Newquay Nursing and Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection the provider had failed to ensure that the premises and equipment were safe to meet the needs of people using the service. This was a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this assessment the provider had failed to ensure enough improvement had been made and the provider remained in breach of Health and Social Care Act 2008 regulation 15 (safe environment). For example, we identified further concerns relating to trip hazards, falls hazards and the overall ongoing maintenance and security of the building. People’s needs were not adequately assessed or met. We identified significant shortfalls in relation to the care people received from the service. People were not always protected from risk of harm and abuse. Risks associated with peoples on going care needs were not always identified and acted on. This put people at an increased risk of harm. There were insufficient staffing levels and oversight to ensure people’s needs were being met. Some people we spoke with told us staff were rushed in their duties and people had to wait for long periods of time before support was available. We identified risks to the health and safety of the people were not always assessed and all reasonably practicable steps were not always taken to mitigate those risks. Some people had medicines prescribed to be given when required. Staff did not always have up to date guidance available to help them make consistent decisions about when these medicines might be needed. People who required support with their catheters were placed at an increased risk of harm because the provider failed to follow national guidelines related to catheter care. This was a breach of Health and Social Car Regulation 12 (safe care treatment).

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People gave mixed views on whether they felt safe living at the service. Whilst some people told us they felt safe others did not. For example, one person we spoke with told us “I’m not happy here”. The findings from this assessment demonstrate that people were not always safe and were exposed to an increased risk of harm.

Staff had knowledge about reporting safeguarding concerns. One staff member expressed they had confidence the registered manager would take action safeguarding concerns. During a care task we observed staff interacting with a person in a cheerful and friendly manner.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) We found the service was not working within the principles of the MCA and appropriate legal authorisations were not in place to deprive a person of their liberty.

Safeguarding systems were established, however safeguarding processes failed to operate effectively. For example, during our visit to the service we identified 2 safeguarding concerns which the provider's systems and processes had failed to identify. We raised this with the registered manager who then raised this with the Local Safeguarding Team. The registered manager was not able to provide evidence of submitted DoLS applications. This meant people were at increased risk of not being protected from abuse because the registered manager and staff did not have the relevant information to help them take the right action to safeguard people. The registered manager did not always have processes to assess people’s capacity to make decisions about their care and treatment.

People were not always involved in managing risks to themselves. For example, one person described how they had requested changes to their environment in order to mitigate some of the risks associated with their care needs. However, this was refused by the registered manager and provider, who had failed to recognise this as positive risk taking.

Staff told us they could find information on the ongoing management of risk within peoples care records. This was confirmed by the registered manager who described how they would expect risks associated with ongoing care needs such as diabetes and skin care to be included within peoples care records. However, our checks confirmed that peoples care records were either incomplete or did not always contain relevant information relating to risk.

Policies and procedure were in place to reduce the risks associated with people’s care. However, the service did not always follow these. We noted and the registered manager confirmed that one person needed additional checks to take place and that these checks were required to be recorded. However, it was unclear as to whether these additional safety procedures were being carried out. When we raised this with the registered manager they told us “Thought the checks had taken place, but it has not been recorded”. Therefore, the registered manager and provider could not be assured that risks associated with people's on-going health needs, were monitored safely, which exposed the person to the risk of avoidable harm.

One person was at risk of malnutrition and had experienced significant weight loss. Staff did not know when asked if the person had been referred to a healthcare professional to review their weight loss and dietary needs. There was no record in the person's care records of a referral being made. There was no information within this person's care records to show staff were monitoring their weight loss. When we spoke with the registered manager about these concerns, they confirmed that action had not been taken to flag, report and refer to the relevant agencies. A safeguarding referral was made to the Local Authority as a result of our findings.

We spoke with people to learn more about their experiences of using the service. Peoples feedback did not highlight any concerns they had about the safety of the environment. However, our findings from this assessment demonstrate that peoples living environments were not always safe.

