Archived: Thelwall Grange Nursing Home

Updated 18 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook a comprehensive inspection of Thelwall Grange Nursing Home on the 22 October 2015, 12 and 28 January 2016. A specialist pharmacy inspector These visits were unannounced.

The inspection was undertaken on the various days by one inspection manager, four adult social care inspectors and an enforcement lead inspector. A specialist advisor pharmacist visited the home on 27 November 2015 and a specialist advisor with regard to Mental Capacity Act and Deprivation of Liberty Safeguards accompanied us on 12 and 28 January 2016.

During our inspection we observed how the staff interacted with people who used the service, including during lunch. Some people were unable to speak with us directly because of communication needs relating to dementia. We used the Short Observational Framework for Inspection (SOFI). The SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Before our inspection we reviewed the information we held about the home, this included the provider’s action plans, which set out the action they would take to meet legal requirements.

At the visit to the home we spoke with the acting manager, registered provider, quality assurance lead, looked at the care records for 17 people, staff training records, four staff personnel files, the quality assurance system in place which including checking of room temperatures and staffing rotas. We spoke with 16 people who live at the home, 4 relatives/friends and 16 members of staff.

Updated 18 April 2016

This unannounced comprehensive inspection took place over several days; 22 October, 28 November and 2 December 2015 and 12 and 28 January 2016 as part of our on-going enforcement activity. As part of this process the registered provider completed an on-going action plan that was continually updated. As a consequence of this it was decided to keep the inspection process open and to undertake visits over a period of time to assess the actions taken.

We had previously completed an unannounced comprehensive inspection of this service on 3 July 2015, 3 September 2015, and 12 September 2105 and found the provider was failing to meet legal requirements.

This inspection was carried out to check that the registered provider was now meeting the legal requirements. We found that they had not made sufficient improvements in relation to person-centred care, need for consent, safe care and treatment, premises and equipment, supporting staff, fit and proper persons employed and good governance and remained in breach of these regulations.

The contracts monitoring team from Warrington Borough Council (WBC) and Warrington CCG are monitoring the home. This is the council’s usual practice that is designed to ensure any improvements are sustained. The CQC are continuing to work with the council.

Thelwall Grange is registered to provide accommodation for up to 43 older people with personal or nursing care needs. Respite care is also offered. The home is situated within its own grounds in a rural location and has access to local amenities. There were 26 people living in the home at the time of our inspection.

One of the conditions of registration for the home was that it must have a registered manager. The service had not had a registered manager in post since September 2015. 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 voluntarily agreed not to accept admissions at the home following our last visit. The home has also been under an embargo [not allowed to admit new residents] from the Warrington Borough Council since our last visit in August and September 2105. Workers from Warrington Borough Council and the Warrington Care Commissioning Group with particular input from Warrington's care homes and contract monitoring teams have been supporting the home throughout this process to assist the provider to improve the quality of care given to people living at the home.

Care plans we looked at during the five days of the inspection did not contain up to date information

We found that the recording of checks on people and the recording of food and drinks given to people in their bedrooms were inaccurate and could not be relied on to effectively monitor how people’s care needs were being met.

We found that issues raised at the last inspection in September 2015 with regard to safety of hot radiators and hot water temperatures had not been fully addressed. Some radiators were still hot to the touch and had no covers in place. Some water temperatures were too hot, leaving people at risk of scalding.

Risk assessments were not updated to ensure that people were kept safe.

References were not always in place to ensure people were suitable to support people living at the home.

Staff lacked knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and were unaware of which people living in the home were subject to DoLS so that they could support them with any restrictions in place. Care files looked at for people with DoLS in place with recommendations had not been updated to ensure that the recommendations were being carried out.

We had concerns about the skill mix and the level of experience of staff. There was no clinical lead at the service. There was also only one qualified nurse employed directly by the registered provider and there was no evidence of clinical supervision for this person so that they could be supported. Clinical supervision has been promoted as a method of ensuring safe and accountable practice in nursing.

There were no staff undertaking the Care Certificate. The Care Certificate is an identified set of standards that health and social care workers adhere to in their daily working life. Induction and training for staff did not fully equip them to provide a good standard of care to people using the service.

The environment had not been updated to ensure people living with dementia could move around the home independently. Whilst the home appeared visually cleaner, there was a strong malodour on a number of days that we visited.

Some improvements had been made however issues found at this inspection had not been identified in the monitoring system in place.

The registered provider had developed a new governance system to assess quality and monitor risk. Whilst some parts of this and the concept behind it was good, it was not fully functioning. This meant that issues were not picked up on and addressed in a timely way.

Notifications to CQC had not always been sent in a timely manner.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.