Background to this inspection
Updated
26 July 2018
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 an unannounced focused inspection on 26 September 2016 due to concerns that had been raised with us since our last inspection on the 22, 23, 30 August 2016 and 12 September 2016. The concerns raised were the competence of nursing staff at the home, the poor quality of care plans used to inform staff and lack of clinical oversight and management within the home. We inspected the service against one of the five questions we ask about services: is the service safe.
The inspection team consisted of two adult social care inspectors and a specialist advisor. The specialist advisor was a registered nurse.
At the time of this inspection there were 16 people who used the service. During the inspection we spoke with two people who were living at Fresh Fields Nursing Home and three visiting relatives. We also spoke with the provider, four care workers and two registered nurses.
We looked at a range of records including care plans recruitment files and medication records.
Updated
26 July 2018
This inspection was a focussed inspection following on from further information of concern we had received from visiting healthcare professionals about the competence of the registered nurses working at the home and the impact this may have on the safety of people living there.
We had carried out a comprehensive inspection on 22 and 23 August which was done to check the progress and improvements the provider had said they had made, and as a consequence of the findings additional safety and welfare checks were carried out on the 30 August 2016 and the 12 September 2016 to ensure people were safe.
Fresh Fields Nursing Home is a purpose built home set in the grounds of Wythenshawe Hospital but the hospital has no association to the service. The home provides nursing and residential care for up to 41 people. At the time of the inspection there were 16 people living in the home.
The home still did not have a manager registered with the Care Quality Commission. The home had been without a registered manager since 2014. A manager had been recruited but had not registered with the commission. This was the sixth Manager to be recruited to the service during this time and we found on the safety and welfare check done on 12 September 2016 that they had also left the service. The service is required to have a registered manager and was therefore still in breach of this regulation. 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 and associated Regulations about how the service is run.
At the last inspection in April 2016 we found there were not enough qualified skilled or experienced staff to meet the needs of the people using the service. After that inspection we were made aware that only two nurses had been recruited. At this inspection we found the registered nurses did not demonstrate competence needed to meet the standards set out by the Nursing and Midwifery Council (NMC) and we made a referral to the NMC. We found the home was still in breach of the regulation relating to staffing.
We found people who were at risk of malnourishment did not have adequate food supplements to meet their assessed need which placed them at risk of harm. We found the home was in breach of regulation relating to nutrition and hydration.
We found the provider had not protected people from the risk of unsafe care and treatment and were in breach of regulation in relation to safety.
The provider had also failed to operate systems to identify improvement or to act on improvements that had already been identified. This was a continued breach in relation to good governance.
At the inspection in August 2016 we did not consider enough improvement had been made and the service remained in special measures. At this inspection we found the risk to people had increased and considered urgent action.
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.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.