Archived: Finney House Also known as London and Manchester Healthcare (Deepdale) Limited

Finney House is a nursing home providing accommodation and personal care for up to 96 adults. There were 41 people living at the service at the time of the inspection. Some of the people lived with mental health needs, dementia and required support with their physical needs.

People’s experience of using this service and what we found

People and their relatives told us they felt safe and protected from the risk of abuse and avoidable harm by staff who understood how to recognise, respond and report concerns. While some improvements had been made to the management of medicines, practices were not always safe and further improvements were required. The provider and their manager had improved their systems to ensure people’s clinical needs were identified, monitored and safely met. Risk assessments were in place to monitor and minimise the potential risk of avoidable harm to people during the delivery of their care. People were supported by staff who had been safely recruited. Staff had received training and guidance in the prevention and control of infections including COVID-19.

Arrangements for staff supervisions needed to be improved to follow best practice guidance. We made a recommendation about staff supervisions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s consent was sought however some improvements were required and the manager took immediate action to address them. People's care and support had been planned in partnership with them, their specialist professionals and their relatives where possible. Staff had received training that was suitable to meet the needs of people in the home and the induction and support of new staff had improved.

People and their relatives shared positive comments about the caring nature of the staff team. They said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. There had been a focus on monitoring and supporting people’s personal care, hygiene and dignity.

People received person-centred care, which was responsive to their needs. Care records reflected people’s needs and had been reviewed when people’s needs changed. Staff supported people with meaningful activities. People's individual communication needs had been assessed. The registered manager dealt with people's concerns and complaints appropriately. People received dignified end of life care.

The provider made improvements to the quality monitoring, governance and leadership arrangements which contributed to driving improvements at the home. The provider and staff worked hard to improve people’s experiences and to address shortfalls found at the last inspection. Comments from relatives included; "They seem to be heading in the right direction for sure we can see a difference". The provider audited various areas of people’s care however, they needed to sustain the changes they made and to continue to monitor areas of improvement including medicines management and seeking consent. The service worked in partnership with a variety of agencies to ensure people received the support they needed. Staff were positive with how the service was managed and the culture and morale within the staff team had improved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was inadequate (published 27 October 2021) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations 9, 10, 11,13, 17 and 18. The provider remains in breach of regulations in relation to medicines management.

This service has been in Special Measures since 27 October 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on our inspection scheduling.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Finney House is a nursing home providing accommodation and personal care for up to 96 adults. Finney House accommodates people across four separate units, each of which has separate adapted facilities. Two of the units specialise in providing care for people living with dementia. There were 72 people living at the service at the time of the inspection.

People’s experience of using this service and what we found

People and their relatives gave us mixed responses in relation to their safety and care approaches at the home. Some relatives felt their relatives were not safe and some felt they received safe care. Our observations and findings showed that people did not always receive safe care and treatment. Safeguarding concerns had not always been shared with relevant authorities. People did not always receive their medicines safely to manage their conditions which led to poor outcomes. Clinical risks to people were not always adequately monitored and records of care and did not accurately guide staff on what actions they were to take. Some people had been exposed to poor experiences and outcomes due to poor risk monitoring. Risks associated to weight loss, pressure care, self-neglect and infections needed to be improved.

The governance systems at the home had not been adequately implemented to protect people from risks and to promote a person-centred approach and the delivery of safe and high-quality care. Audits identified shortfalls but these were not always addressed in a timely manner and repeatedly carried over in some instances. Staff gave mixed responses regarding the culture and management style in the home and there was low morale. There was a lack of robust clinical oversight to ensure the clinical risks were continually monitored to prevent deterioration. There had been a high turnover of managers, however there was a new leadership team which had established community links with local health and social care services.

People were not supported by adequate numbers of suitably qualified staff to reduce risks of harm. People were not always supported by staff who had the right skills and knowledge. Staff did not receive suitable induction and training to meet the specialist needs of people they supported. In some instances, people were not consistently supported to have maximum choice and control of their lives. Staff supported people to have access to health professionals and specialist support however guidance was not always followed to reduce risks to people.

People and their relatives gave mixed feedback regarding their experiences and the caring nature of staff and people’s personal hygiene. Relatives told us staff were caring and patient. A significant number of relatives shared concerns that their family members’ personal care needs were not met. While we observed caring approaches from staff during the inspection, we received concerns about some of the staff’s attitude towards people, we also observed this in some of the records written about people. This did not demonstrate people were always treated with dignity and respect.

