Archived: The Augustinian Nursing Sisters Ince Blundell Hall

The Augustinian Nursing Sisters Ince Blundell Hall is a residential care home providing personal care to 8 people aged 65 and over at the time of the inspection, including people living with dementia. The service can support up to 22 people. The service is a domestic style property and accommodation is over three floors.

People’s experience of using this service and what we found

Risks to people were not always appropriately assessed or managed. Care plans did not contain enough information to support people safely. Plans were not updated when people’s needs changed which put them at risk of not receiving appropriate care that kept them safe from harm.

There were no systems in place to effectively and consistently analyse incidents to ensure learning could be implemented at the earliest opportunity to prevent reoccurrence.

People were at risk of being supported by staff that had not been recruited safely. There were enough staff to meet people's basic needs. However, there were ineffective systems to determine staffing levels and not all staff had completed training necessary for their role.

There was a lack of leadership, oversight and governance in the home. There had been a high turnover of managers at the service. There was no current manger in place. A senior member of staff had assumed some management responsibilities, but this was not clearly defined. There was confusion amongst all staff about roles and responsibilities.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were some concerns with fire doors and fire safety. Some fire doors did not close fully or had smoke seals missing. Fire evacuation drills had not taken place regularly and not all staff were aware of the fire evacuation procedure. A fire evacuation plan was in place but was not effective. The local fire service had recommended the evacuation plan was changed but this was not completed. We raised concerns with the local fire service and the provider responded immediately to address these.

Safeguarding procedures were in place and appropriate, but the safeguarding policy was out of date. Staff knew how to recognise, and report concerns of a safeguarding nature, however they had not all been trained in safeguarding. We made a recommendation about the providers safeguarding procedures.

Medicines were safely managed. However, not all staff had appropriate competency checks in place to ensure their practice remained safe. This was addressed during the inspection.

People were at risk of not having their nutritional needs met. Records showed that when people required their food and fluid intake to be monitored, this was not always recorded effectively. Care records did not always accurately reflect people’s nutritional needs and staff did not always know what people’s nutritional needs were.

People were supported by staff who were kind and caring in their interactions. A relative told us staff were “too caring” and sometimes did too much for people restricting their independence. One person told us, although staff were kind and caring, they were sometimes demeaning in the way they spoke to people.

People were supported at the end of their lives in a respectful and dignified way.

People were supported with their religious needs and to maintain social contact with loved ones.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28th January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about standards of care, staffing and records. A decision was made for us to inspect and examine those risks under the key questions of safe and well-led.

We inspected and found there were further concerns, so we widened the scope of the inspection to become a comprehensive inspection which looked at all five key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

The registered provider has been responsive to concerns noted during the inspection and has started to take action to make improvements and promote safety within the home.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Augustinian Nursing Sisters Ince Blundell Hall on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the assessment, management and mitigation of risk, recruitment processes, compliance with Mental Capacity Act 2005 and governance and oversight of the service.

We have made a recommendation about the providers safeguarding procedures and policy.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress with improvements and the closure of the service. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The home had policies and procedures to manage risks associated with the COVID-19 pandemic which were regularly reviewed and updated following any changes in national guidance. These included the management of people with a COVID-19 positive diagnosis, staffing, admissions of people to the home, visitors and PPE.

People living in the home and their family were supported to maintain contact. This included designated essential carers. Visiting was by appointment only. In the event of COVID-19 visiting restrictions people were supported to maintain contact by the telephone and video calls.

They had good supplies of Personal Protective Equipment (PPE) for staff and visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE, and we observed staff wearing it correctly during our inspection. Signage and information were in place throughout the home to remind staff of their responsibilities.

A programme of regular COVID-19 testing for people resident in the home, staff, essential carers and other visitors to the home was implemented. All visitors, including visiting professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed, however this was not always fully documented. Agency staff used were subject to the same testing and vaccination programme as the home staff. This was checked prior to entry to the home and working; however, this was not always fully documented.

