Nazareth House - Birkenhead

Updated 10 August 2022

The inspection

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act under the domains of safe and well-led, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was undertaken by an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of service.

Service and service type

Nazareth House - Birkenhead is a care home. People in care homes receive accommodation with nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We announced this inspection from the roadside on the first day of the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We contacted the local authority for their feedback on the service. We used all this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with the regional manager, the registered manager, the deputy manager, an agency nurse, a senior carer and two care assistants. We reviewed a range of records. This included three people's care records, a sample of medication records, three staff recruitment files and records relating to the management of the service.

We spoke five people living in the home and six relatives during the inspection to gain their feedback on the service and the care they received.

Updated 10 August 2022

About the service

Nazareth House – Birkenhead provides accommodation for up to 57 people who need help with nursing or personal care. At the time of the inspection 44 people lived in the home. Some of the people living in the home, lived with dementia.

People's experience of using this service

We commenced an inspection at the home on the 16 June to initially just to look at infection control standards. During this inspection, however we identified wider concerns pertaining to the environment that lead to the inspection being widened to a focused inspection. This meant we looked at all aspects of the domains of safe and well-led. We subsequently identified concerns with the management of risk, the delivery of care, premise safety, medication management, leadership and governance.

Information relating to people’s medical needs and risks was insufficient Staff lacked information on what these conditions were, the signs and symptoms to spot in the event of ill health and the action to take. Records relating to the care people received were not properly maintained. The records we looked at did not demonstrate that people received the support they needed to mitigate risks and keep them safe and well.

Medication management was unsafe, did not adhere to best practice guidelines and placed people at risk of significant harm. Some medicines could not be accounted for, which meant some people had not received their medicines as prescribed. There was a lack of overall guidance on the administration of ‘as and when’ required medicines and medicines that needed to be taken at specific times. High risk medicines had not been risk assessed and information pertaining to medicines was not always clear and sufficient.

The systems in place to monitor quality and safety were ineffective. This is the sixth time the service has been given an overall rating of requires improvement since 2015. At each inspection, the well-led domain has been rated as requires improvement. The repetitive nature of this rating indicates that the provider does not have clear oversight of the service or a proactive and positive approach to continuous improvement in the home.

Staff recruitment and staffing levels were safe.

Infection control standards were generally satisfactory but record keeping in relation to cleaning, lateral flow testing and temperature checking for COVID-19 required improvement. On the day of the inspection, the environment was clean and pleasant for people to live in.

Accident and incidents and safeguarding events were recorded, investigated and reported appropriately.

Staff were observed to be kind, caring and respectful. People told us they felt safe and well looked after. People and relatives were positive about the service and had no complaints.

Staff we spoke with liked working in the home, felt the manager was supportive and had improved the service since they had come into post 12 months prior. People told us staff and the manager were approachable and that they were always made to feel welcome.

Rating at last inspection

The last rating for this service was requires improvement (published 13 March 2021).

Why we inspected

The home experienced a COVID-19 outbreak during February 2022, as a result an inspection to examine the standards of infection control commenced on the 16 June 2022. During this inspection, concerns relating to environmental safety were identified and the inspection was widened to a focused inspection of the domains of safe and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection we found breaches of regulations 12 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to the failure to ensure people received safe care and treatment and a failure to ensure the service was governed and managed adequately.

Please see the action we have told the provider to take at the end of this report.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work with the local authority to monitor progress.