Archived: Fresh Fields Nursing Home Also known as Southwolds Nursing Home

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.

This inspection was a follow up inspection done on 22 and 23 August 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. We found some improvement in relation to complaints and notifications but sufficient improvements had not been made in all other areas. For example in relation to medicines and staffing we found that there had been further deterioration and the risks posed to people had increased. We also found further breaches of the regulations in relation to nutrition and hydration, dignity and respect and premises and equipment.

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 23 people living in the home. Due to the level of risk identified at the inspection in April 2016 we asked the home to agree not to admit anybody further, until the required improvements had been achieved. The provider agreed and sent us an action plan outlining improvements they had made. We met with the provider in June 2016 to check progress and found the staffing levels were still not adequate to support any further admissions. The provider then sent a further action plan which we looked at during this inspection.

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 we found, ‘the lack of a registered manager over the last twelve months had significantly impacted on the quality of the service provided at Fresh Fields Nursing Home’. At this inspection we found there was not enough autonomy, support or resource available to enable the manager to make the positive changes needed.

We had been made aware of a number of people who had been recently recruited into the service such as the human resource manager and the head of quality and compliance. We were able to speak to both these people during the inspection to ascertain their position and commitment to the home. Unfortunately the head of quality and was not available to speak with during all of our visit as we were made aware on 5/9/2016 that they had also left the service. The provider told us they were currently on sick leave which we were unable to corroborate.

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. The provider had agreed to block book agency nurses to ensure all nursing needs were met, aid communication and provide continuity whilst permanent nurses were recruited. We checked and found that the provider had still not ensured there were enough suitably trained or qualified staff deployed to meet the needs of people who used the service. We found the home was still in breach of the regulation relating to staffing.

Due to the level of risk we found during the inspection we made Manchester City Council aware of the concerns we had which included the staffing levels at the home. The Council liaised with the provider and ensured there was an extra nurse available on shift to support the home over the bank holiday weekend. This was funded by the Local Authority. We also asked the provider to send us an emergency action plan outlining what they were doing to safeguard the people at the home along with some additional information. We carried out a safety and welfare check on 30 August 2016 and because the situation at the home was changing on a daily basis we carried out a further care and welfare check on the 12 September 2016 also to ensure that people were kept safe.

At the last inspection in April 2016 we reviewed people’s care files and found, ‘improvements had been made since the last inspection’. At this inspection we noted that information contained within the care plans was not passed onto staff and some people were receiving care and treatment which was not in line with their assessed needs. We looked at risk assessments and saw there was comprehensive information to identify what the risks were to some people but not all staff we spoke with knew what some of the risks were. We therefore found the home was still in breach of the regulation in relation to safeguarding and improper treatment.

We found some people who were nursed in bed were deprived of their liberty. Suitable arrangements had not been made to protect their rights in line with the Mental Capacity Act and Deprivation of Liberty Safeguards.

At the last inspection in April 2016 we found a number of concerns in relation to medicine management. These included, ‘people running out of medicines and staff not keeping a record of when, where or why they were administering creams’. At this inspection we found a significant number of people were not receiving their prescribed medicine safely or at all. We asked the home to raise two safeguarding alerts to the local authority as a result of what we found. We found the home continued to be in breach of the regulation in relation to medicine management.

At the last inspection in April 2016 we saw the home was in need of new carpets and redecoration in some areas. The provider told us they were going to make a significant investment to ensure this was done. At this inspection we found no evidence this investment had occurred. We saw areas of the home and garden in a state of disrepair with some areas of the garden being unsafe. The provider again told us this was still something they planned to do. We asked the provider to send us the design plans and improvement plan. We did not receive this.

At the last inspection we reviewed the information and support available to ensure people received enough nutrition and hydration. We found, ‘Records kept to monitor people’s intake of food and fluids were poorly completed, inaccurate and did not outline why people were being monitored. We asked the provider to review their current system of recording and monitoring the food and fluid intake to ensure it was done correctly for those people who needed it.’ We followed up on information of concern we had received regarding people’s food and fluid intake. We found the provider had not reviewed the systems and there had been no improvement since the last inspection which meant people were placed at risk. We found there were breaches in relation to this regulation.

At the last inspection we found there was, ’no system in place to assess people’s capacity to consent to care and consideration was not given to the principles of the Mental Capacity Act 2005.’ At this inspection we saw that the manager had begun the process of assessing the capacity of people who were most at risk but found evidence of people receiving care and treatment without their consent. This meant the provider was still in breach of this regulation.

At the last inspection we,’ saw examples of staff interacting with people in positive and caring ways but it was clear that at times they were simply too busy and some interactions were rushed or missed. We therefore found improvement was needed in relation to how some staff carried out interventions.’ We found the same thing occurred at the inspection in August 2016 which meant some people received poor care and treatment. We found this to be a breach of regulation regarding dignity and respect.

At the last inspection in April 2016 people we spoke with were not happy with how complaints they had made had been managed. We found this had improved since the last inspection because the manager ensured all complaints were dealt with in a timely manner. People told us they were now confident the manager would sort things out. Therefore at the time of our visit we found the provider was no longer in breach of this regulation.

