Archived: Ingwood Nursing Home

Our last inspection of Ingwood Nursing Home took place on 23 July 2014. At that time the service was found to be compliant with regulations and was given a rating of 'Good.' Since that inspection the provider took the decision to cease the provision of nursing care at the service. This meant that people living at the home who required nursing care went to live at other services. Nursing staff, including the registered manager, were transferred to another of the provider's services. The service is referred to in this report as Ingwood Nursing Home as the provider has not informed the Commission of change of name for the service.

The previous registered manager of Ingwood Nursing Home deregistered with the Commission in January 2015. 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.

There was no manager in place at the home and staff did not know who was in charge. There was a lack of regular quality auditing by senior management.

People who lived at the home told us they felt safe and staff had a good understanding of their responsibilities in keeping people safe. However, staff were unfamiliar with how to report safeguarding concerns. Accidents that happened in the home were not audited which meant staff were not doing everything possible to mitigate risks to people who lived at the home.

Systems for managing medicines were not safe. Staff who had not been adequately trained or assessed as competent were supporting people with their medicines.

Staffing was adequate but better deployment of care staff, including the arrangements for the use of agency staff, was needed to make sure staff were always available to respond to people.

We recommended the provider considers the deployment of staff to make sure care staff are not taken away from supporting people living at the home.

Procedures for recruitment of new staff were safe with thorough checks always completed before staff started work to make sure they were safe and suitable to work in the care sector.

Staff had not received the training they needed to support them in their roles.

Staff were caring and people we spoke with were complimentary about the staff.

Food provided at the home was of a good standard but mealtimes were not managed well and staff had failed to make sure that all of the people who lived at the home received the nutrition they needed to maintain their health.

Risk assessments were misleading and out of date.

Care plans did not demonstrate a person centred approach to care and were not up to date.

We saw people engaging in activities which they enjoyed although the working hours of the activities coordinator restricted the opportunity for planned activity.

People were restricted in their movements within the home. A series of key pad locks meant that people could not always access two of the lounges and bedrooms.

Complaints made to the service were not managed in line with the complaints policy.

Systems for auditing the quality and safety of care were in place but were not up to date.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’.

This means that usually the service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, would be inspected again within six months.

However in this instance the provider took the decision to cease residential care provision at this service and Ingwood Nursing Home is now closed. The provider is in the process of applying to the Care Quality Commission to deregistered this service. In view of this the Commission took the decision not to take enforcement action against the provider in relation to Ingwood Nursing Home.

You can see what action we told the provider to take at the back of the full version of the report.

The provider sent us action plans keeping us informed of work that had been taken to effect the improvements needed.

We made this visit to see what actions had been taken.

We found that work had been done to review and bring care records up to date. We saw that healthcare professionals had been involved where appropriate. We found that people's social and recreational needs were not being addressed.

We saw the systems for handling medicines had been reviewed and medication reviews had taken place.

Standards of hygiene and infection control had improved. Some effective quality auditing had taken place but audits and assessments of the quality of life experienced by people living at the home had not taken place.

We saw recruitment was ongoing and that some appointments had been made. However, we found staffing was not always appropriate to the needs of the people who lived at the home.

We found that staff were not always respectful of people's privacy and dignity needs we observed some practices that showed a lack of regard for people.

A relative we spoke with told us the standards of cleanliness in the home had improved recently. They said, 'The cleaners are wonderful; I have no problem with the cleaning here.'

We spoke with one person who said, 'You can choose what you want to eat, I get enough to eat. I'm diabetic so I can't have bread or potatoes, but I get ice cream. The staff here are all so nice.'

On this visit we found improvements had been made in meeting people's nutritional needs but did not find improvement in any of the other areas.

We found care documentation did not support safe care and found people were not receiving the care and support they needed to promote or maintain their health.

Areas of the home were not clean and arrangements were not in place to maintain appropriate cleanliness and hygiene standards.

Medications were not stored or administered safely.

Staffing was not arranged to meet the needs of the people who lived at the home.

Monitoring of safety and quality was not effective.

We spoke with two visiting relatives. One told us that they thought there had been improvements in the home recently and they were satisfied with the care their relative received. Another person told us that staff were very good and they were very satisfied.

None of the people we spoke with who live at the home were able, due to complex care needs to tell us about their experience of living at the home.

We observed that staff were rushed and appeared at times, disorganised and misinformed. People had care plans in place but these were not always appropriate to the needs of the individuals concerned. Care documentation was not always in place to instruct staff in supporting people's nutritional needs, and we had concerns that these may not always have been met.

We had concerns relating to the management of medicines and the processes in place for monitoring the quality of service provided by the home.

Two members of staff said that the increase in staffing had made a big difference in that that they time to meet people's needs properly.