22 June 2023
During an inspection looking at part of the service
Downham Grange is a nursing home providing accommodation and personal care to up to 62 people. At the time of our inspection there were 56 people using the service. The service is purpose built and set over two floors with lift access. There are several communal areas, including gardens. The service accommodates people who require nursing or residential care and for people living with dementia.
People’s experience of using this service and what we found
People were not receiving good quality standards of safe care. Areas of the care environment were visibly unclean and increased the risk of the spread of infection. People, including those living with dementia were at risk of consuming items such as denture cleaning tablets, personal care products and prescribed creams as these were not being stored securely.
People with risks of developing pressure sores, the management of choking risks, as well as ensuring their fluid and nutritional intake was well monitored were poorly managed. This did not protect people from the risk of harm. Diabetes care needed improvements to ensure people’s long-term healthcare needs were well managed.
People were not receiving their medicines safely, with medicines running out, and not being re-ordered to ensure they were available to people. Unsecured creams increased the risk of people accessing items that could cause them harm. We found issues with record keeping in relation to the application of creams, and rotation of medicines given in a patch form.
Changes to levels of staffing, particularly at night time were needed to ensure people’s needs were met safely and in a timely way. Increased levels of governance and oversight of the service were required to ensure people’s basic standards of care were being met, such as personal cleanliness and appearance, as quality checks and audits of care records were not identifying gaps in the completion of care tasks.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 26 September 2022). The service has been rated requires improvement for the last 2 consecutive inspections and has not held a compliant rating since 2019.
Why we inspected
This focussed inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Downham Grange on our website at www.cqc.org.uk.
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.
Enforcement and Recommendations
We have identified breaches of the regulations in relation to safe care and treatment, staffing and good governance at this inspection.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.