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Nazareth House - Manchester Inadequate

The provider of this service changed - see old profile

Reports


Inspection carried out on 15 April 2021

During an inspection looking at part of the service

About the service

Nazareth House – Manchester is a care home registered to provide nursing and residential care for up to 66 older people. At the time of inspection 65 people, some who lived with dementia, were receiving support.

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

A lack of provider oversight impacted the ability of the service making the required improvements. The provider's inspection history demonstrated improvements had not been sustained and embedded.

Since our last inspection the provider had made limited progress in addressing the concerns, we found with the management of people’s medicines. Although regular audits were taking place, these were not effective at highlighting the shortfalls and we found continued breaches of regulation during this inspection.

Systems in place were not effective enough to support the safe management and administration of medicines. This resulted in some medicines running out of stock and documentation connected to medicines was not always accurate. This placed people at risk of harm from unsafe practices in relation to the management of medicines.

Processes and systems in place to oversee the safety of the home were not always effective. The provider failed to ensure the home’s three passenger lifts received their recent examination due to outstanding essential checks not taking place. The provider decided to suspend the passenger lifts until the works had been completed.

Sufficient numbers of staff continued to meet people's individual safety and support needs. A small number of agency nurses worked at the home, whilst two new permanent nurses awaited their final employment checks to be completed.

The provider carried out checks before staff commenced employment to ensure their suitability to work with people. People received support from a consistent staff team who knew them well.

Risks relating to infection prevention and control (IPC), including in relation to COVID-19 were assessed and managed. Staff followed good infection, prevention and control (IPC) practices. They had access to the required personal protective equipment (PPE), and they used and disposed of it safely.

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 requires improvement (published 1 January 2020). At the last inspection we issued the provider with a warning notice for Regulation 12. At this inspection we found persistent issues connected to the homes medicines and the home remained in breach of regulations 12 and 17. At this inspection improvements had not been sustained and the provider was still in breach of regulations. The service has deteriorated to inadequate.

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since the last inspection in December 2019. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of Safe and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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 COVID-19 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

Inspection carried out on 10 December 2019

During a routine inspection

About the service

Nazareth House – Manchester is a care home registered to provide nursing and residential care for up to 66 older people. At the time of inspection 58 people were using the service. People of all religious faiths are welcomed.

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

At our last inspection medicines were not always managed safely. Quality assurance systems were not robust. At this inspection we found ongoing issues with medicines management and the governance of the service.

Although we identified continued concerns around the safe management of medicines and good governance, we identified other key areas in which improvements had been embedded and sustained. We found improvements to the environment, training and staff deployment had been made.

We found shortfalls in the homes approach to safety. An electrical conditions report completed in March 2016 highlighted the electrical wiring systems needing to be replaced. We found this work had not been completed. During the inspection we were provided with high level assurances from the provider this work would take place in January 2020.

People's care plans did not always contain sufficient or accurate information for staff to be able to support them. End of life care plans were not always in place for people. We recommend the provider develops end of life care planning for people.

Complaints were dealt with in accordance with the organisation's complaints procedure, people said they knew how to complain. People were supported to engage in activities in the home and in the community.

Incident and accidents were recorded and dealt with appropriately. However, the service needed to develop systems that analysed patterns and trends in order to reduce the likelihood of such events occurring in future.

Staff were supported through induction, training and supervision. The management team had identified gaps in staff training at the last inspection and clear timescales were provided for when this would be completed.

Staff knew how to safeguard people from abuse. Staff were recruited using systems which reduced the risk of unsuitable candidates being employed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff sought consent from people when assisting them.

The management team had been responsive to feedback from health professionals and commissioners, however, the provider had not been pro-active in identifying the issues raised themselves. The provider's audit systems were not always robust enough to monitor, assess and improve the safety and quality of the service in all areas.

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 requires improvement (published 3 July 2019).

Enforcement

At our last inspection we served requirement notices for Regulations 11, 12, 17 and 18. Although improvements had been made in certain areas, this did not reflect a sustained approach. At this inspection we have identified breaches for Regulations 9, 12 and 17.

