Archived: Nethercrest Residential Home

The provider had failed to ensure that staff had the qualifications, competence, skills and experience to keep people safe and ensure people were protected from harm. This resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to ensure there were sufficient numbers of suitably qualified, competent and skilled staff to meet people's care and welfare needs. This resulted in a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to ensure that all people using the service have given consent before any care or treatment is provided. This resulted in a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to ensure people using the service were treated with dignity and respect at all times. This resulted in a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to ensure there were effective systems of governance, including assurance and auditing systems or process to assess, monitor and drive improvement of the quality of service provided. This resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to notify the Commission of authorisations with regard to DoLS, as is required by law. This resulted in a breach of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations 2009 (Part4) Notifications.

Following the last inspection, we met with the provider to discuss our concerns and asked them to complete an action plan to show what actions they would take and by when, in order to improve the ratings of the key questions of Safe, Effective, Caring, Responsive and Well Led. We also imposed conditions on their registration which required them to provide us with information, on a monthly basis, outlining actions taken and improvements made. At this inspection, we found improvements were being made, but there still remained work to be done in a number of areas.

Nethercrest Residential 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.

At the time of the inspection there was a manager in post who had recently been recruited and was in the process of submitting an application to become 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.

People felt safe and were supported by staff who were aware of the risks to them and how to manage those risks. Staff were aware of their responsibilities to raise any safeguarding concerns. A dependency tool was in place to ensure staffing levels were based on people’s individual needs. Health and safety checks were in place to ensure equipment was safe to use. People received their medicines as prescribed but administration of medication was not consistently recorded. Accidents and incidents were reported, recorded and acted upon but information was not routinely analysed to ensure lessons were learnt.

Systems were in place to observe staff practice and training had been sought to ensure staff were provided with the skills to meet people’s needs effectively. Where people were deprived of their liberty, the appropriate applications had been made, and staff routinely obtained people’s consent prior to supporting them. Staff were not fully aware of who was being deprived of their liberty and further work was required regarding the recording of this information.

People’s dietary needs and preferences were catered for and people were supported to make choices at mealtimes. Drinks were readily available to ensure people remained adequately hydrated throughout the day.

Staff were aware of people’s particular healthcare needs and how to support them to maintain good health. People were supported to access a variety of healthcare services.

Improvements had been made to the environment and this had created a more homely atmosphere. There was a programme of works in place and this was ongoing. Where maintenance work was required, systems were in place to ensure this was completed in a timely manner.

People described staff as kind and caring and were treated with dignity and respect. Staff supported people to make choices regarding their daily living and where possible, encouraged people to retain some form of independence.

Care records continued to be reviewed in order to provide staff with more information and guidance to meet people’s needs. Systems were being developed in order to involve people in the development of their care records. People were supported to take part in activities but there was recognition that this was an area for improvement and an action plan was in place to address this.

There was a complaints process in place and where complaints had been received, they had been responded to appropriately.

There was an improvement in the management oversight of the service. People were complimentary of the manager and the improvements that had taken place since the last inspection. Staff felt supported and listened to and were provided with the training and support to meet people’s needs. Audits were in place to assess the quality of the service but there was a lack of analysis of information in some areas which would help drive improvement. People’s opinion of the service was sought and action taken in response to concerns and suggestions made.

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.

Nethercrest Residential Home is registered to provide accommodation and personal care to a maximum of 43 older people who may have a diagnosis of dementia. At the time of the inspection there were 41 people living at the home.

The inspection was a responsive comprehensive inspection and was taken to follow up on serious concerns that had been brought to our attention by the provider and a whistle-blower with regarding to Nethercrest Nursing Home which shares a site with the residential home. These concerns included people sustaining fractures, people being dehydrated and having unexplained bruising. Due to the severity of these concerns, we took the decision to also inspect Nethercrest Residential Home. We have also shared this information with partner agencies.

There was no registered manager on site during our inspection visits, as they were on leave on the first day of our inspection. One the second day of our inspection we found the registered manager had been dismissed from their 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. Nethercrest Residential Home was being run by a new manager, who had been in post for two days on the first day of our inspection.

