Archived: Ainsworth Nursing Home

At the last comprehensive inspection on 5 and 6 December 2016 the service was rated requires improvement. Whilst no breaches of the regulations were found the provider was asked to develop support systems for staff and checks to monitor and review the service needed embedding. At this inspection we found some improvements had been made, however monitoring of the service provision needed expanding upon.

Ainsworth 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.

Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. The building is a large, converted former hospital, based in the Ainsworth area of Bury, Greater Manchester. Accommodation is separated into two units; one providing general nursing and residential care and the second provides nursing care for people living with dementia. All rooms are situated on the ground floor and are easily accessible. At the time of the inspection there were 25 people living at the home.

The registered manager had recently left the service. Therefore there was no registered manager at the time of this inspection. However the provider had taken prompt action to appoint a new manager to the position. 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.

During this inspection we identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Effective systems to monitor, review and assess the quality of service were not in place to help protected people from the risks of unsafe or inappropriate care.

Robust systems were not in place to ensure people received their prescribed medicines safely.

Assessments and management of the environment need to be put in place so that potential risks to people are minimised.

Robust recruitment procedures were not in place to ensure the suitability of staff employed to work at the home. Sufficient numbers of staff were not always available at core times. Further recruitment was taking place so that better flexibility of support could be provided.

Further training opportunities were needed so that staff have the necessary skills and competencies needed to safely and effectively meet the needs of people living at the home.

We recommend the provider seeks advice from the Greater Manchester Fire and Rescue Service (GMFRS) about the safety and suitability of locks being used at the home particularly as some people were restricted from leaving the building alone. Relevant checks were completed with regards to fire safety. Arrangements had been arranged for an up to date fire drill to be completed.

Activities and opportunities were offered to people to help promote their health and wellbeing as well as maintain community links. Information in people’s ‘life story’ books were to be considered so that other opportunities could be introduced around people’s individual hobbies and interests. We recommend the provider also refers to current guidance when developing opportunities for people.

Suitable arrangements were in place for the recording and responding to any complaints or concerns. People and their visitors were not aware of the procedure in place but said they would speak with the manager or staff and felt confident their concerns would be listened to and acted upon. We recommend the provider informs people of the procedure so they understand how their concerns will be dealt with.

People and their visitors were complimentary about the staff and the standard of care and support offered. From our observations we saw staff speak with people in a sensitive and respectful manner and responded to people’s requests promptly.

People and their relatives, where appropriate, were consulted about their care and treatment. The provider had sought the relevant authorisation to ensure people being deprived of their liberty were protected.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedures. Staff confirmed and records showed that annual training was provided in this area.

Care plans were person centred and contained good information about the current needs, wishes and preferences of people.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Where people’s health and well-being had been assessed as at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Hygiene standards were maintained to help minimise the risks of cross infection. The premises and equipment were adequately maintained and regular checks were undertaken to help keep people safe.

Ainsworth Nursing Home is situated in the village of Ainsworth, in a rural position. Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. There were 20 people living there on the day of our inspection.

The manager of the service was registered with the Care Quality Commission (CQC). A registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We have identified a breach in regulation. You can see what action we told the provider to take at the back of the full version of the report.

Some checks were being completed to monitor and review the service provided. Thorough oversight of the service and effective communication between the management team will help to ensure that robust systems are in place to sustain the improvements made so that people who use the service are protected.

Opportunities for staff training and development were in place. Staff we spoke with said they felt supported in their role. Through our discussion with the registered manager it was acknowledged that systems to support staff needed formalising. We have made a recommendation that opportunities for staff so that good practice is followed as well as promoting team building so that morale is improved.

Checks were being completed for newly appointed. The registered manager was aware all checks were required prior to staff commencing work ensuring their suitability for the position so that people were kept safe. Adequate numbers of staff were available.

We received lots of positive comments from people about their experiences and the care and support they received. Staff were described as being compassionate, caring and respectful towards people.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where people lacked mental capacity steps were taken to ensure decisions were made in their best interests.

Improvements had been made to ensure staff were aware of their responsibilities in protecting people from abuse. Staff spoken with demonstrated their understanding of the procedures and confirmed they had completed relevant training.

The management and administration of people’s medicines was safe and demonstrated people received their medicines as prescribed.

Care plans were person centred and contained good information about the current needs, wishes and preferences of people. Where risks had been identified, additional plans and monitoring had been put in place so that staff could quickly respond to people’s changing needs.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. Where people’s health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Social and recreational opportunities were provided to enable people to maintain their independence and encourage their involvement.

Improvements were being made to enhance the standard of accommodation and facilities provided for people. Relevant checks had been made to the premises and servicing of equipment to help keep people safe in the event of a fire. Good hygiene standards were maintained minimising the risks of cross infection.

The registered manager had a system in place for reporting and responding to any complaints brought to their attention. People and their visitors told us the manager and staff were approachable and felt confident they would listen and respond if any concerns were raised.

