Archived: Radcliffe Gardens Nursing Home

We undertook this focused inspection in response to concerns we received about the service which related to fire safety. We also wanted to check that the necessary improvements had been made and to confirm that the location now met legal requirements. This report only covers our findings in relation to those requirements. We found that the service was still not meeting the legal requirements and remained in breach of the three regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Radcliffe Gardens Nursing Home on our website at www.cqc.org.uk.

Radcliffe Gardens Nursing 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.

Radcliffe Gardens Nursing Home is registered to provide accommodation for up to 20 people who require nursing or personal care. The home is located in a quiet area of Pudsey and close to local amenities, shops and churches. The home is on two levels with lift access and has a garden area and car parking to the front of the building. At the time of this inspection, 17 people were using the service and all were receiving nursing care.

The service had a manager in post but they were not registered. 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 provider had failed to complete all works relating to an enforcement notice served on them by West Yorkshire Fire and Rescue Service in June 2018.

People remained at risk because the provider had not provided staff with proper equipment and training to enable them to support people safely in the event of a fire. Staff did not have opportunities to practise the action they would take in relation to fire safety and this meant people's safety could not be assured.

Staff told us they were not confident about the action they would take if there was a fire at the service. They said they needed training and equipment to ensure they could support people safely.

People's personal emergency evacuation plans (PEEPs) were not up to date and did not include proper guidance for staff. They referred to equipment which was not available within the service, and did not anticipate people's moving and handling needs.

Fire evacuation floor plans for the service were not up to date. They included people who were deceased and did not include a recent admission to the service, or a move of bedroom of one person.

The provider now had a dependency tool in place. We were not assured this meant the service was staffed appropriately as it did not include all of the current care needs of people using the service.

There were no contingencies in place to cover shortages in nursing staff. This meant staff had worked excessively over their contracted hours.

Care staff had completed training regarding the management of medicines but their competency had not been checked. Competencies for nursing staff could not be located at the time of the inspection.

The provider and manager had not operated effective governance systems to ensure that the safety and quality of the service were adequately monitored and improvements made when required.

The provider had not communicated with staff about the concerns at the service. Staff told us they felt they were not valued by the provider, and their views were not included about the running of the service.

Relatives told us they were not aware of the issues at the service relating to fire safety. They said the provider had not provided them with any information about improvements that were needed.

Staff had not communicated with one person who had to move to a different bedroom because their bedroom did not meet fire safety regulations.

The overall rating for this service is Inadequate and the service remains in ‘special measures’.

The service 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.

We found three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

Radcliffe Gardens Nursing 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.

Radcliffe Gardens Nursing Home is registered to provide accommodation for up to 20 people who require nursing or personal care. The home is located in a quiet area of Pudsey and close to local amenities, shops and churches. The home is on two levels with lift access and has a garden area and car parking to the front of the building. At the time of this inspection, 17 people were using the service and all were receiving nursing care.

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.

We identified a number of concerns relating to fire safety. This included the service not having an up to date fire safety risk assessment in place, a number of 'immediate' actions on the previous risk assessment from June 2014 which had not been addressed and insufficient staffing levels at night. This put people at risk of harm. Following our inspection, we contacted the fire service and they visited the service and issued an enforcement notice.

An electrical test dated October 2012, which, in line with best practice guidance required a retest in October 2017, had not been completed at the time of our visit. The provider told us they had arranged a retest and would send us the certificate. We have not received this.

Medicines were not managed safely. Care staff had not completed training they required to assist nurses when they administered controlled drugs. Guidance for staff to follow when administering 'as required' medicines was not available. This meant people were at risk of not receiving their medicines when they needed them.

The provider did not consider people's needs when they arranged staffing levels at the service. Staff and people we spoke with said staffing levels were not sufficient to meet people's needs. Most people using the service required the assistance of two staff to have their care needs met. Current staffing levels compromised people's safety and meant they had to wait and were limited as to when they could have a bath or a shower. Staffing shortages often meant that the activities staff were included in the numbers and therefore, were not available to facilitate planned activities.

Quality assurance systems were in place and internal audits had been completed, however these were not robust enough to identify any areas of concern we identified during our inspection.

The provider did not have a policy in place regarding the Accessible Information Standard. We have made a recommendation about this.

The provider did not ensure information about how to access advocacy services was available for people. We have made a recommendation about this.

There was a large communal lounge where most people spent their time. We saw no other space dedicated as a quiet area for people to sit or to see their relatives and friends.

Staff told us they received regular supervision and annual appraisals.

Recruitment practices were safe and thorough. Staff demonstrated a good understanding of how to protect vulnerable adults. They told us they had attended safeguarding training. Policies and procedures were in place to make sure any unsafe practice was identified and people using the service were protected. People told us they felt safe and knew how to report concerns about their safety if they had any.

Systems were in place to ensure accidents and incidents were dealt with appropriately and monitored by the service.

During our visit we observed staff were attentive to people, we saw them speaking in a warm and respectful manner to people. Staff demonstrated that they knew people's individual characters, likes and dislikes. People were treated with dignity and respect by the staff supporting them and our observations were that people’s independence was promoted at every opportunity

People's nutritional needs were met and they had access to a range of health care professionals to maintain their health and well-being. Care plans were person centred and individually tailored to meet people's needs. Care delivered on a practical level was also person-centred. We looked in people's bedrooms and found people had personalised their rooms with ornaments and photographs.

Staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The service worked in partnership with other health and social care organisations to achieve better outcomes for people.

There were systems in place to ensure complaints and concerns were fully investigated. People who used the service and their relatives were aware of how to report concerns.

In the absence of a registered manager the deputy manager was aware of the requirement to notify CQC of specific incidents and displaying the current CQC rating.

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.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.