Archived: Tordarrach Nursing Home

Updated 21 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.

This inspection took place 5 February 2018 and was unannounced. The inspection was undertaken by an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Prior to this inspection we reviewed the information we held about the service, including the statutory notifications we received. Statutory notifications are notifications that the provider has to send to the CQC by law about key events that occur at the service. We also received feedback from the clinical commissioning group (CCG) and the local authority. The provider did not meet the minimum requirement of completing the Provider Information Return at least once annually. The registered manager informed us they experienced difficulties submitting the PIR and submitted this 17 days after our inspection after we raised this with them. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we made the judgements in this report.

During the inspection we spoke with three people, two relatives, one care worker, one nurse, the chef and the administrator. We spoke with the registered manager via telephone as they were abroad. We also spoke with a consultant who had been advising the registered manager on the running of the business. We reviewed five people's care records, five staff records and records relating to the management of the service. We looked at medicines management processes. Throughout the day we undertook general observations and used the short observation framework for inspection (SOFI) in the main lounge. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

After the inspection a person contacted us anonymously to relay their concerns about the service.

Updated 21 August 2018

This inspection took place on 5 February 2018 and was unannounced.

At our first comprehensive inspection of the service in April 2016 we identified breach of regulations relating to depriving people of their liberty, good governance and staff training. We rated the service ‘Requires improvement’ overall. We carried out a focused inspection in October 2016 and found the provider was meeting the breaches of regulations we had identified previously. We did not change the rating at that inspection and the service remained ‘Requires Improvement’.

At our comprehensive inspection in June 2017 we identified breaches of regulations relating to safe care and treatment, good governance, person-centred care and submitting notifications of significant incidents to CQC. We rated the service ‘Requires Improvement’ overall and ‘Inadequate’ in the key question ‘Is the service well-led?’ We served the provider with warning notices for the breaches relating to safe care and treatment and good governance and told the provider they must be compliant by July 2017. We carried out a focused inspection in October 2017 to check whether the provider was compliant with the warning notice and found they were. We did not change the rating because we needed to see sustained improvement over a greater period of time.

Tordarrach Nursing Home provides nursing care for up to 20 people. People presented with a complex range of needs. Most people were older people, many of whom were living with dementia. There were also two younger adults using the service, one with a mental health condition and the other a regular respite user of the service who had a brain injury. There were 11 people using the service at the time of our inspection.

There was a registered manager 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 inspection we found the provider had not maintained systems to reduce risks relating to falls from height and water hygiene. In addition we found the provider had not assessed and managed risks relating to cold temperatures well. We identified two radiators in the communal lounge were broken which made parts of the lounge cold, and the provider was unaware of this. Staff did not always do all they could to mitigate risks relating to a person’s care and we observed a person experienced pain when staff supported them to reposition their legs.

Medicines management was suitable although systems to ensure medicines outside the fridge were stored at safe temperatures were lacking. Our checks of medicines stocks and records indicated people received their medicines as prescribed.

The provider did not always obtain evidence staff had the right to work in the UK and we reported our concerns about one staff member to UK Visas and Immigration. The provider had not always obtained two references for each staff member in accordance with their recruitment policy. There were not always enough staff deployed to support people promptly. People were safeguarded from abuse and improper treatment due to systems in place.

The provider had an improvement plan in place in relation to infection control after an inspection by the clinical commissioning group (CCG) identified concerns. We found most areas of the service were clean although some areas of the dining room such as curtains had food stains.

We found the provider had not fully followed the recommendation we made at our last comprehensive inspection regarding adapting the environment to cater for people with dementia. In addition the provider had not considered best practice in dementia care in other aspects of service delivery. The provider had also not considered best practice in occupying and stimulating people with dementia.

The provider had not ensured Mental Capacity Act (2005) assessments were decision specific in accordance with the Act. This meant the provider may have incorrectly determined people’s capacity in relation to key decisions and so may have prevented people making their own decisions in relation to their care.

We observed people were sat in armchairs with tables in front of them for the whole day which may have deprived them of their liberty unnecessarily. We raised our concerns with the provider who informed us they would review this. Besides this the provider applied for authorisations to deprive people of their liberty appropriately.

Staff received a programme of support although training was lacking in some areas and records relating to staff training were not always clear. Staff attended key training in relation to their role but training in relation to people’s individual needs, such as brain injury and mental health issues, were not provided.

People were not always supported to receive choice of food. The lunchtime meal was shop bought frozen food reheated on the day of our inspection which meant the quality of some meals could be improved. The chef had a good understanding of people’s dietary needs and received updates from staff if people’s needs changed. We observed people received the support they required from staff to eat. People received the necessary support in relation to their day to day health needs.

People did not always receive kind, compassionate, person-centred care. Staff did not engage well with people using the service and some staff required support to improve their communication skills. We observed some interactions which showed staff did not always show empathy in the way they cared for people and did not always ensure people felt they mattered. The provider lacked systems to check staff provided care to people in a compassionate and personal way.

People were not always treated with dignity and respect. Staff exposed parts of people’s bodies in the communal lounge when carrying out tasks such as hoisting and clinical procedures. A screen was not used to maintain people’s dignity. Staff had not always explored and maintained systems to help people express themselves. Information about people was not always stored in a way which ensured confidentiality.

Relatives were able to visit at any time besides mealtimes. We observed some people waited long periods to be served their meals while those around them ate. Relatives told us they were willing to support their family members to eat to reduce the burden on staff and increase the quality of care to people but the provider rejected their requests for this.

People lacked meaningful activities to stimulate and occupy them and staff heavily relied on the TV to entertain people on a day to day basis. This meant the provider had not improved in relation to this since our last comprehensive inspection. People were also not supported to maintain and improve their mobility on a daily basis with people seldom supported to move from their seats.

The provider’s complaints policy remained suitable although the provider told us they had not received any complaints since our last comprehensive inspection so we did not look at complaints in depth.

The provider had poor systems to govern the service and had not sustained improvements we found at previous inspections. The auditing systems in place were not robust as these had been ineffective in alerting the provider to the concerns we identified during our inspection. Staff lacked the leadership and support they required to develop in their roles and the service was poorly managed. There were ineffective systems to observe the care of people who were unable to express themselves verbally to check it was delivered in a responsive, compassionate manner.

Systems to gather feedback and experiences from people using the service could be improved. Systems to gather feedback from relatives and staff were in place.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘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.

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.

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.

During this inspection we found breaches relating to safe premises and equipment, consent, person-centred care, dignity and respect and good governance and we are taking enforcement action against the provider. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after a