Information in respect of people’s care was held securely, ensuring confidentiality was maintained.

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use of enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The service was inspected again on 5 and 6 January 2016 when we undertook a further comprehensive inspection to see if improvements had been made since the service was placed in ‘special measures’. Multiple breaches of the regulations were found again and the condition to restrict further admissions to Ainsworth Nursing Home on the 14 September 2015, remained in situ. The service was rated as “requires improvement” with one domain rated “inadequate” and therefore remained in ‘special measures’.

This was an unannounced comprehensive inspection which took place on 6, 7 and 8 June 2016. We have rated the service as “inadequate” and therefore the provider remains in ‘special measures’. 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.

Ainsworth Nursing Home is situated in the village of Ainsworth, in a rural position. Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. There were 23 people living there on the day of our inspection.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service has been without a registered manager since 1 February 2016 when we cancelled the previous registered manager due to their unfitness. The provider had promoted the deputy manager but they withdrew their application to register as the manager. A new manager had been appointed, however they had only been in post three weeks.

During this inspection we found continued and new breaches of the regulations. You can see what action we told the provider to take at the back of this report.

Staff members did not understand their responsibilities in relation to safeguarding people who used the service. During our inspection we found issues relating to the safe care and treatment of people that required a safeguarding alert to be raised with the local authority.

Staffing levels were not consistent with what we had been told by the manager. We found occasions when there were not the amount of qualified nurses or care staff on duty that the manager told us there should be. We also witnessed an occasion during our inspection where the dementia unit had been left without any staff members for approximately five minutes; resulting in people being left unsupervised. This left vulnerable people at risk.

We looked at all the records relating to fire safety. We saw these checks had not been completed since the 17 May 2016, when the maintenance person went on leave. This meant any fault would not be discovered until the maintenance person returned to work. We found the only fire drill that had been completed within the service was done on the 13 August 2015 by a fire consultant who had attended the service to provide training to the staff members. Robust systems need to be in place to ensure the premises are safe and staff know what to do in the event of an emergency so that people kept safe.

People were still not protected by robust recruitment practices ensuring only those suitable to work with vulnerable people were employed to work at the service.

A nurse who worked in the service had conditions placed on their registration. One condition was that they did not work unsupervised when on duty. However records we looked at showed that the nurse had worked unsupervised as the only qualified member of staff on duty on a number of occasions.

Medicine administration records (MAR’s) we looked at showed some people were to be given ‘when required’ (PRN) medicines. We found evidence to suggest that people were being given this type of medicine at times when it was not required or in accordance with the prescriber’s instructions. Following our inspection we raised a safeguarding alert with the local authority.

We checked to see if people were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. The cook asked people what they wanted for their lunch the day before; it is unlikely that those people living with dementia would remember what choice they were given. We did not see any evidence that people who used the service were involved in the development of menus; the cook decided what people would be offered for lunch and evening meal. Nutritional care plans were not always followed.

We found there was a continued lack of missed opportunities to engage and stimulate people to relieve boredom.

During our inspection it was necessary to speak to the manager and provider regarding the attitude of one staff member. We observed them to be disrespectful and patronising in their interactions with people who used the service and the expert by experience.

The provider had not notified us of changes to the service statement of purpose as required in the regulations and continued to show a lack of understanding of their responsibilities in relation to the regulations.

We looked at the personal care records for four people who used the service. We found that one person's records showed they had not had a shower for 25 days, another person told us they wished to have a shower daily although records showed they had only received 12 showers in a three month period and another person's records showed they had received one shower in the same three month period. This demonstrated that care records were not up to date, accurate and did not reflect the care and treatment being provided.

We looked at four re-positioning charts that were in place for those people who were at risk of developing pressure ulcers. We noted that all the charts were pre-printed with the times 08:00am, 10:00am, 12:00noon, 14:00pm and so on every two hours. We found records did not accurately reflect the time when support was offered, there were omissions in records and information was unclear about where the person had been repositioned, for example their armchair or bed thus placing them at risk of developing pressure ulcers. We noted there was no one in the service with a pressure ulcer at the time of our inspection.

The policies and procedures we looked at on the day of our inspection were not relevant to the service. Until new policies and procedures were developed that were relevant and staff had read and understood them, there was limited guidance for staff to follow.

We saw a lack of robust quality assurance systems in place within the service. The provider had failed to understand the importance of monitoring and assessing the service provided so that people were kept safe. This resulted in us making three further safeguarding alerts following this inspection.

The manager was in the process of arranging specific training for staff members such as catheter care, epilepsy, Parkinson’s disease and the use of thickeners.

All the relatives we spoke with spoke highly of Ainsworth Nursing Home and felt their loved ones were safe, well cared for and that staff were kind and caring.

