When we carried out a comprehensive inspection of Swinton Hall Nursing Home on 05 and 06 April 2017 we found the service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance, and Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe care and treatment.
We then carried out a focussed inspection on 07 June 2017 and a pharmacist who is a medicines inspector with CQC visited the home to see if the necessary improvements had been made to ensure that people were protected from the risks associated with the safe handling of medicines. At that inspection we found continuing concerns regarding medicines management and the service was still in breach of this regulation.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this comprehensive inspection on 06 and 07 December 2017 we found medicines were still not being administered safely.
During this inspection, we also found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regard to receiving and acting on complaints, good governance, staffing, fit and proper persons employed. We are currently considering our enforcement options in relation to these breaches.
Swinton Hall 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.
Swinton Hall Nursing Home is a privately owned nursing home and is within easy access to the cities of Salford and Manchester. The home is registered to provide accommodation with personal and nursing care for up to 62 people across two units. The home has a 15 bed continuing care unit to support people with complex nursing needs. At the time of the inspection there were 42 people using the service with 11 people residing in the continuing care unit, 18 people in the ground floor and upstairs nursing units and 13 people occupying residential beds.
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.
Medicines were not always handled or administered safely. Effective systems for the safe administration and storage of drink thickeners were not in place, which placed people at risk of harm. Records regarding the administration of moisturising or barrier creams were not always completed and this meant people’s skin might not be cared for properly. Although medicines had been audited, these had failed to identify the continuing issues we found during the inspection regarding the unsafe management of medicines.
The provider had a process of staff recruitment in place but this was not consistently followed for every staff member. One staff member had been recently recruited but did not have a specific job role identified and references supplied were insufficient. The manager also confirmed this staff member had also not received any formal period of induction.
A staff vacancy of ‘unit lead’ in the main nursing unit of the home had not been replaced and attempts at recruiting to this role had been unsuccessful. The registered manager was unclear why this had happened, and how to ensure that it did not happen again. As a result the registered manager was engaged in clinical nursing activities which detracted from their ability to undertake the registered manager role.
The home had a management and staffing structure but not all job roles had been filled. This meant there was a lack of appropriately skilled staff deployed which resulted in the registered manager being unable to ensure effective oversight and governance, due to being involved in clinical tasks.
Building cleaning schedules were in place and the premises were clean and tidy and there were no malodours. Staff wore appropriate personal protective equipment (PPE) such as gloves and aprons as required.
The provider had failed to submit statutory notifications to CQC regarding applications/decisions for when a person was deprived of their liberty (DoL). Information received from a best interest assessor during the inspection indicated DoLS applications were not submitted in a timely way and information in applications submitted was poor.
People we spoke with and their visiting relatives agreed that staff were kind and compassionate and thought staff treated them with respect. However we observed people were left alone in the communal lounges on many occasions and this was particularly apparent when staff were engaged in supporting other people.
Some people’s needs and care plans had been reviewed and updated but this was not consistent. This meant we could not be confident their needs and the risks associated with them had been identified and managed. It was not always possible to determine how often people needed support to change position as this was not detailed on all people’s turning charts.
There was no clear identification of people with end of life care needs which meant they may not be supported in ways that reflected their current medical condition and personal preferences. This could result in insufficient care being provided which could undermine people’s dignity and preferred choices.
The manager acknowledged the home had received complaints but these had not been recorded properly and therefore we could not determine the nature and number of any complaints received since February 2017 and if these had been responded to correctly.
The home has been rated as requires improvement since 2015 and the provider had failed to improve the overall rating of the home from 'requires improvement' over time. The expectation would be that following the previous 'requires improvement' rating, the provider would have ensured the quality of care received had improved and attained a rating of either 'good' or 'outstanding' at this inspection. This had not been the case, as we found the quality of service provided to people living at the home was not continuously improving over time.
We identified significant shortfalls in the care provided to people at the home. This was linked to ineffective governance arrangements and leadership both by the provider, and through the management arrangements in place at the home. Audits were not up to date and day-to-day clinical and operational leadership of staff was inadequate. The provider had failed to provide sufficient oversight to recognise and respond to emerging issues identified at this inspection.
Shortly after the date of the inspection the provider contacted us to inform us they had taken the decision to close the home. Following this we attended a meeting with the provider, the clinical commissioning group (CCG) and local authority commissioners to identify the next course of actions and expectations of the service regarding the closure process. It was agreed a high level action plan would be drawn up by the provider to mitigate the risks identified at the inspection during the closure process.
Salford adult social care and Salford CCG made direct contact with all the people living at Swinton Hall and their families to identify wishes and needs and help find alternative suitable care home places. This took place in close co-operation with the owners of Swinton Hall to ensure the service continued whilst ensuring a smooth and safe transition for all the people living there. CQC also worked together with Salford local authority regarding the situation, in line with the joint national guidance on care home closures.