The home appeared clean and hygienic throughout. Daily cleaning schedules were implemented by housekeepers. These have been reviewed and enhanced. All staff were involved in undertaking extra cleaning throughout the day and night.

The Augustinian Nursing Sisters Ince Blundell Hall, known as Ince Blundell Hall, is a residential care home providing personal and nursing care to 15 people aged 65 and over at the time of the inspection. The service can support up to 22 people in one adapted building.

People’s experience of using this service and what we found

People received person-centred care and support based on their preferences and wishes. There was a stable staff team who were knowledgeable about the people living at the service and had built trusting and meaningful relationships with them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Activities were organised around the wishes and aspirations of people living at Ince Blundell Hall. People’s spiritual needs were supported with on-site clergy and a chapel within the home.

We received positive feedback about the quality of care and support people received from people and their relatives. There was no registered manager in place; however, the deputy manager was aware of their role and responsibilities. Staff were recruited safely, and sufficient numbers were employed to ensure people's care and social needs were met. Staff knew how to keep people safe from harm.

Staff treated people with kindness and compassion. There was a very caring and friendly atmosphere in the home between staff and people using the service. People described staff as, “Lovely”, Kind” and “Absolutely fabulous”.

Family members were complementary about the care their relatives received. People had end of life care plans in place, which helped to provide information to staff about how they wanted to be cared for. The home provided facilities to enable relatives to stay overnight with their family member.

People's preferred method of communication was recorded to help people to express their wishes and communicate with staff.

People were supported to eat a varied and nutritious diet based on their individual preferences. People were complimentary about the food provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 13 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was carried out over two days on 6 and 7 September 2017 and was unannounced.

At the last inspection in June 2016 we found the service in breach of three regulations the service was given a quality rating of ‘Requires improvement’. We followed this up in November 2016 and found improvements had been made and all three breaches were met. The service remained ‘Requires improvement’ as we needed to ensure consistency would be maintained.

At this inspection we found consistent standards were being maintained, although there had been a recent change in the leadership of the home.

There was a new manager in post who had commenced working at the home two months prior to our inspection. The previous registered manager had left in June 2017. The manager was yet to register with the Commission (CQC). 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.

We found medicines were being safely managed. The administration records for some medicines such as external applications [creams] and prescribed ‘thickeners’ for drinks (for people with swallowing difficulties) could be further improved.

We looked at how staff were recruited and the processes to ensure staff were suitable to work at Ince Blundell Hall. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

We found there were sufficient staff on duty to meet people’s care needs.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training in-house. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis so hazards could be identified. Maintenance was assessed and planned well so that people were living in a comfortable and safe environment.

The home was clean and there were systems in place to manage the control of infection.

Staff said they were supported through induction, appraisal and the home’s training programme.

We found the home supported people very well to provide effective outcomes for their health and wellbeing. We saw there was regular and effective referral and liaison with health care professionals when needed to support people. Feedback from visiting health care professionals we spoke with was positive.

People we spoke with said they were happy living at Ince Blundell Hall. Staff interacted well with people living at the home and they showed a caring nature with appropriate interventions to support people. We found a caring ethos throughout the service.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made. People felt involved in their care and there was evidence in the care files to show how people had been included in key decisions.

When necessary, referrals had been made to support people on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The applications were being monitored by the managers of the home.

We saw people’s dietary needs were managed with reference to individual preferences and choice. Lunch time was seen to be a relaxed and sociable occasion.

There were limited social activities organised for people although most people did not see this as an issue. The home had employed an activities organiser who was starting work shortly.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. There were no complaints recorded in the past year.

The manager and senior managers for the provider were able to evidence a range of quality assurance processes and audits carried out at the home. We found some supporting management systems continued to be developed in line with good practice.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

Ince Blundell Hall provides accommodation, support and nursing care for up to 22 people. The service is owned and managed by the Augustinian Nursing Sisters, several of whom have lived and worked in the service for many years. The service admits people for long term care but also offers short term support for people who require respite care. The home is a Catholic service although is open to people outside this faith. The home is a listed building, set within 55 acres of well-maintained grounds and has many features within it, such as a private chapel.