People’s care records were not always accurate to support the delivery of safe and person- centred care. A significant of records we reviewed did not accurately reflect people’s current needs. People were not assured their end of life care needs would be adequately met. We received overwhelming concerns from visiting relatives about the difficulties in accessing the home either by phone or visiting in person especially on weekends.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 16 March 2021). The service has deteriorated to inadequate.

Why we inspected

The inspection was prompted in part by notification of a specific incident where a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of people’s clinical needs, medicines management, moving and handling, staff responses to people’s needs and the leadership in the home. A decision was made for us to inspect and examine those risks. This inspection examined those risks.

We have found evidence that the registered provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this report. The registered provider took immediate action to address some of the concerns and improve people’s experiences.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold register providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe from preventable harm such as medicines management and clinical risks, safeguarding and responding to changes in people’s needs. We also found concerns with records keeping, person- centred and dignity, deploying suitably qualified staff, failure to report incidents and poor governance at this inspection. 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the registered provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the registered provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 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.

People’s experience of using this service and what we found

Since the last inspection, there had been changes to both the management and staff team and an outbreak of Covid-19 had impacted on staff absence; this resulted in the use of high numbers of agency staff which had created further instability in the home. Permanent staff were being recruited with further recruitment ongoing. We found, sufficient numbers of staff deployed to meet people's needs and ensure their safety.

The provider's quality assurance systems, audits and action plans had improved but were still not sufficiently robust or embedded into the service as we found continued shortfalls around medicines management, care planning, incident reporting and record keeping that could place people at risk of not receiving proper and safe care. The senior management team were aware of the shortfalls and was taking appropriate action to improve. An updated action plan for improvement was in place. This reflected the shortfalls found, action being taken and timescales for action.

Some people's care records were well written and provided staff with clear guidance about people's needs whilst others were not sufficiently detailed. This could result in people not receiving the care they needed or wanted. Record keeping was inconsistent and records such as care charts for nutritional/fluid intake and pressure care were lacking in detail.

Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. However, records did not always provide clear guidance for staff about peoples care and support needs. There were shortfalls in the management of behaviours that challenge; care records were not sufficiently detailed and guidance for staff was not always consistent. This placed people at risk of avoidable harm because records of care did not provide clear guidance about peoples care and support needs and these were not consistently recorded. Records of accidents and incidents were not always fully completed or analysed to avoid reoccurrence. Some aspects of the management of people’s medicines had improved. However, further improvements were necessary to ensure people received their medicines safely and when prescribed.

The management team were aware of where improvements were needed and needed time to embed systems to ensure they were effective. They provided us with an updated action plan dated 29 January 2021 to support actions being taken. The management team and staff had a clear understanding of their roles and contributions to service delivery. Staff told us there had been recent positive changes to the management team and more permanent staff had been employed, which had made a difference to staff morale. Staff told us they were being listened to and confirmed training was up to date and said they felt supported.

People told us they felt safe living in the home and staff were kind and respectful to them. People looked comfortable and settled and we observed caring interactions. Relatives were confident their family members were safe and made positive comments about the care and support provided by staff. Staff understood how to safeguard people from abuse and report any concerns. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home. People were protected from the risks associated with the spread of infection. The home was clean and odour free. We discussed some areas for improvement which had already been noted.

Communication with relatives had improved. Relatives were happy with the contact they received and said staff on the units were knowledgeable about their family members. They felt they were kept up to date and involved in decisions. Relatives were complimentary about how staff had helped them to maintain contact with their family members during the pandemic and more recently during the outbreak in the home. Relatives praised staff for the support they provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 December 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about care, management of medicines, staffing and infection prevention control. A decision was made for us to carry out a focused inspection to examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We found evidence the provider needs to make further improvements and embed them into practice. The provider is aware of where improvements are needed and has updated their action plan accordingly. Action was being taken to mitigate any risks. Please see the Safe and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Finney House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2008 in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Finney House is a residential care home providing accommodation for up to 96 adults, who require assistance with personal or nursing care needs. Finney House accommodates people across four separate units, each of which has separate adapted facilities. Two of the units specialises in providing care for people living with dementia.

