We carried out this unannounced inspection on 20 and 21 September 2018.Daleside Nursing Home is a three-storey building situated in Rock Ferry, Wirral. The home is registered to provide residential and nursing care for up to 43 people. This includes accommodating up to 22 people in receipt of transfer to assess care. Transfer to assess care enables people, once medically fit, to be discharged from hospital into a care home setting on a short-term basis. During this time a multidisciplinary team of health professionals assess people’s ongoing care and support needs prior to them being discharged home or into another community care setting. At the time of our inspection there were 33 people living at the home, two of which were in hospital and an additional two people arrived at the home during our inspection.
The home had a registered manager who is also the registered provider. 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 registered manager was unavailable at the time of our inspection, although we did speak with them over the phone. Therefore, the deputy manager assisted us with our inspection.
During our last inspection in April 2016 we found that the home was performing well and was rated good overall. During this inspection we found that there had been a significant deterioration in standards at the home. We identified breaches in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because the home had failed to ensure the premises were safe as the maintenance and cleanliness at the home was poor and the home had failed to adequately monitor, assess and improve the quality and safety of the service provided.
Prior to our inspection we received concerns about hygiene and cleanliness at the home which had been identified by the local infection prevention and control (IPC) team during their visits to the home in August 2018. These concerns included poor basic cleaning standards, stained mattresses and linen and faeces marks on an en-suite bathroom wall. Following the IPC team’s visit they provided some additional training for staff at the home.
We noted that the home had taken some steps to address the concerns raised, such as amending domestic working hours, shift patterns and cleaning schedules and replacing equipment and furniture that was no longer safe to use. However, during our inspection we found that standards of hygiene and cleanliness at the home were poor and had not improved despite input from the IPC team. We saw several examples of this throughout our inspection. However, the most concerning related to the home’s clinical waste room. This room contained a macerator and commode pot washing machine, equipment used to dispose of incontinence pads and cleaning commodes. We found that both of these machines had broken several days before our inspection. During this time staff had continued to stack bags full of used incontinence pads in this room. We saw several used commode pots stacked up, one of which was smeared with faeces. A clinical waste bin in this room was also smeared with faeces and there was an open bag in a bucket containing faecal matter.
Health and safety information and records of environmental checks carried out were not easily accessible. At the time of our inspection the home’s maintenance person was on leave and staff at the home were unable to assist further. The records we were able to review were unspecific and not up-to-date.
We found that parts of the home had not been maintained properly. For example, in the yard area to the rear of the property there was a collection of disused chairs, shower chairs, a sofa and mattresses which had not been disposed of.
Overall, medication was correctly administered, stored and recorded. However, we found that some people living at the home required emollient creams to be applied by staff. We saw that staff had applied and recorded the application of these creams. However, there was no adequate risk assessment, and no policy or documentation in people’s care plans describing risks associated with the use of paraffin based emollients or how to mitigate these risks.
We saw that there was a lack of evidence to show what food and drink people were supported to have outside of the regular mealtimes. We observed that food and drink was not easily accessible to people throughout the day.
We found that wound care and pressure area care at the home was good and well-managed. This included liaison with the tissue viability nurse (TVN) when necessary.
Staffing levels at the home were sufficient to meet the basic needs of the people living there. However, we saw that people sometimes had little or no interactions with staff for long periods of time. The range of activities and things for people to do was also limited.
Quality assurance and audits were in place but were not always effective, as the environmental concerns that we saw during our inspection had not been identified and addressed.
We also found that the home failed to store people’s personal information securely. For example, we saw a pile of care records dating back several months in the unlocked staff room. This room also contained an unlocked cabinet full of care files for people who had previously lived at the home.
We saw there were policies and procedures in place to guide staff in relation to safeguarding adults and whistleblowing. All of the staff we spoke with were able to tell us who they would contact both internally and externally if they were concerned about a person living at the service.
Staff were recruited safely and they were appropriately supported with an induction process at the start of their employment. We saw that staff had received suitable training to carry out their job role effectively. Staff had had supervision and appraisal meetings. The registered nurses had appropriate checks of their registration with the Nursing and Midwifery Council (NMC).
We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed by the service. We saw that the service carried out appropriate capacity assessments when necessary. Deprivation of Liberty Safeguard (DoLS) applications had been appropriately submitted to the Local Authority and there was a clear system in place to closely monitor and renew them when needed.
People living at the service had personalised care plans and risk assessments. The care plans we looked at were regularly reviewed by staff and, where possible and appropriate, the people, their relatives and other relevant health professionals were involved in the process of reviewing this information.