At the last inspection in April 2016 we found breaches in relation to good governance. This was because, ‘there was a lack of leadership and management within the home which meant quality audits were not being completed and the quality of care being delivered was compromised as a result’. At this inspection we found little or no improvement because systems already established were not being used to monitor or manage the quality of service provided either at service or provider level. This was a continued breach of this regulation.

At the inspection in April 2016 we placed the service into special measures. We did not consider enough improvement had been mad

The home was last inspected in July and August 2015 where we found breaches of the regulations in relation to person centred care, consent, premises and equipment, good governance, staffing, notifications and medicine management. Notifications are things providers must tell us about which affect people using the service. We checked at this inspection to see that action had been taken to meet these regulations.

Fresh Fields Nursing Home is a purpose built home set in the grounds of Wythenshawe Hospital. The home provides nursing and residential care for up to 41 people. At the time of the inspection there were 32 people living in the home. The home is spacious with a large communal area on the ground floor with an open plan dining area attached. There are separate lounges throughout the home which have their own small kitchen area for residents and their visitors to use. The main kitchen and laundry facilities are on the ground floor of the building and there is also a hairdressing salon. All floors are accessible by a lift and stairs.

The home did not have a registered manager in post. The service is required to do so and was therefore 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. We found the lack of a registered manager over the last twelve months had significantly impacted on the quality of the service provided at Fresh Fields Nursing Home. Details can be found in the main body of the report.

After the last inspection in 2015, the provider sent CQC an action plan to show how they would meet the regulations. We found some areas of the action plan had been completed but others had not.

At the last inspection in 2015 we found there were not enough staff to meet the needs of the people using the service. Since then, the staffing levels had been increased and over the two days of the inspection we saw there were enough staff to meet people’s immediate needs in relation to personal care and medicine administration. However, we found the home was still in breach of the regulation relating to staffing because staff had not been appropriately trained and this impacted on the quality of care some people received.

We reviewed people’s care files and found improvements had been made since the last inspection. We looked at risk assessments and saw there was comprehensive information to identify what the risks were to people, and staff we spoke with knew how to keep people safe.

We saw individual plans were available to support people in an emergency. They contained enough information about how to mobilise people if they needed to be evacuated from the building.

At the last inspection we found there was a breach in relation to person-centred care. This was because people were not always involved with planning their care. At this inspection we found improvements had been made which meant some people had had more involvement in care plans relating to their clinical needs, but we did not see any person-centred care plans for people who were living with dementia or who did not communicate in conventional ways. This constituted a continued breach of this regulation.

We found staff were recruited safely. Suitable checks were made to ensure people recruited to posts were of good character and had appropriate experience and qualifications.

Whilst reviewing how the home managed and administered medicines, we found improvements had been made since the last inspection; for example the introduction of a more robust system of recording on Medicine Administration Records (MAR). However we still had a number of concerns. These included people running out of medicines and staff not keeping a record of when, where or why they were administering creams. We found some people were not receiving their topical medicines and some other medicines as prescribed. The home was therefore still in breach of the regulation about how they managed and administered medicines.

When walking around the building we noted whilst people’s bedrooms and communal areas were mostly clean and tidy, bathrooms and bath chairs were not and the home was in need of new carpets and redecoration in some areas. At the last inspection in 2015 we found breaches in relation to the safety of premises due to issues with infection control and unsafe flooring which presented a trip hazard. At this inspection we found improvements had been made and were shown plans the provider had to improve things further, including plans to fit a new carpet within the two weeks following our inspection. We considered the provider had done enough to comply with the regulations but that improvement was still needed in this area.

We reviewed the information and support available to ensure people received enough nutrition and hydration. Records kept to monitor people’s intake of food and fluids were poorly completed, inaccurate and did not outline why people were being monitored. Whilst we did not see that anybody at was at risk, we asked the provider to review their current system of recording and monitoring the food and fluid intake to ensure it was done correctly for those people who needed it.

There was no system in place to assess people’s capacity to consent to care and consideration was not given to the principles of the Mental Capacity Act 2005. We found this at the last inspection in 2015. This meant the provider was still in breach of this regulation.

The people who lived in the home and their visitors and relatives were positive about the staff. We saw examples of staff interacting with people in positive and caring ways but it was clear that at times they were simply too busy and some interactions were rushed or missed. We therefore found improvement was needed in relation to how some staff carried out interventions.

We noted that information regarding people’s use of glasses, hearing aids and dentures was prominent in their files and staff were prompted to ensure people had these items at all times.

We saw a complaints procedure was available within the home and on notice boards, however people we spoke with were not happy with how complaints they had made had been managed.

We were told and it was clear that staff morale at the home was low.

At the last inspection in 2015 we found breaches in relation to good governance. This was because there was a lack of leadership and management within the home which meant quality audits were not being completed and the quality of care being delivered was compromised as a result. We found little or no improvement at this inspection and so this was a continued breach of the regulation.

The kitchen and laundry were organised with appropriate risk assessment and cleaning schedules in place in the kitchen. The provider had recently purchased new equipment for the kitchen and they had scored a hygiene rating of five out of five at the last local authority inspection. We found improvements had been made since our last inspection.

Although improvements had been made since our last inspection, we found a number of areas where improvement was still needed. We therefore placed the service into special measures.

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. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked the provider to take at the back of this report.