Archived: St Wilfrid's Hall Nursing Home

St Wilfrid’s Hall 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.

St Wilfrid's Nursing Home is situated in the small village of Halton-on-Lune, just north of Lancaster. The home has many historic features and is set in its own extensive grounds. Accommodation is provided on the ground and first floors. There are three lounges, a separate dining room, plus additional seating areas in the hall and on the first floor landing. The bedrooms all have a wash basin, with the majority having en-suite facility of a toilet and hand wash basin.

At the time of the inspection there was no manager who was registered with the Care Quality Commission (CQC). There was an interim manager who was supported by senior management. We were informed by senior management and the interim manager that a manager had been appointed and they were awaiting their recruitment checks to be completed. They explained it was intended that the newly recruited manager would apply to the CQC to become the 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.

The inspection was prompted by information of concern that people who lived at the home were not supported safely, staffing was not arranged to meet people’s needs and equipment was not available to prepare meals. In addition, we were informed there was no hot water in some bedrooms, paperwork was not always up to date and people had no toiletries to use.

We also used this inspection to check improvements had been made since our inspection in August 2017. At our last inspection in August 2017 we found two breaches of regulation. Staffing levels at the home were not sufficient to provide support people required and people were not always supported safely. We issued Requirement Notices for these breaches in Regulation. We also noted improvements were required in the safe management of medicines. We made a recommendation about this. The service was rated as Requires Improvement.

Following the inspection in August 2107 we asked the registered provider to take action to make improvements for the areas we had noted. The registered provider was required to send the CQC an action plan, outlining how they intended to make improvements. This was not provided to us.

At this inspection in June 2018 we found people were not always supported in a safe way. Two people had had accidents as a result of staff not following safe moving and handling guidelines. We noted equipment was not always used safely to support people’s skin health and staff did not report when people had not reached their individual fluid targets. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

People told us they had to wait for support if they asked for help. We observed this during the first day of the inspection. We timed call bells and found these were not always answered quickly. Relatives told us their family members sometimes had to wait for support and staff told us they did not always have time to respond to people quickly. This was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Documentation was not consistently reflective of people’s needs. Care plans did not always contain accurate information to enable staff to give person centred care. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Medicines were not always managed safely. We noted one person had their medicines after they had food. This was in contradiction to the medicines instructions which said they should have their medicine a specific time before food was given. Medicine administration records (MAR) were not always an accurate reflection of a person’s medicine and a barrier cream was not available for a person to use. In addition, we noted a person’s medicine total on a MAR record did not match the total of medicine left and fridge temperatures were not consistently monitored. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

People were not always protected from inappropriate response from staff. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

People were not always lawfully restricted of their liberty. We noted some people without mental capacity used equipment to maintain their safety. Applications to lawfully deprive people of their liberty had not been submitted to the Lancashire Local Authority in a timely way. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We looked at recruitment records. We found one prospective staff member had gaps in their employment. There was no record to show this had been discussed with them and the reasons for them leaving their last place of employ had been explored. We also saw the previous manager for St Wilfrid’s had provided them with a reference as they had worked with them at their previous place of employ. This was not a previous employers reference and there was no risk assessment to show how any risks were to be managed. This was a breach of Regulation 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Care planning had not always been carried out to ensure people’s needs and preferences were met. People could not be assured their individual preferences were recorded or that care planning would take place to help them live with behaviours which may challenge. This was a breach of Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Audits and checks carried out at St Wilfrid’s Hall Nursing Home had not identified some of the issues we identified on inspection. This was a breach of Regulation 17 of the Health and Social Care Act (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.

We discussed our concerns with the interim manager and operational director. They took swift action to address the concerns we had identified. Staffing was increased, additional audits were carried out and we were informed investigations would be carried out where this was appropriate.

Staff told us they were supported to attend training to maintain and increase their skills. During the inspection we saw training was taking place. We spoke with the regional trainer who confirmed there was a training plan to ensure staff skills were developed. We have made a recommendation about the training at the home.

We received mixed feedback on the food provision at the home. Some people told us they felt it could be improved. Other people told us they liked it. Everyone told us they had a choice of meals to choose from and we saw people were offered more if they wanted it. We saw people were given the meal of their choice and staff were available to help people if they needed support. There was equipment available to cook meals.

