and provided care and support. We saw staff speaking with people who lived at the home in a respectful and dignified manner.

Staff had a good understanding of protecting and respecting people's human rights. Some staff had received training which included guidance in equality and diversity.

We observed lunch being served, we saw some people who had difficulty cutting their food being offered support to eat their meal. We observed people eating in a relaxed manner and they enjoyed their meals. Comments about the food included, “The food is always very good, there is always a good choice.”

There were activities for the residents to engage in and people were supported and encouraged to take part. One person told us, “There is entertainment through the week.”

The overall rating for this service is '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 or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection we asked for some urgent action to be taken to mitigate some of the concerns which were highlighted. We found the whole staff team receptive to feedback and keen to improve the service. They worked with us in a positive manner and provided al

Fleetwood Nursing Home provides care for people who require residential or nursing care. The home has two floors a lift is available for access to both floors, some rooms are en-suite. Registered for 30 people. The home is located near Fleetwood town centre. Car Parking is available at the front and side of the home. At the time of the inspection visit there were 23 people living at Fleetwood Nursing Home

A registered manager was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection of the service in April 2014, we found the provider was meeting all the requirements of the regulations inspected.

During this inspection people told us they felt safe at Fleetwood Nursing Home. There were sufficient numbers of staff deployed to meet people’s needs and provide a flexible service. We found a registered nurse was on duty 24 hours a day.

The registered manager had systems in place to check people’s safety, including the safe management of accidents and incidents. Staff demonstrated they had a good understanding of protecting individuals from potential harm or abuse. Staff we spoke with told us they had received training in safeguarding adults.

We observed people’s medicines being administered at lunch time. They were dispensed in a safe manner and people received their medicines on time. Nursing staff only gave out medicines. The registered manager and local pharmacy had carried out checks to ensure processes were completed safely.

The home was maintained, clean and hygienic when we visited. No offensive odours were observed by the inspection team. People we spoke with said they were happy with the standard of accommodation provided.

The registered manager had completed an assessment of people’s support and nursing needs. This was before they moved into the home. People who lived at the home said they were happy with their care and support provided to them by caring staff. One person said, “Lovely staff.” Also, “I feel safe here.”

Safe recruitment procedures were in place and appropriate checks made before new staff commenced their employment. Sufficient staffing levels were in place to provide support and nursing care people required.

Staff told us access to training courses was good and training records we looked at confirmed this. Staff told us they were encouraged by the registered manager to further their skills by obtaining professional qualifications.

People who lived at the home were happy with the variety and choice of meals available to them. The service employed cooks who prepared homemade meals and comments were positive about the quality of food. Regular snacks and drinks were available between meals to ensure people who lived at the home received adequate nutrition and hydration.

We found examples where the service had responded to changes in people’s care needs. We found evidence in records where referrals had been made to external professionals.

People who lived at the home were encouraged and supported to maintain relationships with their friends and family members. People told us they were also encouraged to take part in activities of their choice. One person said, “We have singers come in now and then I enjoy that.”

Staff we spoke with had a good understanding of how people should be treated in terms of respect and supporting people with dignity. We observed examples of staff respecting people’s privacy and dignity.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were comfortable with complaining to staff or management when necessary.

The registered manager and owner used a variety of methods to assess and monitor the quality of the service. We looked at a number of audits that were undertaken by the registered manager and owner. This ensured the service continued to be monitored and improvements made when they were identified.

People were supported to feed back about the quality of their care through meetings and one to one discussions. The registered manager was looking at ways of formalising meetings for people who lived at the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff supporting them, relatives and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Fleetwood Nursing Home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required. The manager said, 'This training is ongoing for all staff to complete.'

People were treated with respect and dignity by the staff. People told us they felt safe. One relative said, 'Mum is well cared for here I am confident she is kept safe and looked after by caring staff.' Relatives we spoke with said their family members were receiving safe and appropriate care which was meeting their needs. One said, 'I come here often and take mum out, there is no place better.'

The environment was safe, clean and hygienic. Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk. Records we looked at confirmed this. One staff member said, 'It is important to ensure all checks are carried out on the building and fire safety equipment is up to date.'

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care where possible. Relatives views were also sought to ensure people receive the right care to meet their needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

The manager and staff members we spoke with had an awareness of people's care needs. We discussed with staff the individual needs of people and one said, 'We all get involved in the care plans so we have a good understanding of each individual.'

Is the service caring?

We spent part of the day observing staff interaction with residents. People were supported by kind and attentive staff. We saw staff and the manager showed patience and gave encouragement when supporting people. Comments from people living at the home included, 'I cannot fault the place it feels like home. The manager and staff are always checking to see if we are ok. They are wonderful.'

Is the service responsive?

People completed a range of activities in and outside the home regularly. We saw evidence of daily activities in place and delivered by various staff. They were in the process of employing an activities co-ordinator to support people to undertake chosen interests and activities. One resident we spoke with said, 'I do like to go out in the summer and if there are enough staff around I do. Also my family take me out often.' Another resident said, 'The violinist is really good I do enjoy entertainers when they come into the home.'

Is the service well-led?

We had responses from external agencies including social services .They told us they had a good working relationship with the manager and staff to make sure people received their care and support they required.

There were a range of audits and systems put in place in by the manager and provider to monitor the quality of the service being provided.

During the inspection we looked at care planning, recruitment and staff induction training records. We also observed care practices during the day and talked with residents and relatives about the home. Comments were positive and included from relatives, 'This has to be the best place around. ' Also, 'I come and see mum twice daily and I am very picky. However I have to say this place is brilliant the staff and manager are so caring.'

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved people to ensure they received the right care and support. One resident we spoke with said, 'Yes I am asked about my health and how I would want staff to treat me.'

There were a range of audits and systems in place to monitor the quality of the service being provided.

Prior to our visit we contacted Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

During our inspection we looked at care records and the homes staff duty rota. We did this to confirm people were well supported and staffing levels were sufficient to meet peoples needs. Residents and relatives we spoke with said they were receiving safe and appropriate care which was meeting their needs. They told us the staff were polite, caring and respectful when undertaking their work. Comments received were all positive and included:

'The staff are wonderful'.

'No complaints the staff are kind, helpful and nothing is too much trouble.'

'When I need help I press the alarm and I never have to wait more than a moment or two.'

'Plenty of staff around to make me feel safe and comfortable.'

A relative we spoke with said, 'No complaints the people are so friendly and helpful my husband could not be in a better place.'