People’s experience of using this service and what we found

People were at risk of avoidable harm because they were not always supported by staff with the skills or experience to keep them safe. Staff had not received appropriate training and plans of care did not provide clear guidance about the management of one person’s challenging needs. This exposed the individual to potential risks of abuse and improper treatment. This had not been adequately managed or escalated in line with safeguarding and duty of candour processes. We shared this with the local authority safeguarding team.

People’s needs and choices were not always assessed to ensure their care, treatment and support was delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes. There were significant shortfalls in the management of behaviours that challenge. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

People and their relatives were not involved in planning their care and support, and therefore they did not always receive personalised care that was responsive to their needs. Care and support provided was not always accurately recorded.

Systems were either not in place or effective enough to support safe medicines management. Medicine Administration Records were not always completed by the person administering the medicine.

The premises were clean and well maintained throughout. However, people were not always protected from the risk of transmitting Covid-19 and other infectious disease. This was because we found a number of staff failed to comply with best practice guidance around the use of Personal Protective Equipment (PPE) and the processes to manage infection control were not robust.

We could not determine if there were always enough staff deployed on each shift, as the staff rotas were not clear or accurate. Recruitment process were in place, however there were some gaps in employment histories, which had not been explored further. We made a recommendation about recruitment practices and staff rotas.

Most staff members of the 16 we spoke with told us they could approach the managers of the home. However, others said they did not feel able to raise their concerns with the management team.

Systems were not fully in place to monitor and assess the quality of care provided. Action plans were not updated.

People were being treated with kindness and compassion. We saw some good interactions with those people who lived at the home and people were assisted in a gentle and respectful manner.

Some relatives spoke positively about the care provided. One family member told us, “They (the staff) are always smiling and seem happy”. However, some relatives told us communication could be better. The provider had identified ways to improve communication with relatives moving forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 September 2019).

Why we inspected

We received concerns in relation to people’s care needs, the management of medicines and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infectious outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, and good governance. We also identified one breach of the Care Quality Commission (Registration) Regulations 2009, namely Regulation 18 Notifications of other incidents.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Finney House is a residential care home providing personal and nursing care to 65 people, aged 65 and over at the time of the inspection. The service can support up to 96 people. Finney House accommodates people across four separate units, each of which has separate adapted facilities. Two of the units specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

Staff supported people in a safe and effective way. Staff supported people to maintain their independence, considered positive risk-taking and encouraged people to be involved in making day to day decisions. They managed people's medicines in a safe way.

Staff undertook training courses which enabled them to support people in a safe and effective way. Staff told us they felt supported and involved in development and decisions about how the service was led.

The registered manager completed and regularly reviewed effective assessments of people’s needs and preferences. Staff assessed people's changing needs and when they were transferred between health care services there was a good standard of information sharing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People consistently told us they received support in a kind and respectful way. People had built trusting relationships with staff and spoke highly of them. The registered manager created an inclusive ethos where people were encouraged to have their say. Staff approached people in a friendly and respectful way and protected their dignity.

The registered manager ensured people received person-centred support. They arranged meaningful activities and continually asked for people's feedback about what type of activities they would like to engage in. Staff supported people to make end of life care decisions including their preferred place of care. People were able to stay at Finney House for end of life care and staff liaised with specialist palliative care community professionals.

The service was well-led. There was a substantial senior management team which meant a good standard of quality assurance had been achieved. People, relatives and staff told us they could approach the registered manager and felt confident they would be responsive to their ideas or concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 September 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Finney House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Finney House is a purpose-built care home in the centre of Preston. 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 registered to support up to 64 people. Due to a restriction on admissions given at the last inspection the home was supporting 25 people. Finney House provides support to people over three floors, with each floor supporting people with different needs. The ground floor focuses on supporting people with residential needs, the middle floor focuses on supporting people with nursing needs and the upper floor supports people living with dementia including some people who also have nursing needs.

At the time of the inspection the top floor still required some work to meet the needs of people living with dementia in order to provide the specialist support to the people living on that floor. CQC has received a notification from the registered provider of a variation to their Statement of Purpose, to include dementia. The provider has given the CQC assurances the top floor will be better adapted to support people living with dementia moving forward which will support this.

Finney House is required to have a registered manager and a registered manager was in place at the time of our inspection. 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.

At the last inspection in late August and early September 2017 we rated the home inadequate overall and inadequate for all key questions except caring which was found to require improvement. We found 11 breaches to seven of the regulations including registration regulations for the submission of notifications. At this inspection we found the home had a secure and permanent staff team and steps had been taken by staff at the home and the senior leadership to address the concerns from the previous inspection.