We found the environment was clean and we observed staff wearing protective clothing when required. This minimised the risk and spread of infection. There was hot water available in all areas of the home and people had individual toiletries in their private bedrooms.

Staff spoke fondly of the people they supported and said they wanted to enable people to live a happy life. We observed moving and handling techniques and saw these were carried out with patience and compassion. People were not rushed and staff offered reassurance as they supported people.

Relatives told us they were consulted and involved in their family members care, however this was sometimes led by them. People we spoke with confirmed they were involved in their care planning if they wished to be.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care provided at St Wilfrid’s Hall Nursing Home.

There were meetings held for relatives to raise any concerns or compliments and express their views. Surveys were offered to people to capture their views on aspects of the service provided.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure which was used in practice to investigate people’s complaints. People we spoke with told us they had no complaints, but they if they did these would be raised to the interim manager or staff.

There was documentation to record people’s end of life wishes. We spoke with one person who confirmed they had been given the opportunity to discuss this, however they had decided they did not wish to do so.

People’s privacy and dignity was protected when they received personal care. We observed staff knocking on doors and bathroom doors were closed when people were supported.

We found staffing levels the service had in place were not sufficient to provide support people required. Some people who lived at the home and their visitors told us they had to wait a long time when they needed assistance. We observed call bells often went unanswered for long periods of time and staff were not always available when people needed them.

This was breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed to meet people’s needs.

We found people had not always been supported safely when being transferred with a sling hoist. On three occasions people had received minor injuries including cuts to the nose and arm whilst being manually handled with a sling hoist.

This was breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure care and treatment had been provided in a safe way for people who lived at the home.

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and treated people with dignity and respect.

People who lived at the home and their visitors told us they were happy with the care provided. Comments received included, “The staff are really caring they will do anything for you.” And, “The staff very kind when they’re here.”

We looked at the recruitment of four recently appointed staff members including one registered nurse. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

The service had checked when recruiting nurses that they were registered with the nursing and midwifery council (NMC). These checks had been repeated regularly to ensure nursing staff were still registered with the NMC and therefore able to practice as a registered nurse.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

Staff spoken with had received safeguarding training and understood their responsibility to report unsafe care or abusive practices.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

We found medication procedures at the home were not consistently safe. Medicines were safely kept with appropriate arrangements for storing in place. When we arrived for our inspection visit we observed one person’s medicines had been prepared for administration and left unattended in a communal area. Although this was only for a short period the medicines were accessible to anyone walking past.

We recommend the registered provider reviews the services medicines procedures to ensure they comply with national guidelines.

The service demonstrated appropriate systems to assess risk for people living at the home.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff knew people they supported and provided a personalised service in a caring and professional manner. Care plans had information about people’s needs but were not person centred and we found it difficult to find information about people’s care. These were being reviewed and updated by a representative of the provider when our inspection took place.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We saw people had access to healthcare professionals and their healthcare needs had been met. The service had responded promptly when people had experienced health problems. A visiting healthcare professional told us staff were always receptive to advice given and worked closely with them.

People who lived at the home and their visitors told us they enjoyed a variety of activities which were organised for their entertainment.

The service had a complaints procedure which was on display in the reception area of the home. People we spoke with told us they knew how to make a complaint if unhappy.

The provider had systems in place to monitor the quality of service provided but they were ineffective at identifying and addressing the areas of concern we noted during the inspection visit.

People spoke positively of the care they received and described staff as, 'Compassionate, kind and caring'. One relative told us, 'The staff are brilliant and helpful, not only to **** but to me as well. They really care about people nothing is too much trouble no matter how busy they are'. One person living at the home said, 'I really do like it here, I only came for two weeks but I have never been home since. Alasdair (Registered Manager) came to see me and chatted about it and what went on and I said I was staying for no longer than two weeks. It's a good home I never thought I would like it to be truthful'.

Another person said that staff listened to what he was saying and acted on what he said. We were also told that the meals served were well cooked with plenty of variety with one person saying, 'The cook or another member of staff comes in every morning and asks me what I want for breakfast and dinner. Most of the things I eat and enjoy but if I didn't want what was on the menu, I would have something else.