We noted bedrooms and communal areas were clean and tidy with no malodours. We saw in each bedroom there was a cleaning schedule. This covered dusting, hovering, emptying bins, and cleaning windows.

We observed staff wearing appropriate personal protective equipment (PPE) such as aprons and gloves. We saw that PPE was changed according to the task they were carrying out, such as personal care or serving food.

We saw information to show that authorisations to deprive people of their liberty had been made to the relevant supervisory body (local authority). The provider had notified CQC as required by legislation where authorisations had been made.

We found the kitchen was clean and well organised with sufficient fresh, frozen, tinned and dried food stocks available.

Relatives were given the opportunity to comment on the service through satisfaction surveys.

Ainsworth Nursing Home is situated in the village of Ainsworth, in a rural position. Ainsworth Nursing Home provides nursing and residential care for up to 37 older people including people with mental health and dementia needs. There were 25 people living there on the day of our inspection.

The service did not have a registered manager in place at the time of our 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. There was a manager in place who had applied to CQC to register and their application was in progress.

During this inspection we found some improvements had been made to meet the relevant requirements, however continued breaches of the regulations were found. You can see what action we told the provider to take at the back of this report.

We found people’s care records were not as up to date or as accurate as they should have been, reflecting the current and changing needs of people so that staff were clearly directed in the delivery of people’s care.

Robust recruitment procedures had not been followed to check the suitability of people applying to work at the service.

Insufficient improvements had been made in relation to risk assessments. One risk assessment we looked at did not reflect the person had sustained four falls in recent times.

We saw there was no readily accessible guidance for staff in relation to the amount of thickener to be added to drinks for those people who required it. It was also identified that the majority of the prescribed thickeners were given by the care staff and not by the nurses who had signed on the MAR that they had given them.

We have made a recommendation in relation to water temperature checks and the frequency at which these are conducted.

We found improvements had been made in relation to fire safety, including the replacement of windows, staff training and fire drills.

We have made a recommendation in relation to the competencies of persons undertaking Portable Appliance Testing (PAT).

Records needed improving where ‘best interest’ meetings and decisions had been made for people who lacked the capacity to make decisions for themselves.

Records we looked at showed the confidentiality policy had been discussed with staff; however this was not adhered to by one member of staff who was overheard discussing the care and treatment of a person who used the service with another person’s visitor.

We saw some language used in care records was derogatory. We saw that people were sometimes referred to as ‘wandering’ or ‘wander some’. We also saw there was a ‘wandering’ policy in place.

We saw a range of activities were provided however, these were all condensed to the two days when the activities coordinator was on duty. We have made a recommendation in relation to the expertise of care staff in order to keep people who use the service stimulated and engaged.

We found that two specific incidents that should have been reported to us. We checked our records and found that we had not received any notification from the service to inform us of these.

Appropriate action had been taken to protect people potentially being deprived of their liberty. A programme of training was being provided in the Mental Capacity Act 2005 and deprivation of liberty safeguards. This should help staff understand how to promote and protect the rights of people.

Various equipment was available throughout the service, including hoists, wheelchairs and walking aids. Mechanical hoists were inspected on a regular basis by an external company.

We found improvements had been made with regards to staff training and support. Further training and development should be explored in areas of clinical care and support to meet the specific needs of people living at Ainsworth Nursing Home.

We noted improvements had also been made in relation to infection control. There was only two rooms were we noted an offensive smell but the provider was able to give us an explanation in relation to this.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met. We saw people were supported to access health care professionals, such as GP’s, community nurses and dieticians so their current and changing health needs were met.

We found additional signage had been placed around the home to assist people living with dementia. This included pictorial signs to identify toilet and bathroom facilities as well as photograph’s on bedroom doors.

The care records we looked at showed that assessments were completed in relation to the risk of inadequate nutrition and hydration.

We found that the provider had processes in place to ensure people who use the service were protected from the risk of abuse. The people we spoke with told us that they had no concerns about the care they received. They told us that if they had any concerns or complaints, they would speak to the registered manager or contact external agencies such as the Care Quality Commission (CQC).

People were cared for by staff that had been through the appropriate recruitment checks. The people we spoke with told us they were happy with the staff. They told us the staff were fully aware of their relative's needs. The comments received included 'they are wonderful' and 'the staff here are second to none'.

We found that people were asked for consent and the provider acted in accordance with people's wishes. People who use the service received care in a way that met their needs and preferences. People's care records contained enough information to show how they were to be supported and cared for.

We found the environment in the home to be clean, safe and well maintained. The people we spoke with told us they were happy with the staff. One person commented that 'If I use my alarm button, they come quickly'. We found that people were cared for by staff that had been through the appropriate recruitment checks.

The people we spoke with told us they had no concerns about the care they received. The relative of one person commented that 'I have no complaints; the staff do a good job'. We found there was an effective complaints system available, in case anyone wished to raise a complaint.