Since the last inspection the provider has worked with the Local Authority Quality Improvement Panel. Action plans had been developed by the provider from the findings of the last inspection and Local Authority and Clinical Commissioning Group commissioning contract reviews to drive improvements. The home has reported monthly to this group and met intermittently to update the team on the improvements against the action plan.

At the last inspection we found assessments were not completed when people needed support in certain areas. We also found that when assessments had been completed they were not always implemented.

Since the last inspection new assessments had been developed, including capacity assessments in different formats and choking assessments. However, we found that these had led to inconsistencies across some care plans. When we reviewed the support provided to people, we found records did not include all the information required to for staff to meet people’s needs. Other assessments we looked at were not consistently updated which led to care plans not being informed by the latest and correct information. We have found an ongoing breach in this area.

At the last inspection we raised concerns around the environment on the top floor where people were living with dementia. We recommended the home complete the ‘enhancing a healing environment’ audit developed by the Kings Fund. At this inspection we found that the audit had been completed but little action had been taken to implement the findings. The top floor area in the home had more people living on it and, whilst we were told increased monitoring had been undertaken to ensure the environment met the needs of the people in that area of the home, there was no evidence of this. We have been assured the environment will be developed once the home is able to admit new people to the home. At the time of the inspection the top floor area did not meet the needs of the people living there and we have found the provider in breach of the associated regulation.

There were concerns around how the home acquired consent for the support people received. We found this had much improved but there were still some concerns. It was clear more consent had been gained but this was not always given as required and by the appropriate person with the authority to give consent under the Mental Capacity Act (MCA).

At the last inspection we found that those people being restricted with equipment or decisions about to support them had not received appropriate assessment and consent had not always been acquired. At this inspection we saw action had been taken in this area but it was not consistent across the home. We saw assessments that determined best interest decisions were required and the appropriate paperwork had not been completed and signed off by the person with the authority to do so. We also found where capacity assessments identified people had the capacity to give consent that the home had gone on to make decisions in their best interest and applied for Deprivation of Liberty Safeguards (DoLS). We have found the provider in continued breach of this regulation.

At the time of the inspection the home was developing policy, systems and procedures to support people to have maximum choice and control of their lives. This would ensure that moving forward staff supported people in the least restrictive way possible.

You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection we also made 13 recommendations. At this inspection we have made four recommendations. Two of those are around the dementia support at the home and include staff training and the monitoring of the environment on the dementia floor. We have also made recommendations about the detailed monitoring of accidents and incidents to identify themes and trends. As well as the configuration and affirmation of the quality assurance framework and the consistent and complete production and use of a dependency tool. We have also recommended a consistent completion of care planning and assessment paperwork.

At the last inspection we found there was not enough suitably trained and competent staff to support the people living in the home at that time. Following a restriction to admissions the home now supported people with less complex needs. We found the home had recruited a full staff team who had received a good induction to their role. Staff confidently met the needs of people living in Finney House. However, as stated above we have recommended that staff working on the top floor with people living with nursing and dementia needs received more focused and specialist training. We were assured that this was to begin.

The home’s management team had better developed systems for quality audit and monitoring and whilst these still required time to properly embed they were beginning to identify issues as they arose. The home was sending the CQC all the required notifications in line with the registration regulations.

Other breaches from the previous inspection had been met in their entirety. This includes better and safe management of medicines, more focused and appropriate person-centred care being provided and appropriate support was in place in case people needed it at the end of their life.

We found the provider had reviewed the home’s policy and procedures and had acted to ensure staff at the home were aware of their content and implementation. We found complaints were better managed in that they were handled effectively and people received timely and appropriate response.

The home continued to develop its community relationships and had focused on the ethos and values of the home. Staff were content in their roles and felt supported. People living in the home were complimentary of the improvements made and felt confident things would continue to improve.

When we completed our previous inspection in August and September 2017 we found concerns relating to end of life care. At that time this topic area was included under the key question of caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is included under the key question of responsive. Therefore, for this inspection, we have updated our findings under the new key question area.

Following the last inspection Finney House was put into special measures. An urgent notice was given to restrict further admissions. We have found at this inspection that enough action has been taken to remove the home from special measures and lift the restriction. The home will continue to work with the commission and quality improvement team to monitor the safe admissions to the home.

