Archived: St Wilfrid's Hall Nursing Home

Updated 2 August 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.

The inspection visit took place on the 13, 14, 18 and 19 June 2018 and the first day was unannounced. On the first day the inspection was carried out by two adult social care inspectors. The second day was announced and carried out by two adult social care inspectors. The third and fourth day was carried out by one adult social care inspector and both days were announced. At the time of the inspection there were 30 people living at the home.

Before our inspection visit we reviewed the information we held on St Wilfrid’s Hall Nursing Home. This included notifications we had received from the provider, about incidents that affect the health, safety and welfare of people who received support. As this inspection was carried out in response to information of concern, we did not request a Provider Information Return (PIR.) This is a form which asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at minutes of meetings held between St Wilfrid’s Hall Nursing Home, the local authority and clinical commissioning groups. We used all information gained to help plan our inspection.

We spoke with six people who received support, and five relatives. We also spoke with 10 care staff, the interim manager and the regional manager. In addition, we spoke with the cook, the operations director, the regional trainer and the regional maintenance person. As part of the inspection we spoke with the deputy manager, a qualified nurse and a peripatetic manager. We used 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 talk with us.

We looked at care records of eight people who lived at St Wilfrid’s Hall Nursing Home and a sample of medicine and administration records. We also viewed a training matrix and the recruitment records of four staff. We looked at records relating to the management of the service. For example, we viewed records of checks carried out by the interim manager, accident records and health and safety certification. We also viewed audits carried out by the senior management team.

Updated 2 August 2018

St Wilfrid’s Hall Nursing Home was inspected on the 13,14,18 and 19 June 2018 and the first day of the inspection was unannounced. St Wilfrid’s Hall Nursing Home is registered to provide personal care for up to 41 older people who require support with personal care. At the time of the inspection there were 31 people receiving support.

St Wilfrid’s Hall 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.

St Wilfrid's Nursing Home is situated in the small village of Halton-on-Lune, just north of Lancaster. The home has many historic features and is set in its own extensive grounds. Accommodation is provided on the ground and first floors. There are three lounges, a separate dining room, plus additional seating areas in the hall and on the first floor landing. The bedrooms all have a wash basin, with the majority having en-suite facility of a toilet and hand wash basin.

At the time of the inspection there was no manager who was registered with the Care Quality Commission (CQC). There was an interim manager who was supported by senior management. We were informed by senior management and the interim manager that a manager had been appointed and they were awaiting their recruitment checks to be completed. They explained it was intended that the newly recruited manager would apply to the CQC to become the registered manager.

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 inspection was prompted by information of concern that people who lived at the home were not supported safely, staffing was not arranged to meet people’s needs and equipment was not available to prepare meals. In addition, we were informed there was no hot water in some bedrooms, paperwork was not always up to date and people had no toiletries to use.

We also used this inspection to check improvements had been made since our inspection in August 2017. At our last inspection in August 2017 we found two breaches of regulation. Staffing levels at the home were not sufficient to provide support people required and people were not always supported safely. We issued Requirement Notices for these breaches in Regulation. We also noted improvements were required in the safe management of medicines. We made a recommendation about this. The service was rated as Requires Improvement.

Following the inspection in August 2107 we asked the registered provider to take action to make improvements for the areas we had noted. The registered provider was required to send the CQC an action plan, outlining how they intended to make improvements. This was not provided to us.

At this inspection in June 2018 we found people were not always supported in a safe way. Two people had had accidents as a result of staff not following safe moving and handling guidelines. We noted equipment was not always used safely to support people’s skin health and staff did not report when people had not reached their individual fluid targets. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

People told us they had to wait for support if they asked for help. We observed this during the first day of the inspection. We timed call bells and found these were not always answered quickly. Relatives told us their family members sometimes had to wait for support and staff told us they did not always have time to respond to people quickly. This was a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Documentation was not consistently reflective of people’s needs. Care plans did not always contain accurate information to enable staff to give person centred care. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Medicines were not always managed safely. We noted one person had their medicines after they had food. This was in contradiction to the medicines instructions which said they should have their medicine a specific time before food was given. Medicine administration records (MAR) were not always an accurate reflection of a person’s medicine and a barrier cream was not available for a person to use. In addition, we noted a person’s medicine total on a MAR record did not match the total of medicine left and fridge temperatures were not consistently monitored. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

People were not always protected from inappropriate response from staff. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

People were not always lawfully restricted of their liberty. We noted some people without mental capacity used equipment to maintain their safety. Applications to lawfully deprive people of their liberty had not been submitted to the Lancashire Local Authority in a timely way. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We looked at recruitment records. We found one prospective staff member had gaps in their employment. There was no record to show this had been discussed with them and the reasons for them leaving their last place of employ had been explored. We also saw the previous manager for St Wilfrid’s had provided them with a reference as they had worked with them at their previous place of employ. This was not a previous employers reference and there was no risk assessment to show how any risks were to be managed. This was a breach of Regulation 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Care planning had not always been carried out to ensure people’s needs and preferences were met. People could not be assured their individual preferences were recorded or that care planning would take place to help them live with behaviours which may challenge. This was a breach of Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Audits and checks carried out at St Wilfrid’s Hall Nursing Home had not identified some of the issues we identified on inspection. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We discussed our concerns with the interim manager and operational director. They took swift action to address the concerns we had identified. Staffing was increased, additional audits were carried out and we were informed investigations would be carried out where this was appropriate.

Staff told us they were supported to attend training to maintain and increase their skills. During the inspection we saw training was taking place. We spoke with the regional trainer who confirmed there was a training plan to ensure staff skills were developed. We have made a recommendation about the training at the home.

We received mixed feedback on the food provision at the home. Some people told us they felt it could be improved. Other people told us they liked it. Everyone told us they had a choice of meals to choose from and we saw people were offered more if they wanted it. We saw people were given the meal of their choice and staff were available to help people if they needed support. There was equipment available to cook meals.

We found the environment was clean and we observed staff wearing protective clothing when required. This minimised the risk and spread of infection. There was hot water available in all areas of the home and people had individual toiletries in their private bedrooms.

Staff spoke fondly of the people they supported and said they wanted to enable people to live a happy life. We observed moving and handling techniques and saw these were carried out with patience and compassion. People were not rushed and staff offered reassurance as they supported people.

Relatives told us they were consulted and involved in their family members care, however this was sometimes led by them. People we spoke with confirmed they were involved in their care planning if they wished to be.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care provided at St Wilfrid’s Hall Nursing Home.

There were meetings held for relatives to raise any concerns or compliments and express their views. Surveys were offered to people to capture their views on aspects of the service provided.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered manager or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure which was used in practice to investigate people’s complaints. People we spoke with told us they had no complaints, but they if they did these would be raised to the interim manager or staff.

There was documentation to record people’s end of life wishes. We spoke with one person who confirmed they had been given the opportunity to discuss this, however they had decided they did not wish to do so.

People’s privacy and dignity was protected when they received personal care. We observed staff knocking on doors and bathroom doors were closed when people were supported.