During the inspection, there were 12 people living in the home.

During the last inspection in June 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment and person centred care and we issued warning notices in relation to these areas. The provider was also not meeting legal requirements in relation to protecting people from abuse and improper treatment and we issued a requirement notice regarding this. During this focused inspection we checked to see whether improvements had been made in these areas and to ensure legal requirements were being met. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Augustinian Nursing Sisters Ince Blundell Hall on our website at www.cqc.org.uk.

A manager was in post and had begun the process of applying 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.

When we carried out the last unannounced comprehensive inspection in June 2016, we identified concerns in relation to the management of medicines and risk management. During this inspection we looked to see if the provider had made improvements and to ensure they were compliant with legislation and found that improvements had been made.

We found that drugs to be disposed of were recorded appropriately and signed by two staff members in line with best practice. Controlled medicines administered were signed electronically by two staff and times of administration were recorded on the system.

The medicine policy viewed during the last inspection was not reflective of the system in use within the home as an electronic medicine management system had been implemented but was not reflected within the policy. The policy we viewed during this inspection had been updated and provided clear guidance to staff on how medicines were to be managed within the home.

We found that the provider had made improvements with regards to medicines management and legal requirements were now being met.

In June 2016 we identified concerns regarding identified risks to people not being safely managed. During this inspection, we found that improvements had been made and when risk reduction measures were recorded within people’s care plans, there was evidence that these were implemented and legal requirements were now being met.

During the last inspection in March 2016, we identified concerns regarding the application procedures in use to deprive people of their liberty to receive care or treatment. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). During this inspection we found that improvements had been made and appropriate DoLS applications had been made to the local authority for those people who required them. The manager told us they would continue to assess people and make further applications when necessary.

We found that the provider had made improvements with regards to Deprivation of Liberty Safeguards procedures and legal requirements were now being met.

When we carried out the last unannounced comprehensive inspection of The Augustinian Nursing Sisters Ince Blundell Hall on 23 and 24 June 2016, we identified concerns in relation to provision of person centred care and activities. During this inspection we looked to see if the provider had made improvements to ensure they were compliant with legislation and found that improvements had been made.

There was a ‘This is me’ document which provided information on people’s previous jobs, family members, important places, significant events in the person’s life and their preferences in relation to activities, foods, beliefs and preferred daily routines. We found that this information had been transferred to relevant care plans within each person’s care file. Care plans contained appropriate information regarding people’s medical needs and planned care was evidenced as provided.

Care plans we viewed were detailed and provided clear information regarding people’s care needs. This helped to ensure that people received care based on their needs and preferences when they needed it by staff that knew them well.

We found that the provider had made improvements with regards to person centred care and legal requirements were now being met.

At the last inspection we found that there were no activities available for people to participate in. During this inspection, the manager told us that an activity co-ordinator had been employed and were in the process of completing activity preference checklists with people living in the home. The manager told us they would use these to ensure appropriate activities were available, based on people’s preferences. Most people we spoke with told us they were satisfied with the activities available to them and enjoyed the relaxed atmosphere within the home.

We found that the provider had made improvements with regards to activities and legal requirements were now being met. Although improvements had been made we have not revised the overall rating for the service; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice’

Ince Blundell Hall provides accommodation, support and nursing care for up to 22 people. The service admits people for long term care but also offers short term support for people who require respite care. The home is a Catholic service although is open to people outside this faith. The home is a listed building, set within 55 acres of well-maintained grounds and has many features within it, such as a private chapel.

During the inspection, there were 21 people living in the home.

A registered manager was in post. 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 visit we completed a comprehensive inspection, but we also checked to see whether the provider had completed the actions they told us they would take following the last inspection in October 2015.

We found during the last inspection that medicines were not always managed safely. During this inspection we found that medicines were still not always managed safely. Staff had not completed competency assessments in relation to medicines and the medicines policy had not been updated to reflect the electronic systems in place. Although the stock balances we checked were accurate, audits showed that there were regular inaccuracies in the stock balances.

