Archived: Nuffield Care Centre

Updated 28 March 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 whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection site visit took place on 31 January 2018 and was unannounced. The inspection team consisted of one inspector, two specialist nurses 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.

Prior to the inspection we reviewed the information we had about the service. This included information sent to us by the provider, about the staff and the people who used the service. We reviewed notifications sent to us about significant events at the service. A notification is information about important events which the provider is required to tell us about by law.

On this occasion we did not ask the provider to complete a Provider Information Return (PIR). This is because we were following up on breaches from the previous inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We were also following up on concerns that were raised by the Coroner’s office in relation to wound care management and concerns raised by the Quality Assurance team from the Local Authority.

During the visit we spoke with the registered manager, the provider’s general manager, 14 people, one relative and nine members of staff. We looked at a sample of six care records of people who used the service, medicine administration records and training, supervision and three recruitment records for staff. We looked at records that related to the management of the service. This included minutes of staff meetings and audits of the service.

Updated 28 March 2018

Nuffield Care Centre 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. Nuffield Care Centre is registered to provide nursing and personal care for up to 35 people. There were 24 people living at the service at the time of our inspection.

This inspection site visit took place on 31 January 2018 and was unannounced.

There was a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 21 July 2017 we asked the provider to take action to make improvements in relation to people’s safety, staffing levels and training, the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the involvement of people in their care, how people were respected, activities and the leadership at the service. We found that these actions had not been completed.

The lack of strong and effective leadership has had an impact across all five key questions that we ask. There had been continued breaches of regulation over two inspections and despite action plans being sent to us to say that the required improvements had been made we found that this was not the case.

There were not sufficient staff to meet the needs of people. People were left waiting for care and at times left isolated due to the lack of available staff. Nurses were often providing personal care to people to support care staff which meant that their nursing duties were not being carried out appropriately.

Staff were not always following good infection control practice. Sluice and medicine rooms were not always clean and waste was not disposed of appropriately. There were some areas in the service that required cleaning and equipment needed updating which was putting people at risk. We did see some good examples of staff washing their hands and using protective equipment when attending to people’s personal care. Paperwork relating to people’s care was disjointed and staff did not always know where to locate the care records for people.

People who were at risk of dehydration were not being prompted enough to drink and staff were not effectively monitoring this. Records of when cream was being applied to people’s skin were not completed appropriately and it was not clear if the cream had been applied or not. Other records were not always being completed appropriately including when how often people required repositioning in bed. This had been raised as a concern by the Coroner in relation to the death of a person using the service.

There were aspects to the management of medicines that were not safe. Reviews of people’s medicines relating to their mental health and dementia were not taking place. Charts were not being routinely used to assess whether people were in pain particularly those that were unable to communicate verbally. Body maps were not being used to show staff where creams needed to be applied.

The premises and equipment was not always in good order. Chemicals were not being stored in a safe way and equipment in areas of the service needed updating or replacing.

Not all staff had received supervisions and nurse competency had not always been assessed. Staff were not up date with their mandatory and clinical training. Staff had not ensured that decisions for people had been undertaken in their best interests although decision specific Mental Capacity Assessments (MCA) had taken place.

Staff were not effectively informed about people which impacted on how care was provided. There were a high number of agency staff at the service that did not know people’s needs. People did not always have access to appropriate health care professionals in relation to their ongoing care. The environment was not appropriate for the needs of people living at the service particularly those living with dementia.

There were mixed responses from people about the caring nature of staff. We found that people were left isolated without meaningful interactions from staff. People did not have choices around when they wanted to get up. Staff did not always have time to support people in a meaningful way. However when staff did interact with people this was done in a caring and respectful way.

People told us that they were bored. We found that there were insufficient meaningful activities for people to participate in. Actions from complaints responses were not always actioned to show that lessons had been learned.

Quality assurance was not always robust and there was a lack of leadership at the service. The issues we identified on the inspection had not been recognised through the registered managers and providers monitoring of the service. Where people had raised ideas about improvements this was not always followed. There were aspects to the quality assurance that were effective in relation to audits of care plans, health and safety and medicines.

There were aspects to the medicines and risks to care that were being managed well. Risks to people’s mobility and those that were nutritionally at risk were managed in a safe way. Accidents and incidents were recorded and action taken. There were appropriate plans in place in the event of an emergency. There was a robust recruitment process in place to ensure only suitable staff were employed.

People told us that they liked the food at the service. There were occasions where people did have the input from health care professionals where needed including GP and Speech and Language Therapists (SaLT). People’s needs were assessed prior to moving in to ensure that the service was appropriate for them. Care and support was planned and delivered in line with current evidence based guidance.

People were able to personalise their rooms and visitors were welcomed to the service any time they wanted. Care plans were detailed in relation to people’s individual needs including mobility and nutritional needs. Wound care management was detailed with appropriate guidance for how to dress the wound. People were supported at the end of their life to have a comfortable, dignified and pain-free death.

Staff told us that they felt supported and could go to the registered manager when they needed.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. Staff had informed the CQC of significant events.

The overall rating for this service is ‘Inadequate’ and has been placed into ‘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.

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.