Archived: Audlem Country Nursing Home

Updated 25 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 checked 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 took place on 14 and 17 May 2018 and was unannounced. The inspection team included one adult social care inspector, two assistant inspectors, a specialist nurse advisor and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We reviewed all the information we held about the service including statutory notifications which are notifications of events the provider is required to tell us about by law. We reviewed information from stakeholders and Commissioners about the service.

We spoke with five people who were living at the home, three relatives/friends, six staff, we case tracked four people which is where we review all of the records for a person living at the home, a short observational framework {SOFI} was undertaken which is a tool used to make observations when people have difficulty talking with us, we made other observations, checked two staff files and reviewed other records. We visited one person in their self contained flat which was in the grounds of the home. The person was receiving a service and was being supported by staff from the home.

The provider confirmed they had sent letter to inform everyone who lived at the home that they were closing Audlem Country Nursing Home in September 2018 and were moving premises.

Updated 25 July 2018

On the last inspection we found multiple breaches of the regulations in Regulation 11 Consent, Regulation 12 Safe Care and Treatment, Regulation 17 Governance and 20A Failure to Display the rating on the website. On this inspection we found improvements had been made however, the provider remained in breach of Regulation 12 Safe Care and Treatment due to medicines not always being managed safely and we made a recommendation regarding Regulation 11 Consent of the Health and Social Care Act Regulations {Regulated Activities} 2014.

We asked the provider to send us an action plan following the last inspection on 12 and 13 October 2017. This had not been sent to us so we asked the provider when we met with them to provide us with their action plan which they then provided. Despite this the provider had implemented actions to drive improvements.

Audlem Country Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is set within a rural area of the village of Audlem. There were 33 people living at the home at the time of our inspection. The original building dated back to 1640. There were self-contained flats within the grounds of the care home where people were receiving regulated activity.

Medicines management systems were reviewed. We found Pro Ra Nata [PRN “as and when prescribed medication”] protocols were not in place when they should have been. The provider therefore, did not meet the requirements of the Regulation 12 Safe Care and Treatment.

We checked if the service was safe and we found improvements had been made. Risks were being recorded and reviewed and the comments we had previously made that related to the safety of the premises had been mitigated by the provider.

Recruitment practices were safe with the appropriate checks undertaken by the provider.

The premises were clean and we could see a cleaning rota in place for all areas of the home. The flooring had been replaced and the fire safety concerns had been resolved since the last inspection.

Staff we spoke with were able to explain the different types of abuse and were clear about their responsibilities of reporting alleged abuse. Staff were aware of whistleblowing procedures.

We viewed rotas and made observations and found the staffing levels within the home were sufficient in meeting people’s care needs.

Care plans were being reviewed. Not all care plans were in place or reflected the care being provided such as for delivering one to one care.

Aspects of person centred care were evidenced in some care records but improvements were needed to ensure everyone who received a service had person centred care.

The provider demonstrated they were inclusive of people who had diverse or complex care needs in line with equality, diversity and human rights.

We found staff were caring and respected people’s choices, preferences and independence. We found people’s dignity was not always being upheld such as stained bed linen which had not been replaced.

Consent and the implementation of the Mental Capacity Act 2005 framework had improved and the provider was no longer in breach of Regulation 11 Consent.

People received enough to eat and drink but improvements were needed such as to ensure people received food in a timely manner when food was warm. Due to the design of the building and restricted access from the kitchen, food could not be transported on a heated trolley.

New systems had been implemented to ensure the provider was seeking people’s views. We viewed questionnaires which people had completed and their relatives.

An activities coordinator worked within the home for two days each week. We received feedback this was not sufficient for people and more activities were needed to ensure people were receiving enough stimulation. We observed activities during our inspection and a trip out for two people living at the home.

There was a complaints process in place and we could see a system of dealing with them by the provider.

Policies were in place and some required review due to there being several policies for dealing with incidents and behaviours which were challenging. This meant it was unclear which policy was being followed when dealing with incidents.

Governance systems had improved with monthly audits now in place. Not all audits such as the medication audits had identified an issue we found on this inspection and these were therefore, not robust enough.

The provider had two website links at the time of our inspection, one of which did not clearly display the rating. This was raised on this inspection and the provider promptly corrected this.

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.