We received mixed feedback regarding staffing levels from people living in the home and staff. A number of staff had left the home and others were due to leave and agency staff were being utilised to help ensure there were enough staff to meet people’s needs. Although some people told us they did not feel there were enough staff, nobody told us that they had to wait long for the support they required.

People we spoke with told us they felt safe living in Ince Blundell Hall.

We found through discussion that staff had a good understanding of safeguarding processes and had completed training regarding this.

We found that accidents and incidents were recorded and reported appropriately. Audits were completed and any actions identified were completed to help reduce further incidents.

Risk management systems were in place to assess and manage risks in relation to the environment as well as risks to individuals. We found that actions had been taken to minimise risks identified in people’s risk assessments.

Safe recruitment processes were evident within the home to ensure staff were suitable to work with vulnerable people.

Staff had completed mental capacity and Deprivation of Liberty Safeguards (DoLS) training; however we found that DoLS applications were not always made for people who may require one. Records showed that consent was sought in line with current legislation.

Staff were supported in their role through induction, supervision, appraisals and regular training. Staff we spoke with told us they felt well supported and were able to raise any issues with the registered manager when required.

Most people told us they enjoyed the food available in the home and they had enough to eat, but did not always have a choice of meal. Staff told us people had a choice of meals and could have alternative meals and snacks whenever they wanted. The chef was aware of people’s dietary needs and preferences and told us they always prepared an alternative meal when they knew a person did not like the meal on the menu.

People told us staff were kind and caring and treated them with respect. People’s dignity and privacy was respected by staff during the inspection and interactions between staff and people living in the home were warm and genuine. People told us that their independence was encouraged.

People we spoke with did not recall being involved with the creation of their care plan, but were happy with the support they received and records we viewed showed that people or their relatives had been involved with the care planning process.

We found on discussion, that staff knew the people they were caring for well, including their needs, choices and preferences. People we spoke with told us their beliefs were respected by staff and they were supported to attend mass whenever they wanted.

Records showed that planned care was not always evidenced as provided. This meant that people’s records did not provide an accurate record of their care and treatment.

Most care plans did not provide information regarding people’s preferences and only one of the care files viewed contained information regarding the person’s life history.

Care plans we viewed provided advice and guidance regarding the care people required to meet specific health needs and had been reviewed regularly.

People had access to call bells in their rooms to enable them to call for staff support when required. However, some communal areas did not have call bells so people were unable to call for assistance when needed.

People we spoke with told us that there were no activities available within the home, except at Christmas. Although some people enjoyed the peaceful atmosphere of the home, others would enjoy more activities to participate in.

Processes were in place to gather people’s views, such as quality assurance questionnaires and regular meetings.

People had access to a complaints procedure and knew how to raise concerns.

Not all actions the provider told us they would take had been addressed.

Effective monitoring systems had been implemented to help monitor and improve the quality of the service. Completed audits identified actions and most of these had been addressed. Regular board meetings were held to help ensure relevant people were kept informed of issues relating to the running of the service.

The last rating awarded to the service was not displayed as required. The registered manager ensured that this was displayed by the end of the inspection and the website was due to be closed.

Feedback regarding the management of the home was positive. Staff told us the registered manager was very supportive and that they could approach them with any concerns.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications.

The home is a Catholic service although is open to people outside this faith. Many of the people using the service were from the Catholic clergy. People told us they receive excellent spiritual support and many regularly attended morning mass or use the chapel for prayer and reflection. People using the service were supported to access the grounds.

We found improvements had been made since our last inspection in September 2012 when we found staff did not have access to all the information they needed to respond appropriately to safeguarding concerns. However, the service still needed to fully implement plans to put in place regular supervision arrangements.

We spoke with two people who were visiting friends or relatives who live in the home. All were pleased with the care and support being provided. One person said 'this place is very special' and 'the care provided gives us so much peace of mind as a family.' Another visitor told us that everybody had been really kind.