Why we inspected

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. 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.

Inspection carried out on 10 April 2019

During a routine inspection

About the service: Nazareth House provides personal and nursing care to up to 66 people, mainly aged 65 and over. People of all religious faiths are welcomed.

People’s experience of using this service:

At this inspection we found four breaches in the Regulations. This related to staffing, safe medicines management, risk management, staff training and supervisions, people’s lack of participation in developing care plans, leadership and management, quality assurance and record keeping, including food and fluid charts and arrangements for consent to care and treatment.

The service was not well managed. We found shortfalls in the leadership and management of the service. Several managers had been running the home on a day to day basis since March 2018 none of whom had registered with us. The area manager supported us throughout this inspection.

During our inspection the home had recruited a new manager who was registered with us at another service which had achieved a good rating. This person had confirmed their appointment and was waiting to take up the role of home manager.

The providers quality assurance audits and systems had identified the shortfalls we found. However, they had not addressed these shortfalls in a timely way to ensure people were kept safe and the good governance of the service.

Many of the records and information we requested to see could not be located by the area manager. Poor record keeping played an important part in determining the quality rating of the service.

We spent time with the new recently appointed chief executive officer (CEO) who was to become the nominated individual (responsible person) for all the providers services. The CEO had a good understanding of the regulatory requirements the provider must meet and demonstrated a commitment to continuing to drive forward improvements.

We had concerns about staffing support afforded to people to ensure they receive safe, effective, responsive and dignified support. High levels of agency staff were and had been being used. However, feedback received by us was that the staffing situation had recently improved.

Systems in place did not ensure that people received their medicines in a safe way.

It was not always clear from people’s care records if all their identified risks had been assessed and a risk assessment put in place to help guide and support staff to mitigate such risks. We found several low level environmental risks during our inspection visit.

Staff had not received all the training and supervision they needed to support people effectively.

People who were able told us they were always asked for their consent before personal care tasks were carried out. It was not clear on people’s records whether a mental capacity assessment had been carried out to determine if they could make a specific decision when they needed to.

People told us they enjoyed their food. However, hostesses, who had previously taken time to assist, monitor and then record people’s food and fluid intake, had been replaced by putting an additional member of staff in the kitchen.

People where supported by staff who had been safely recruited. Staff knew what action to take if they thought someone was at risk of harm.

People spoke highly about the staff supporting them and said they were treated with dignity and respect. People appeared well cared for. The atmosphere was friendly, calm and quiet.

Rating at last inspection: The service was last inspected in October 2016 and had received a good rating

Why we inspected: This was a planned comprehensive inspection in line with our methodology.

Enforcement: Action we told provider to take can be found at the end of full report.

Follow up: We have requested an action plan from the service to tell us how they intend to make improvements. We will inspect the service again within six months.

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

Inspection carried out on 18 October 2016

During a routine inspection

We inspected Nazareth House on the 18 and 19 October 2016. The first day of the inspection was unannounced. There were 60 people using the service at the time of the inspection. We last inspected Nazareth House on 11 April 2014 where we found all the regulations that we looked at had been complied with.

Nazareth House is registered to care for up to 62 people who require nursing or residential care. People of all religious faiths are welcomed. It is a purpose built home that is attached to the convent of the Sisters of Nazareth. The home is situated in large well-kept gardens within easy reach of public transport and the motorway network. There is plenty of car parking and the home is only a short distance from Prestwich Village. There is level access to the front of the home, a lift to both floors and wide corridors allowing wheelchair access.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the 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.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff were able to demonstrate their understanding of the whistle blowing procedures (the reporting of unsafe and/or poor practice).

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

We saw people looked well cared for and there was enough equipment available to ensure people’s safety, comfort and independence were protected. People’s care records contained enough information to guide staff on the care and support required. The records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. We saw that people were involved and consulted about the development of their care plans.

People told us they received the care they needed when they needed it. They told us they considered staff were kind, had a caring attitude and felt they had the right skills and knowledge to care for them safely and properly. We saw that staff treated people with dignity, respect and patience.