The registered manager failed to understand their responsibilities to ensure the building was well maintained and fit for purpose. For example, the registered manager did not know that risk assessments and safety checks were needed. The registered manager and staff did not understand how the environment might pose risks to people and how they could support people to stay safe at the service. For example, in the services “Legionella policy and procedure it states it is the responsibility of the registered manager to ensure that the sources of legionella risk are identified and assessed as part of the water hygiene risk assessment. The registered manager was not able to provide this, this place people at risk of avoidable harm from legionella bacteria in the water system of the service. At our last inspection of the service we found the registered manager had not ensured the premises used by people were suitably decorated and had the necessary items and maintenance to improve people’s quality of life and promote their wellbeing. The provider had not made sure the environment was safe for people go live. At this inspection we found the service was still not safe. For example, there were 11 windows identified on the first floor that were not adhering to Health and Safety Executive (HSE) guidance, Health and safety in care homes guidance. There was 1 fire door on the first floor that was unalarmed and unlocked which presented a risk of falls from height.

We noted an electrical cupboard and an area of the service which was designated for the safe and efficient disposal of human waste, were left unlocked despite signs stating, “This door to be kept locked shut”. The environment had a fire door on the ground floor which could be opened from the outside by a member of the public. This posed a risk to the security of the building and placed people at risk of harm from security breaches in the building. This had not been identified by the provider and registered manager.

The registered manager was not able to provide evidence of servicing and maintenance for the window restrictors, fire doors, gas boiler, moving and handling equipment, water hygiene, and hot water temperatures from the services outlets. This meant they had no assurance these continued to be safe for use.

Through speaking with people and from our observations, it was evident that people were not always provided choice on were they wanted to spend their day.

The registered manager and provider used a 'dependency tool' when carrying out ongoing assessments on people's care needs. The purpose of the dependency tool was to support the manager to calculate the right ratio of staff against people's needs. However, we noted this tool had not been reviewed since March 2022. Throughout of inspection staff were rushed in their duties and people had to wait to have their support needs met. One person we spoke with told us “if I use my bell it can take 3-5 minutes for the staff to arrive, by which time I don’t want to go to the loo, that can be frustrating”. We asked the registered manager how they knew they had enough staff on shift and we were informed “I will know from the staffs (facial expressions) and I speak to the staff all the time”.

We found 'Toileting charts', on which were recorded time-frames for taking people to the toilet. The registered manager confirmed this practice was taking place within their service. This institutionalised practice had contributed the risk of developing a 'closed culture' at Newquay Nursing & Residential Home.

Files relating to the safe recruitment staff were incomplete and lacked important information for example employment histories and interview notes. When we raised this with the registered manager, they were unable to provide us with a satisfactory explanation. This meant the provider had failed to ensure there were safe and effective recruitment procedures in place.

We spend time with people to learn more about their experiences of using the service. Peoples feedback did not highlight any concerns they had about cleanliness and hygiene at the service. However, our findings from this assessment demonstrate that the providers infection, prevention and control measures were not satisfactory in protecting people from harm.

We asked the registered manager for cleaning schedules or any documentation to demonstrate how the service was cleaned. The registered manager was not able to provide us with evidence of any cleaning being completed. The registered manager was able to provide the assessment team with an up to date environment audit, this audit included infection prevention and control. However, this audit had failed to identify any issues with equipment or cleanliness.

The registered manager told us there was one full-time member of staff employed to clean the service and they would be recruiting for another member of staff. We observed personal protective equipment (PPE) was visible and accessible for staff.

We were not assured that the provider was promoting safety through the hygiene practices of the premises. The premises and equipment were not always clean. The first floor bathroom included a hoist and toileting chair which had rust forming on them. Carpet in communal areas and peoples living spaces were extremely worn. There were strong unpleasant odours in areas of the service which were noted on both days of our site visit.

Some people had medicines prescribed to be given when required. Staff did not always have guidance available to help them make consistent decisions about when these medicines might be needed. When guidance was in place, it was not person-centred, outdated and did not describe a person's individual needs. Some staff had not received up to date medicines training and competency checks in line with national guidance. Training records showed that 2 staff members administering medicine had not received training or competency checks since September 2022. National Institute Clinical Excellence (NICE) guidance outlines best practice in ‘Managing medicines in Care Homes'. This guidance states- providers should ensure that all care home staff have an annual review of their knowledge, skills and competencies relating to managing and administering medicines’.

There was a quality assurance process in place to audit the medicines management practices within the service. However, the registered manager last carried out the medication audit review in July 2019. Because of this and our findings in relation to staff skill and competencies we could not be satisfied that the registered manager had safe medicine management practices in place.