Finney House is a purpose built care home in the centre of Preston. The home is registered to support up to 64 people with nursing and residential care needs. At the time of the inspection there were 44 people living in the home.

The home is laid out over three floors. The ground floor area supports those with residential needs the middle floor supports people with nursing needs and the top was beginning to support people with nursing needs who were also living with dementia.

Each floor was designed with an open plan lounge and dining area. Long wide corridors were furnished with additional seating and desked areas. These were repositioned during the inspection to provide sight down each corridor making it both easier for staff to view the whole floor but also for people resting in the chairs to have view of more of the home.

The kitchen and laundry facilities were located on the first floor of the home and each floor was accessible by lifts and stairwells.

This was the first inspection of the service since its registration with the commission in October 2016.

At the time of the inspection the home was in the process of registering a new manager to the service. 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.

At this inspection we found the home to be in breach of seven of the Health and Social Care Act (Regulated Activities) Regulations 2014. The home was also found to be in breach of two of the Health and Social Care Act (Registration) regulations 2009. We have also made 13 recommendations based on the findings of the inspection.

We found the high turnover of staff had led to inconsistencies in how the staff delivered the service. Different managers in the home had different styles and priorities and the homes policies and procedures were not embedded. This also had an impact on the quality of the audits undertaken, as the expected standard was not always clear.

The home supported some very poorly people and a high number of people at the end of their life. Staff employed at the service did not have sufficient skills and knowledge to best support these people. Staff were kind and relatives spoke highly of them, but plans of care to support people at the end of their life were often developed too late.

The complexities of those who lived at the home were not supported by enough qualified nursing hours through the night. It was difficult to gauge the days as the senior leadership team were on site both days of the inspection and were supporting staff in the home. They were not on the rota so the hours they provided could not be guaranteed moving forward.

We found the home did not always make referrals to the safeguarding team when people were found to have unidentified injuries including bruises. We also found these injuries were not mapped appropriately through to healing and recovery. We also found that when particular people were seen to have regular bruising, assessments had not been made to identify potential risks and steps were not taken to mitigate them.

There were many people in the home living with varying degrees of dementia. Some applications had been made to the Deprivation of Liberty Safeguarding [DoLS] team to protect these people from unlawful restrictions, but this was not always the case. We saw capacity assessments which should be made prior to the application had not always been made and best interest decisions had not always considered the principles of the Mental Capacity Act 2005.

The home was not managing medications effectively or safely. Care plans were not person centred and medication records were poor. We found gaps in records without explanation and prescriptions that when recorded onto the medication records were not counter signed and did not include enough detail for staff to safely administer medicines.

Consent was not routinely acquired from people formally and where family members had given consent on behalf of their loved ones it was not clear if they had the authority to do so.

Records held by the home to support people living there were not clear as to what people’s needs were and how the home were to meet them. Records were not always kept in a way that were either easy to understand or evidence that the correct support had been provided.

Complaints made to the home were not managed in line with the homes policy and from the records held it was not clear if they had been recorded, investigated or responded appropriately.

The provider had not sent the commission all the notifications for deaths, serious injury and other incidents as required as part of their registration.

We found the senior leadership responsive to the concerns raised and when possible we saw them take immediate steps to rectify issues. This included the better positioning of desks and closer monitoring of the medications in the home.

All the staff we spoke with were good intentioned and wanted to support the people in the home to meet their needs. Staff were also concerned about how the regulated activity was delivered with four or more staff telling us the home felt disorganised.

People spoke highly of the staff and told us they were caring and doing their best.

We found the home referred people for specialist support when required and had employed the services of a speech and language therapist to meet the needs of people in the home.

Management were aware of the difficulties the home had faced and showed willingness to address concerns moving forward.

Staff had begun to receive supervision and team meetings, resident meetings had also recently begun. We saw schedules for meetings for the coming year.

People living in the home spoke highly of the food and the dining experience with many describing some of the services of the hostesses in the home as ‘hotel like’.

The environment was clean and the home was pleasantly decorated and furnished. We did recommend the provider complete further audits to understand the environment on the top floor and how it could better meet the needs of people living with dementia.

The home had a new manager who was due to start in post shortly after the inspection. We were assured they would be committed to develop and improve provision at the home.

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 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.

You can see what action we told the provider to take at the back of the full version of the report.