The activities provided were varied and people who used the service told us they enjoyed taking part. We saw that people's religious, cultural and dietary needs and beliefs were respected.

Procedures were in place to prevent and control the spread of infection and risk assessments were in place for the safety of the premises. All areas of the home were secure, clean, well maintained and accessible for people with limited mobility; making it a safe environment for people to live and work in.

We saw that appropriate environmental risk assessments had been completed in order to promote the safety of people who used the service, members of staff and visitors. Systems were in place for carrying out regular health and safety checks and equipment was serviced and maintained regularly. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

The medication system was safe and we saw how the staff worked in cooperation with other healthcare professionals to ensure that people received appropriate care and treatment.

Staff were also able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for peop

Inspection carried out on 11 April 2014

During an inspection looking at part of the service

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

� Is the service safe?

� Is the service caring?

� Is the service effective?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, speaking with a relative, speaking with management and from looking at records.

Is the service safe?

We saw that systems were in place to protect the rights of people who lacked the capacity to make decisions about their own treatment, care and support. Senior staff were able to fully demonstrate that they had a good understanding of capacity and consent. and knew the procedure to follow in the event of a Deprivation of Liberty Safeguard being required.

Systems were in place to ensure that management and staff learnt from any complaints made.

Is the service caring?

People we spoke with were complimentary about the care provided. We were told, �Lovely, all very nice� and �Very good, no problems here�. A relative we spoke with told us, �The care is marvellous. It is really excellent�.

All staff were trained in The Six Steps to Success programme which aims to enhance �end of life care� for people.

Is the service effective?

People were assessed before they were admitted to the home to ensure their needs could be met.

People�s health was regularly assessed and monitored to ensure that their health and welfare was protected.

Specialist equipment was in place to aid comfort and help in the prevention and treatment of pressure ulcers.

Is the service responsive?

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people using the service.

The provider had a clear procedure in place with regards to responding to any complaints and concerns made.

Is the service well led?

There were a number of quality assurance systems in place to ensure people were cared for safely.

The service worked in partnership with other organisations to support care provision and service development.

Inspection carried out on 11 February 2014

During a routine inspection

During our visit, we spoke to six people who used the service. They told us about their experiences at the home, although some were unable to speak with us in detail. They were mainly positive about the home and the staff; however, we did find some areas of non-compliance.

We also spoke with seven members of staff.

The atmosphere was relaxed and homely; we observed staff interacting with people who used the service and it was clear that there were good relationships between them.

There were large gardens with seating and parking. There was an accessible entrance and a lift. Accommodation was provided in three units over two floors and we saw that rooms were light, clean and personalised with people�s belongings. Each unit had a separate dining area and a lounge area, although we observed that most people stayed in their rooms. A room was available for families to stay if necessary.

There was a chapel and we were told that Mass took place every day.

We saw that a range of activities was provided and we heard how these were designed to stimulate, for example, to promote hand/eye co-ordination, sensory stimulation and mental stimulation. Staff told us that visitors were encouraged to engage in activities with their relative and we saw a list of suggestions, which included the benefits to be gained, displayed in the home.

A variety of information was displayed around the home, such as complaints, the home�s core values and named dignity champions.

Inspection carried out on 18 December 2012

During a routine inspection

During our inspection we looked at the care records for five people living at Nazareth House. In all cases people were assessed prior to moving to the home. Their care needs were usually reassessed every month and we saw evidence that their needs were being met.

We observed people being treated in a dignified way. People�s records showed that personal choices had been taken into account in the way their care was delivered.

The people we spoke with were very complimentary about the home, the staff and their care. Their comments included �I�m so lucky being here. All the staff are so genuine and caring�, �I couldn�t ask for more. This place is absolutely brilliant and the care I get couldn�t be better� and �All the staff are excellent. They do everything I need them to do�.

The home was spacious and well maintained, and regular checks were carried out to ensure it was safe.

Staff received regular training that was monitored by the Manager. They had an annual appraisal meeting with their manager and staff told us they felt well supported at work.