Archived: Radcliffe Gardens Nursing Home

Updated 12 March 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

We undertook an unannounced focused inspection of Radcliffe Gardens Nursing Home on 3 and 4 October 2018. This inspection was done to check that necessary improvements had been made by the provider after our comprehensive inspection on 5, 8 and 20 June 2018. The team inspected the service against two of the five key questions we ask about services: is the service safe and is the service well led. This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection

The inspection was carried out by two adult social care inspectors. The visit on the 3 October was carried out at night between 9pm and 10.45pm. We returned to the service the following day.

We reviewed other information we held about the service, including the notifications we had received from the provider, including those in connection with deaths, safeguarding concerns and serious injuries. We also contacted the fire service and local authority commissioning teams for the service.

We spoke with one person using the service, five staff, the cook and the manager. We observed how staff interacted with people and looked at a range of records which included the care records of four people and medication records for all of the people using the service. Records relating to the management of the service were also reviewed. Following our inspection, we spoke with two people's relatives by telephone.

Updated 12 March 2019

This inspection took place on 3 and 4 October 2018. At our last inspection in June 2018, the service was in breach of three regulations. These were regulation 12, safe care and treatment, regulation18, staffing and regulation 17, good governance. We rated the service as inadequate.

We undertook this focused inspection in response to concerns we received about the service which related to fire safety. We also wanted to check that the necessary improvements had been made and to confirm that the location now met legal requirements. This report only covers our findings in relation to those requirements. We found that the service was still not meeting the legal requirements and remained in breach of the three regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Radcliffe Gardens Nursing Home on our website at www.cqc.org.uk.

Radcliffe Gardens 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.

Radcliffe Gardens Nursing Home is registered to provide accommodation for up to 20 people who require nursing or personal care. The home is located in a quiet area of Pudsey and close to local amenities, shops and churches. The home is on two levels with lift access and has a garden area and car parking to the front of the building. At the time of this inspection, 17 people were using the service and all were receiving nursing care.

The service had a manager in post but they were not registered. 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 provider had failed to complete all works relating to an enforcement notice served on them by West Yorkshire Fire and Rescue Service in June 2018.

People remained at risk because the provider had not provided staff with proper equipment and training to enable them to support people safely in the event of a fire. Staff did not have opportunities to practise the action they would take in relation to fire safety and this meant people's safety could not be assured.

Staff told us they were not confident about the action they would take if there was a fire at the service. They said they needed training and equipment to ensure they could support people safely.

People's personal emergency evacuation plans (PEEPs) were not up to date and did not include proper guidance for staff. They referred to equipment which was not available within the service, and did not anticipate people's moving and handling needs.

Fire evacuation floor plans for the service were not up to date. They included people who were deceased and did not include a recent admission to the service, or a move of bedroom of one person.

The provider now had a dependency tool in place. We were not assured this meant the service was staffed appropriately as it did not include all of the current care needs of people using the service.

There were no contingencies in place to cover shortages in nursing staff. This meant staff had worked excessively over their contracted hours.

Care staff had completed training regarding the management of medicines but their competency had not been checked. Competencies for nursing staff could not be located at the time of the inspection.

The provider and manager had not operated effective governance systems to ensure that the safety and quality of the service were adequately monitored and improvements made when required.

The provider had not communicated with staff about the concerns at the service. Staff told us they felt they were not valued by the provider, and their views were not included about the running of the service.

Relatives told us they were not aware of the issues at the service relating to fire safety. They said the provider had not provided them with any information about improvements that were needed.

Staff had not communicated with one person who had to move to a different bedroom because their bedroom did not meet fire safety regulations.

The overall rating for this service is Inadequate and the service remains in ‘special measures’.

The service 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.

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 three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.