Archived: Cuerden Developments Limited - Cuerden Grange Nursing

Our inspection took place over two days. On the first day we spent approximately 12 hours in the home. This allowed us to assess the operation of the home over the course of the waking day. On the second day we were accompanied by a pharmacy inspector, who carried out an inspection of the arrangements in place to manage medication. During the inspection we spoke with nine people living in the home, five relatives, eight members of staff, the director of the company and the provider. We also looked round the home and inspected a sample of records. Prior to the inspection we spoke to representatives of Lancashire County Council's safeguarding team and contracts monitoring team.

We considered all the evidence we had gathered under the outcomes we inspected. We have used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

The service was not safe. Appropriate arrangements had not been made to protect people from the risks of unsafe or inappropriate care. Risk assessments had not been carried out to ensure people who required assistance to move were transferred safely. One person told us they experienced pain when staff moved them using the hoist. We raised a safeguarding alert with the local authority in respect to this issue.

There was a failure to report allegations of poor practice to the local authority in line with established protocols to protect vulnerable adults from abuse. There was also a failure to notify the commission of these allegations in accordance with the current regulations.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Deprivation of liberty safeguards are part of the Mental Capacity Act 2005 and are designed to ensure that a person's loss of liberty is lawful and they are protected. We noted an application had been made to the local authority for a DoLS, however, there was no care plan in place to ensure the person's liberty was not unnecessarily restricted.

We asked if medicines were handled safely. We found that medicines were not always safely administered in line with the home's policy and current guidance, increasing the risk of errors. The manager was not on duty when we visited but nursing staff on duty were unable to describe any current concerns with regard to medicines handling, or any action that was currently being taken to bring about improvement.

Is the service effective?

The service was not effective. Staff had completed training relevant to their role, however, there had been no checks on their level of understanding and competency following the training. We looked at a new staff member's induction records, but could not determine the level of training as many sections were blank. Some staff had received supervision, but two staff told us that whilst they had prepared for their supervision meeting there was no one from management team available at their allotted time.

Is the service caring?

The service was not consistently caring. Staff confirmed they could spend little time with people chatting about issues which were important to them. We also asked the staff on two occasions to ensure a person was covered to protect their dignity. However, the majority of people living in the home were complimentary about the staff team.

Is the service responsive?

The service was not responsive. Staff had not read one person's care plan and were not aware of advice given by an occupational therapist. We found night staff had written the majority of people's care plans on the ground floor. The night staff acknowledged they were unaware of people's needs during the waking day. We also noted one person's plan was incomplete and there was no record of an important aspect of personal care in another person's plan.

There had been one relatives and residents meeting since the last inspection in May 2014. However, relatives were unaware what action had been taken in response to their concerns about the staffing levels and some aspects of the decoration of the home.

Is the service well led?

The service was not well led. There had been several changes of manager over the last year and many staff and relatives spoken with had lost confidence in the management of the home. There was a lack of effective systems to assess and monitor the quality of the service. Whilst some audits had been carried out, shortfalls had not been picked up and addressed.

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Some aspects of care were delivered very well. We saw clear action being taken to minimise risks regarding mobility, falls, pressure care, nutrition and weight.

However the current arrangements for assessing people's needs, support planning and reviews did not protect people from the potential risk of receiving of receiving inappropriate care or treatment. Pre admission assessments had not identified some key areas of need, support plans were not always in place and the outcome of reviews was not always acted upon. People were at risk of not having their needs met.

People were not fully protected against the potential risks associated with some medicines. Some people were prescribed medication to be taken when required. There was not always guidance to inform staff when this should be given. Individual guidance would help to promote consistency of use and ensure medication was given when needed. Medication was generally given at set times, as part of a medication round, and there was no system in place to ensure people received their medication under the circumstances it was prescribed, such as before food. People living at the home were at risk of not having their medication when they needed it.

Is the service effective?

The lack of consistent and effective leadership had resulted in staff not receiving adequate support. Management changes during the last year meant that staff had not been receiving consistent support. Regular staff meetings had not been taking place and individual supervision meetings with staff were also limited. Management changes and the lack of a formal support system for staff meant that opportunities to discuss work performance, training needs and professional development had also been limited.

The deputy manager and the staff team had worked hard trying to maintain the running of the home. We saw that staff training had continued and new staff had received an induction into the requirements of their post, plus essential health and safety training had taken place. Staff received training to enable them to meet the needs of people living at the home.

There was insufficient equipment in place to meet the needs of all those living at the home. Some people living at the home were unable to use the bath or shower chair and not everyone had access to the call bell system. The lack of appropriate equipment did not meet their assessed needs of all people living at the home.

Is the service caring?

We observed staff interacting with people in a kind and friendly manner. We saw that staff were considerate, respectful of people's wishes, and delivered care and support in a way that maintained people's dignity. Relationships between staff and residents appeared warm and friendly.

The staff we spoke with showed a good understanding of the needs of the people they were supporting. Staff showed an understanding of what people wanted when they had difficulty in expressing themselves.

People living at the home and the relatives we spoke with told us staff were kind and hardworking. Comments included; 'There have been some new ones but they seem nice.' And 'People are kind and they do their best.'

Is the service responsive?

The current ways of working did not ensure that staff had the most up to date information about each person. This meant that people were at risk of not having their needs met or of receiving inappropriate care or treatment. Changes to people's health and wellbeing were not always responded to in a timely manner.

Is the service well led?

There had been three different managers in post during the past year. These changes had impacted upon quality monitoring at the home. During this period the deputy manager had worked hard trying to support staff and oversee the running of the service, whilst continuing their nursing position at the home. A new manager had recently been appointed.

Although some audits and checks had been taking place, these had not identified serious shortfalls in key areas such as equipment, medication, support planning and reviews. The quality assessment and monitoring systems had not lead to the effective management of risks relating to health welfare and safety of those living at the home.

We found staff had been appropriately recruited and were well supported by the management team. Those living at Cuerden Grange looked comfortable in their presence. Methods for monitoring the quality of service provided had been established and systems had been developed in order to protect the health and safety of those living at the home.

Comments from those living at the home included:

"They (the staff) are very good to me. I have no complaints at all."

"The staff are all fantastic. They look after me very well indeed."

"It is smashing here. I get everything I need."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at the management of medications. Standards relating to recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

We reviewed the care records of people living at the home during our visit and found that improvements had been made. The plans of care were more person centred, incorporated people's assessed needs and how these needs were to be best met.

We found staff to be well supported and appropriately trained and those living at Cuerden Grange looked comfortable in their presence. People we spoke with were very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been well established and processes had been developed so that any shortfalls could be appropriately addressed.

Comments from those living at the home and their relatives included:

"Mum likes living here. The home is lovely. It is so warm, comfortable and friendly."

"They (the staff) are absolutely fine, but I have to get up earlyish, but that suits me OK. I really don't mind. In fact I like to be up quite early."

"The care here is brilliant. Mum's clothes are always clean. The laundry service is fantastic."