Fleetwood Nursing home provides support for people who require residential or nursing care. The home has two floors a lift is available for access to both floors; some rooms are en-suite.Fleetwood 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.
Fleetwood Nursing home was last inspected February 2016 and received an overall rating of Good. This inspection took place on 18 January 2018 and was unannounced. A further inspection site visit to conclude the inspection took place 01 February 2017 which was announced.
There was a registered manager in place during the first inspection visit. However the registered manager was not in post from October 2017 and had stepped down and de-registered as of 31 January 2018. There was a new manager appointed who had not yet registered with us. 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 asked the registered manager how they monitored accidents within the home. We were told all accidents were reported using accident forms. We reviewed the records and found no oversight of the accidents and no action taken following these to lessen the risk of accidents happening again.
We viewed three care records to look how risks were identified and managed. We found inconsistencies in individualised risk assessments and the plans in place to mitigate these. The documentation did not always contain information to adequately mitigate the risks to individuals.
From the documentation reviewed we saw fire safety equipment audits had not been completed at the home since September 2017. Therefore we could not be assured that the fire safety equipment at the home was safe, this put people at risk.
We looked at how the service managed medicines. We found that there were gaps in peoples records. There was no documentation in the care plan to guide staff around how the medicines should be given to individuals. We found people did not have support plans to guide staff when giving medicines which are taken “as needed”. Therefore staff did not have all the relevant and necessary information to give the medicines appropriately and safely.
We found people had been assessed for the use of moving and handling equipment. However, people did not have personalised equipment such as the correct slings in place.
The above matters were in breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2008 (Safe care and treatment).
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. We found people’s capacity to consent to care had not always been assessed and information was, at times, conflicting. For example, in one person’s care file their next of kin had signed for the consent to the service where the person’s mental capacity had not been considered. In another person’s care file the next of kin had given consent to medical treatment without the legal authority to do so. The MCA stipulates that if a person lacks capacity to consent to a decision then a best interests process needs to be carried out. Therefore the correct processes had not been followed.
This failure to follow the MCA code of practice amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent.)
We spoke with the registered manager to assess their understanding of their responsibilities regarding making appropriate Deprivation of Liberty Safeguards (DoLS) applications. We noted people had bed rails in place. We asked the registered manager if DoLS applications had been made regarding the use of the rails. The registered manager told us they had not.
We found staff were able to tell us about safeguarding principles and recognised signs of possible abuse. However, they did not always put this knowledge into everyday practice. For example, we found not all safeguarding incidents had been appropriately reported to the relevant authorities, in line with current legislation and the policies and procedures of the home.
The above matters amounted in a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2008 (Safeguarding service users from abuse and improper treatment.)
We reviewed five care files and found people’s current needs were not always identified. Care plan information was not always an accurate, complete and contemporaneous record. Person centred information in care files was inconsistent.
The above concerns amounted to a breach of regulation 9 (Person centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We asked the management and registered provider to tell us how they monitored and reviewed the service to make sure people received safe, effective and appropriate care. We found the service did not have a robust quality auditing system.
The inconsistencies we found across the service also demonstrated the lack of oversight from the registered provider. From the evidence we found during the inspection it was apparent the leaders in the home lacked the knowledge to ensure the home was run effectively. The registered manager informed us that they were mainly working as a nurse on the floor.
These shortfalls in leadership and quality assurance amounted to a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Providers of health and social care services are required to inform the Care Quality Commission, (CQC), of important events that happen in their services. The registered manager of the service had not informed CQC of significant events as required. This meant we were unaware of the events and could not check appropriate action had been taken.
This was in breach of Regulation 18 (Notification of other incidents) CQC (Registration) Regulations 2009.
We found there was no staff dependency tool in place at the home. A tool such as this helps determine the amount of staff that are required to ensure people’s needs are met. We have made a recommendation about this.
We walked around the home to check it was a suitable environment for people to live. There was very little signage to orientate people in the home. We have made a recommendation around this.
You can see what action we told the provider to take at the back of the full version of the report.
People were protected by suitable procedures for the recruitment of staff. The registered provider had carried out checks to ensure staff had the required knowledge and skills, and were of good character before they were employed at the home.
During the inspection visit we observed staff as they went about their duties and provided care and support. We saw staff speaking with people who lived at the home in a respectful and dignified manner.
Staff had a good understanding of protecting and respecting people's human rights. Some staff had received training which included guidance in equality and diversity.
We observed lunch being served, we saw some people who had difficulty cutting their food being offered support to eat their meal. We observed people eating in a relaxed manner and they enjoyed their meals. Comments about the food included, “The food is always very good, there is always a good choice.”
There were activities for the residents to engage in and people were supported and encouraged to take part. One person told us, “There is entertainment through the week.”
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. 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.
Following the inspection we asked for some urgent action to be taken to mitigate some of the concerns which were highlighted. We found the whole staff team receptive to feedback and keen to improve the service. They worked with us in a positive manner and provided al