Archived: Finch Manor Nursing Home

Updated 23 January 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 the provider was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to relook at the overall quality of the service and to provide a rating for the service under the Care Act 2017.

At the last inspection of the service in May 2017, the service was rated inadequate. This was due to multiple and significant breaches of the Health and Social Care Act 2008 regulations. The service was placed in special measures. When a service is placed in special measures, we re-inspect the service within 6 months. This is to check that the provider has taken appropriate and sufficient action to address the failings of the service and mitigate risks to people’s health, safety and welfare.

Since our last inspection in May 2017, The Commission continued to receive significant concerns about the service and the quality and safety of people’s care. Due to this, we changed our timescale for returning to the service and brought forward the date of the inspection to the 30 October 2017.

Prior to our return to the service, we reviewed the concerns we had received, looked at any information sent to us by the registered manager, nominated individual and provider. We liaised with the Local Authority and the NHS Clinical Commissioning Group for their feedback. Both the local authority and the clinical commissioning group have been involved with the service since the last inspection due to the serious concerns identified.

The inspection was conducted over three days on 30, 31 October and 6 November 2017. The first day of the inspection was unannounced. This inspection was carried out by three adult social care (ASC) inspectors, a specialist medicines inspector and an expert by experience. An expert by experience is person who has personal experience of using or caring for someone who uses this type of service.

Since our last visit to the home, the nominated individual for the service had changed from the provider to a person contracted by the provider to act in this role. A nominated individual is a person who represents the provider and carries out the provider’s role on their behalf. A nominated individual is responsible for supervising the management of the regulated activity. The registered manager remained the same.

During our visit, we spoke with ten people who lived at the home, nine relatives and six visiting health and social care professionals. We spoke with the registered manager, the nominated individual, four nurses, a care co-ordinator, seven care assistants and three members of the housekeeping team.

We looked at fourteen people’s care records, six staff recruitment files, records relating to staff training and supervision, medication administration records and other records relating to the management of the service.

We observed people and staff throughout the inspection and saw how people were being cared for.

After our inspection, we spoke with a medical professional involved who had contacted us to give us specific feedback about the home.

Updated 23 January 2018

We carried out an inspection of Finch Manor Nursing Home on 30, 31 October and 6 November 2017. The first day of the inspection was unannounced.

Finch Manor 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. The home is registered to provide accommodation with support for personal or nursing care for up to 89 adults. At the time of the inspection 65 people lived at the home.

The home had 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.

We last inspected the service in May 2017. During this visit we identified significant breaches of the Health and Social Care Act Regulations with regards Regulations 9,10,11,12,14,16,17, 18 and 19. These breaches were assessed by CQC as serious as they placed people who lived at the home at risk of significant harm. The home was rated inadequate and placed in special measures.

Following the last inspection, we met with the provider and the manager to discuss our concerns. We asked the provider to complete an urgent action plan to show what they would do and by when to improve the service and make it compliant with the Health and Social Care Act regulations. During this visit we found insufficient improvements had been made and that the provider had failed to adhere to the urgent action plans that they had submitted to The Commission. This meant that they failed to take appropriate and timely action to mitigate the risks to people’s health, safety and welfare identified at the May 2017 inspection.

We looked at the care files belonging to 14 people. We found their needs and risks were not properly assessed or managed. Some people had new risk management and care plans in place but they still failed to provide sufficient information on how to meet people’s needs and keep them safe. Records relating to people’s day to day care did not show they received the care and support they needed for example, some people had not received sufficient nutrition and hydration and little action had been taken to address this. Some people had not been repositioned in accordance with risk management advice and some people’s health monitoring had not been undertaken to identify and respond to changes in their physical well-being. Some pressure mattress settings remained unsafe and posed a risk to people’s skin integrity.

New capacity assessments were in place for some people but not others and we found that some people’s capacity was still not properly assessed in accordance with Mental Capacity Act 2005. Some people did not have capacity assessments in place for covert medication or bed rails and some capacity assessments had already been filled in before an assessment had taken place, There were best interest information in people’s care files where decisions on people’s behalf had been taken but sometimes these lacked detail of the discussions that had taken place. One person had conditions attached to their deprivation of liberty safeguard authorisation but despite this we found that the manager and staff had not ensured these conditions were compiled with. This meant that there was a risk that the DoLS was unlawful.

Some improvements had been made with regards to the management of medication for example, stock levels of people’s medications were correct and records indicated that most people had received the medication they needed. The improvements made however were insufficient. Concerns were still identified with regards to the use of thickening agents in the drinks of people who had swallowing difficulties, some medication records were not completed properly and ‘as and when’ required medication plans lacked adequate detail. Some people had their medication administered covertly and we saw that some people had adequate guidance from the pharmacist on how to administer this medication safely, whereas other people did not. This placed people at risk of avoidable harm.

People’s nutritional needs were not always clearly identified or properly managed. Kitchen staff lacked up to date and accurate information on people’s special dietary requirements and some people did not receive the diet they need to keep them well.

Staff were recruited safely but some recruitment decisions made were not properly documented. Staffing levels were not always safe and some of the people and relatives we spoke with raised concerns about this during our visit. Some improvements in staff training had been made and the nursing staff had undertaken the provider’s mandatory training programme. Records showed the supervision of staff was still inconsistent and insufficient. The manager also failed to produce any records to show that staff had received an appraisal of their skills and abilities. This meant they could not be assured that staff had the competency or the support they needed to provide good care.

Parts of the premises were in need of repair or were not suitable for use. The environment in which people lived was not dementia friendly and did not support people who lived with dementia to remain as independent as possible for as long as possible. The provider’s fire safety arrangements were not safe and after our inspection we referred the home to Merseyside Fire Authority. This resulted in the provider being issued a enforcement notice.

Care staff were observed to be kind and patient in their interactions with people but tended to focus more on the completion of tasks. Some care staff demonstrated that they had a good knowledge of the different ways people used to communicate their needs but we saw that this information had not always been used to design or plan people’s care so that all staff were aware of them. The language used in one person’s care plan was also disrespectful. Nursing staff, the registered manager and the nominated individual were not a visible presence in the home and we found that the manager and nursing staff failed to have oversight of people’s care.

People’s privacy and dignity was compromised by the fact that some communal bathroom doors did not fit their door frames. This meant it was possible to see people using the bathroom from the outside. In addition records showed that people’s access to regular baths or showers was limited. This placed their personal hygiene, dignity and skin integrity at risk.

People’s previous complaints about the food on offer at the home had still not been adequately addressed as some people continued to voice similar concerns at this inspection. People’s feedback as to how the manager responded to complaints was mixed.

There were no effective systems or processes in place to ensure that the service provided was safe, effective, caring, responsive or well led. Audits were undertaken but they were ineffective in identifying the issues found during the inspection, most of which were of a serious nature. The manager and provider had failed to take proactive and timely action to the concerns identified at the last inspection. The overall rating for this provider remains 'Inadequate'. This means that it will remain in 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will 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 we will move to close the service by adopting our proposal to vary the provider's registration to remove this location from the providers registration.

After our visit, we referred our continued concerns to the Local Authority and Clinical Commissioning Group. An urgent meeting was held to discuss the service and the action that needed to be taken to mitigate risks to people’s health, safety and welfare.