Archived: Nethercrest Nursing Home

Updated 24 November 2017

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 on 04 and 06 October 2017. The first day of our inspection visit was unannounced. We inspected the home with two inspectors.

This inspection was a responsive inspection following a number of concerns we had received from the provider and a whistle-blower about people’s well-being and safety.

Before the inspection visit we looked at our own systems to see if we had received any concerns or about the home. We analysed information on statutory notifications we had received from the provider. A statutory notification is information about important events which the provider is required to send us by law. We considered this information when planning our inspection of the home.

To gain people's experiences of living at Nethercrest Nursing Home, we spoke with two people and four relatives of people who used the service. We spoke with the nominated individual, two members of care staff, a nurse, the interim manager, the head of quality assurance, and observed the care provided to people

We held a meeting with the provider on the second day of our inspection visit to determine what actions they planned to take, following the identified concerns.

We looked at four people's care records in detail to see how they were cared for and supported. We also looked at a range of records related to people's care such as medicine records, daily logs, food and fluid charts and risk assessments.

We looked at a range of documents produced by the interim manager and provider which demonstrated how quality assurance was undertaken at the home, and what issues they had identified as part of their on-going improvement planning.

We have reviewed the information received from the provider following our inspection visits, as part of this inspection process.

Updated 24 November 2017

The inspection took place on 04 and 06 October 2017. The inspection visit was unannounced on 04 October 2017; we then announced our return on the 06 October 2017 to continue our inspection.

Nethercrest Nursing Home provides nursing and residential care to older people including some people who are living with dementia. Nethercrest Nursing Home is registered to provide care for up to 41 people. At the time of our inspection there were 27 people living at the home. Two people were in hospital. The home was divided into two floors; there were 13 people on the top floor of the home and 14 people downstairs. Most of the people on the top floor of the home were cared for in bed.

The inspection was a responsive comprehensive inspection and was taken to follow up on serious concerns that had been brought to our attention by the provider and a whistle-blower. These concerns included people sustaining fractures, people being dehydrated and having unexplained bruising. We have also shared this information with partner agencies.

There was not a registered manager on site during our inspection visits, as they were on leave on the first day of our inspection. One the second day of our inspection visit we found the registered manager had been dismissed from their 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. The service was being run by an interim manager during our inspection.

At our last inspection in November 2016 we rated the home as ‘Requires Improvement’. We found people’s needs were not always met in a timely way during busy times of day. We also found people were not given choices consistently and privacy was not always respected. In addition, audits completed by the registered manager had not been effective in identifying the issues raised in our inspection, information had not been analysed to identify trends or patterns.

We found similar issues on this inspection, improvements to the service had not been made and there had been a further deterioration in the quality and safety of care people received. We found that people were not cared for safely and were placed at risk of harm. There were more than 25 identified safeguarding concerns at the home, which were being investigated by the provider, that they had identified during a two week period (up to and following) our inspection visit. This meant some people had been receiving unsafe care.

There was not always enough staff with the right skills and competencies to ensure people were supported safely at Nethercrest Nursing Home. There was a large amount of agency usage for nursing staff, which meant staff did not always know people well. This was as a direct result of a number of recent staff dismissals at the home. This coupled with a lack of up to date record keeping meant people’s needs were not being met and placed them at risk of harm.

The facilities and environment of the home required improvement; especially in regard to a part of the home having no hot water, and toiletries, to ensure people were protected from the risk of infection.

We found staff practice was not always sufficient to ensure people received safe and effective care. A lack of effective management and deployment of staff meant people were not always supported in a timely way, or had time to spend with staff when needed.

We found people were not always supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The registered manager and provider had not acted in an open and transparent way and had not consistently notified the CQC and the relevant authorities of accidents and incidents that occurred at the home, and safeguarding concerns had not always been investigated or referred to other agencies in a timely way. There was a lack of analysis following accidents and incidents to identify how these could be prevented in the future.

There was a lack of management oversight by the provider to check delegated duties had been carried out effectively by the registered manager. Quality assurance procedures were ineffective and had failed to identify the concerns that we found in a timely way. There was a culture in the home that was accepting of the neglect of people; people did not always receive the care and treatment they needed in a timely way.

Some relatives told us they felt their family members were safe and were satisfied with the service their family member received. However, most people at the home were unable to tell us how they felt, due to their complex health needs.

Because of our concerns we have rated the home ‘Inadequate’. This means the legal requirements and regulations associated with the Health and Social Care Act 2014 were not being met. The overall rating for this service is 'Inadequate' and the service has been placed 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 there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will consider the action we need to take in line with our enforcement procedures, to bring about improvement. This could include action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration 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.

Following our inspection visit, the provider decided to close Nethercrest Nursing Home and to ensure during the closure procedure, that people were cared for safely.

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