Archived: Kearsney Manor Nursing Home

Updated 10 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by concerns raised with the Care Quality Commission (CQC) by whistleblowers, regarding staffing levels. We visited the service at 7am to check that there was enough staff available at night.

This inspection took place on 4 April 2018 and was unannounced. Two inspectors and an expert by experience carried out the inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The provider completed a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We looked at the previous inspection reports and any notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.

We spoke with the registered manager, a clinical lead, the head of care, three care staff and two senior carers. We spoke with two visitors and three relatives. We looked at ten people’s support plans and the associated risk assessments and guidance. We looked at a range of other records including three staff recruitment files, the staff induction records, training and supervision schedules, staff rotas and quality assurance surveys.

During our inspection we spent time with the people using the service. We spoke with 18 people. We observed how people were supported and the activities they were engaged in. Some people were unable to tell us about their experiences of care. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection we shared our concerns with the local safeguarding and commissioning teams.

Updated 10 July 2018

This inspection was completed on 4 April 2018 and was unannounced.

Kearsney Manor 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.

Kearsney Manor provides accommodation and nursing care for up to 47 older people who have nursing needs and who may be living with dementia. The bedrooms are located on two floors and accessed by a lift. There are communal rooms on each floor. The gardens are well maintained with scenic views and parking is available. On the day of the inspection there were 44 people living at the service.

There was a registered manager in post. 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 last inspected Kearsney Manor on 4 and 5 April 2017, we found ongoing breaches of the regulations and the service was rated ‘Requires Improvement’ in all domains. There was a lack of sufficient guidance for staff to follow to show how risks were mitigated including when supporting people with behaviour, moving people and managing health conditions. There was a lack of safe and effective systems to ensure that people's medicines were managed as safely as possible. There were not enough staff to meet people’s needs. People were not always treated with dignity and respect. Checks and audits were not effective. Feedback from people and staff had not been used to improve the service. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Although the provider had made improvements regarding treating people with respect they The provider had not met all of the previous breaches of regulations and further breaches were found.

When people first moved into the service a ’14 Day Care Plan’ was completed, which contained basic information regarding how to support people. Staff told us these were updated as and when staff knew more about people, however, we found that they were in place for several months after people had moved in. Although this was completed with people and their loved ones these 14 Day Care Plans lacked essential information to ensure people received the support they needed. For example, one person was living with epilepsy and their care plan contained no information regarding this. They had experienced seizures whilst living at the service, but staff were unable to tell us what the person’s seizures may look like or when they should seek further medical advice. The person had been prescribed emergency medicine when they had a seizure, but no one was trained to administer this.

Risks relating to people’s care and support were not effectively managed. Some people’s skin was damaged and they used pressure relieving equipment. There was a lack of oversight regarding this equipment and we found multiple instances where it was not set correctly, leaving people at risk of their skin breaking down further. Similarly, some people used oxygen, and there was a lack of oversight regarding the cleaning of people’s oxygen filters, and this was not consistently happening as required.

Staff did not always recognise and report incidents that had left people at risk of harm. People had become trapped in their bedrails, and although nursing staff had recorded this in their handover document the registered manager had not been informed, and no one had recognised the potential seriousness of these incidents. No action had been taken to reduce the chance of it happening again. The registered manager did not collate and analyse accidents and incidents to look for trends or patterns.

Medicines were not managed safely. When people came to live at the service, they were requested to bring their medicines from home, until the service was able to order medicines from the GP. One person had been given medicine bought in from home, that they were no longer prescribed or needed. Staff had not always followed procedures for medicines with specific storage and administration requirements. Staff had handwritten some people’s medication administration records (MARs) and these had not been checked to ensure they were correct. Staff had not taken action when the temperature where medicines were stored was too high. There were no charts to show staff where to apply the creams, how often and sign to record when they had.

We started our inspection early, at 7am as we had received concerns from whistleblowers that there was not enough staff at night. Although we found that there was enough staff to meet people’s basic care needs, people told us that during the day they were bored and there was not enough staff to keep them engaged. Staff were kind and cared about people, however they were focused on ensuring people’s basic needs were met and as such were task led. There was no activities co-ordinator and therefore a lack of formal activities occurred day to day. Information was not always presented to people in an accessible format.

The provider’s vision for the service was to, ‘Provide a warm homely and caring environment, where staff feel valued and we acknowledge and embrace the uniqueness of each resident, whose individual physical, emotional and spiritual well-being needs are met.’ Although this was the case, people did not always receive person-centred care. Staff used one person’s thickening powder for everyone who needed their fluids thickened, even though this was individually prescribed. People were not using incontinence aids designed for their individual needs as they were waiting for continence assessments to be completed.

Only one nurse and the registered manager had been trained to administer a syringe driver, which is used to administer medicine to keep people pain free at the end of their life. There was a risk people may have to wait to receive this medicine if these members of staff were not immediately available.

The provider and registered manager lacked oversight. This was the first nursing home that the registered manager had run. Checks and audits had failed to identify the shortfalls found at this inspection. People, relatives, staff and stakeholders feedback had been sought in January 2018, and although this had been analysed many of the issues we identified, such as a lack of staff to ensure people were engaged had not been rectified, four months on. Staff were not always recruited safely. The registered manager had failed to notify CQC of important events that had happened in the service, as required by law. Complaints were documented and responded to in line with the provider’s policy.

The registered manager had sought advice from the local safeguarding and commissioning teams and worked with them closely. They had listened and acted on any advice given, however, this had still not ensured compliance with the fundamental standards and regulations. Staff had sought advice from a range of healthcare professionals when people’s needs had changed, to support people to live healthier lives.

Care staff had received the training they needed to carry out their roles. Staff received regular supervision and an opportunity to reflect on their role. The registered manager had recently introduced a new role to assist people to eat and drink throughout the day. Food appeared home cooked and appetising.

The registered manager had applied for Deprivation of Liberty safeguards when people were unable to consent to living at the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Since our last inspection the service had renovated to increase the communal space available for people to enjoy. The building had been adapted to meet people’s needs, including a large lift and specialist bathrooms. The service was clean and people were protected from the spread of infection.

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 dem