At our last inspection in September 2016 we rated the home as ‘Requires Improvement’. We found staff did not always manage risks to keep people safe, that there were not always enough staff available in communal areas, that staff training was not always up to date or specific to meet the needs of the people being supported. We also found that staff did not always know how to support people in line with Deprivation of Liberty Safeguards (DoLS) and there were no systems in place to ensure people’s dietary requirements were being met. In addition, there was no registered manager in post at that time and audits completed to monitor the quality of the service had not identified the issues raised at the inspection.

We found similar issues on this inspection. Improvements to the service had not been made and there had been a further deterioration in the quality and safety of care people received. We found that people were not cared for safely and were at risk of harm. We identified two safeguarding concerns at the home during our inspection visit and these were referred to the Local Authority.

People were supported by insufficient numbers of staff with the right skills and competencies to meet their needs. Occupancy levels had increased but staffing levels had remained the same. People’s dependency levels had been assessed, but some of the information recorded was incorrect and was not used to assess staffing levels in the home. People had been admitted to the home with complex needs and staff were not provided with the training, guidance and support on how to support these people safely and effectively.

Staff practice was not observed and management could not be confident that people were being supported safely and in line with their assessed needs. A lack of effective management and deployment of staff meant that people were not always supported in a timely way.

People were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and DoLS. This meant people were at risk of being unlawfully deprived of their liberty. The provider had failed to notify CQC when authorisations to deprive people of their liberty, had been made.

Accidents and incidents were not consistently recorded and there was no analysis of events taking place that would ensure lessons were learnt and risks to people were reduced. Professional advice was not always sought in response to people’s changing needs.

People were not always treated with dignity and respect and the environment did not promote people’s dignity.

Care records did not provide staff with the information and guidance required to meet people’s needs. People were not routinely enabled to contribute to their care plans that would enable them to live their lives as they wished.

There was a lack of management oversight by the provider to check delegated duties had been carried out effectively by the registered manager. Staff felt unsupported and not listened to. Quality assurance systems in place had failed to identify a number of concerns that were found during the inspection. Information collected in audits including accidents and incidents, safeguarding concerns and complaints were not analysed for any trends.

Relatives and some people were happy with care provided and were satisfied with the service received. However, other people were not happy with the care and level of service provided.

Because of our concerns, we have rated the home ‘Inadequate’. This means the legal requirements and regulations associated with the Health and Social Care Act 2014 were not being met. The overall rating for this service is ‘Inadequate’ and the service has been placed 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 there is not enough improvement and there is still a rating of inadequate for any key question or overall, we will consider the action we need to take in line with our enforcement procedures, to bring about improvement. This could include action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration and, if needed, could be escalated to urgent enforcement action.

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.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Nethercrest Residential Home is registered to provide accommodation and personal care to a maximum of 43 older people who may have a diagnosis of Dementia. At the time of the inspection there were 41 people living at the home.

There was no 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. The home was being managed by a deputy manager and an acting manager from the provider’s sister home. Both managers were present during the inspection.

Staff did not always manage risks to keep people safe. Guidance available for staff on how to support people where risks are posed was not always clear. People were supported by staff that had undergone checks to ensure they were safe to work but these checks had not been updated for staff who had worked with people for a number of years. People had their care needs met in a timely way but there was a lack of staff available in communal areas for people. Medication was given as prescribed but where concerns around the storage of medication were found, these had not been acted upon. Staff knew how to report concerns to safeguard people from abuse.

People were supported by staff who understood the need to seek people’s consent but where people had Deprivation of Liberty authorisations in place, staff were not always aware of what these were and how they should support people in line with these. Staff were given an induction prior to starting work and had been given training to ensure they could support people effectively. However, this training had not always been updated and training specific to people’s needs had not been provided. Staff did not have access to regular supervisions with their manager. People were supported to have enough to eat and drink. However, there were no systems in place to ensure that all staff were aware of people’s dietary needs. People were supported to access healthcare services where required.

People felt that staff were caring. People were given choices although not all staff communicated effectively with people to ensure they could express their wishes. People were treated with dignity and supported to maintain their independence where possible. People were able to be involved in reviews of their care if they wished. Staff knew people’s needs well and understood how to support people in line with their preferences. There were on going activities available for people. People were aware of how to make complaints if required.

People knew who the acting manager was and felt able to approach them. Staff understood the current management structure and felt supported by the deputy and acting manager. Audits had been completed to monitor the quality of the service but these had not been effective in identifying the issues we found at this inspection. People were given opportunity to feedback on their experience of the service and their suggestions were acted upon by the manager.