Archived: Donness Nursing Home

Updated 13 March 2020

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team:

This inspection was carried out by an inspector, a member of the medicines team, an assistant inspector, a specialist nursing advisor and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise is dementia care.

Service and service type:

Donness Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission, who was also the provider. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager chose to retain only a few managerial duties, such as meeting with the new manager.

Notice of inspection:

The inspection was unannounced on 30 October 2019 and 1 November 2019.

What we did:

Prior to the inspection we reviewed the information we held about the service. We reviewed notifications we had received from the service. A notification is information about important events which the service is required to send us by law. We sought feedback from the local authority and professionals who work with the service.

Prior to the inspection, we liaised with health and social care professionals and the safeguarding team in relation to a safeguarding concern linked to an individual. We used all of this information to plan our inspection.

Some people using the service were living with dementia or illnesses that limited their ability to

communicate and tell us about their experience of living there. We would normally use the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not speak with us and share their experience fully. However, due to a carpet being laid in one communal room, there was not enough space for us to spend time with people in the lounge or dining room.

During the inspection we met with nine people using the service, including people in their rooms,

and spoke with them about their views on the care at the service. We also spoke with eight relatives, the management team and staff, including nursing and care staff.

We reviewed four people's care files, recruitment and training files, meeting minutes, rotas and audits. We looked around the premises. We reviewed medicine administration records.

The provider did not participate in this inspection but was provided with detailed written feedback.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

Updated 13 March 2020

Donness Nursing Home is a residential care home that was providing personal and nursing care to 20 people aged 65 and over at the time of the inspection. The home is registered to support 34 people.

In 2017, the service was rated as 'good' by CQC. The appointment of a second registered manager had helped improve the standard of care and the management of staff. A team of multi-disciplinary health and social care professionals had also provided intensive support to the service to address a previous lack of staff training, poor record keeping and poor management. This high level of support had been instigated when the service was rated as 'inadequate' and 'requires improvement' following CQC inspections in 2016. The second registered manager left shortly after the inspection in 2017.

In July 2018, there was a further inspection and the service was rated as 'inadequate'. This showed the provider was unable to sustain the improvements made. A team of multi-disciplinary health and social care professionals provided further input to support the provider. The provider chose to employ an interim management team to help them make improvements. When we inspected in February 2019, the service was rated as Requires Improvement in all key areas of care. The interim management team withdrew their services in September 2019 and a proposed sale of the home to a new provider did not happen.

At the time of our inspection the local authority adult safeguarding team were investigating allegations of poor care, and the service was being supported by the local authority quality and improvement team. Following our inspection and the number of concerns identified, the provider decided to voluntarily suspend all new placements to the service until improvements were made.

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

The systems to help identify where improvements were required had been ineffective. The systemic failings found at this inspection demonstrated the provider had failed to ensure people received a well-managed service which was safe and compassionate; placing people at risk of potential and continued harm.

Since our last inspection, the ratings for all key questions had either stayed at Requires Improvement or deteriorated to Inadequate.

People told us they felt safe living at the service. However, practices were not safe. Poor monitoring of people’s fluid and nutritional intake put people at risk of dehydration and malnutrition. This risk was increased by poor monitoring of weight loss. Changes to people’s health needs were not routinely addressed in a timely way.

People received or experienced unsafe or inconsistent care. Risks associated with people's care were not always documented and/or monitored effectively by staff. People were not effectively protected from abuse because some staff did not recognise their responsibilities to ensure people were safe.

Communal areas were clean but there were bedrooms that had an unpleasant odour. The environment had been assessed for safety. Fire training did not take place regularly which put people at risk in the event of a fire as staff may not be competent and confident to respond appropriately. The staff training matrix showed some staff had undertaken little training. Staff competency in using a person-centred approach was variable.

The level and standard of activities and meaningful occupation did not meet the social needs and wellbeing of everyone living at the home.

People were not involved in planning their care and support; people’s care was not effectively reviewed and changes to their health needs were poorly managed.

Concerns were not routinely responded to in a consistent manner, so some people lost trust in the staff because their complaints had not been handled appropriately. When the manager was made aware of complaints, they followed the formal process and took steps to address issues and reassure people.

People and relatives said staff were kind and caring. And overall, people's privacy and dignity was respected. People's medicines were generally managed safely.

Rating at last inspection The last rating for this service was requires improvement (published 26 April 2019) 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 improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and in part due to safeguarding concerns for one person. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We judged five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been repeated. These linked to safe care and treatment, staff recruitment, the cleanliness of the environment, staff training and supervision and good governance.

On this inspection there were a further five new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These linked to staffing arrangements, safeguarding, person centred care, meeting nutritional and hydration needs and need for consent.

We recommended the provider improved some areas of medicine practice and improved the range of activities.

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.

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

Follow up

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

Special Measures:

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 provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the 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 provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. The provider voluntarily decided to close Donness Nursing Home. It will be closed by the end of March 2020.