Archived: Ennerdale Nursing Centre

Updated 30 March 2016

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 took place on 14, 15 and 28 January 2016 and was unannounced.

The inspection team comprised of an adult social care inspector, an inspection manager, a pharmacy inspector, a specialist nurse advisor 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 care service. A follow-up visit was undertaken on 28 January 2016 to check whether the service had made changes to improve and therefore, ensure people were safe.

The Provider Information Return was returned to us 10 December 2015. This is a document providers are asked to complete and return us with details about their service. The information provided to us confirmed that there were 13 medication errors in the last year, 27 people with do not attempt to resuscitate decisions in place, 6 people at risk of malnutrition and dehydration and 27 safeguarding incidents.

We reviewed the safeguarding incident which occurred on 20 October 2015, whereby a health professional visiting a person at Ennerdale Nursing Centre intervened and prevented a staff member from giving the person a scone and un-thickened drink of tea. The person who required thickened drinks went on to develop a chest infection on 24 October 2015 and concern was raised by the health professional that the person had consumed some of the un-thickened tea.

Healthwatch were contacted prior to the inspection, as well as the local authority safeguarding team and continuing health care team who funded some of the people at Ennerdale Nursing Centre. Health care professionals were also contacted as part of the inspection.

We looked at 12 care plans and other documentation in resident’s rooms such as positioning charts. We spoke to approximately 11 people who use the service and seven people visiting on the days of the inspection. Two residents at Ennerdale were case tracked which involves looking at their records from pre-admission to when they arrived at Ennerdale.

We looked at 6 staff recruitment files and spoke with 14 staff members of varying grades and roles. A pharmacist inspector visited the service on 14 and 28 January 2016 and looked at how medicines were managed for 15 of the 54 people living in the home.

Updated 30 March 2016

Ennerdale Nursing Centre is a nursing home provider based in the grounds of Aintree Hospital. At the time of our inspection the care home were providing personal care to 54 people and they had 7 empty beds. The care home has three separate units on two levels. Stananought unit is on the ground floor with 23 people requiring nursing care. Tarleton and Bridge were dementia care units located on the first floor with 16 people on Tarleton and 15 people on Bridge unit. We were informed by the manager that most people on the nursing unit on the ground level required 2 to 1 care due to their complex care needs. We were informed there were no people with challenging behaviour living in the home.

A registered manager was not in post at the time of inspection since approximately September 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.

We found people were not safe in the care home. We were concerned people who were prescribed thickeners for their drinks were not being given the appropriate amount of thickener. As a result of this we were concerned people were at extreme risk of choking or not being able to consume the drink and at risk of dehydration.

We spoke to the managers about our concerns and sent safeguarding referrals to the local authority to ensure all the people who were prescribed thickeners in their drinks were safeguarded.

The service lacked good governance as we found systems were failing to monitor care and encourage improvement. We met with the managers of Bupa following our inspection and expressed our concerns and that improvements were required to ensure people were safe. We returned to the care home on 28 January 2016 to monitor any progress made since our inspection on 14 and 15 January 2016 and found the system of administering prescribed thickeners was still failing people. The service had demonstrated a failing to robustly reassess their systems in place in order to determine what the failings were to correct them and improve. We found the service was unable to mitigate the risks for people when we pointed them out. We were concerned that the service did not have adequately skilled staff to effectively implement a safe system and the lack of improvement was continuing to place people at risk of harm or death. Concerns raised at the inspection should have been highlighted within the service itself through quality assurance checks and audits of systems, however they were not. Therefore, the service demonstrated an inability to identify risks which were placing people at risk of harm, neglect or death through inadequate governance.

We looked at people’s care plans and found that information pertaining to the individual person didn’t include their background, interests or preferences and so information about the person was incomplete and not person centred. We observed people’s needs were not always being considered with one person lying on their left side despite written instructions above the person’s bed stating ‘do not turn me onto my left side whilst I am in bed’. People who had suffered a stroke and were unable to move themselves in bed, were reliant on staff to position them on their unaffected side. By staff not adhering to this, there was a risk of people sustaining further injury.

We couldn’t ascertain when the care plans had last been reviewed or if the information had been updated in accordance with the changing health needs of people receiving care. Therefore, we could not be sure the information in the care plans was either current or accurate. This meant that staff may not have the required information to meet people’s needs. We looked at positioning and weight charts and found that people were not always being turned or weighed as advised by health care professionals. One person had the incorrect positioning chart in their room which belonged to another person. This was brought to the attention of the manager and the quality assurance manager. Another person had been assessed by a health professional dated 23 October 2015 advising that the person requires a weight recording every second week. We could only see one weight recorded since then documented on 22 November 2015. This led us to believe that advice given by health care professionals was not always being followed which may then lead to people not being cared for effectively placing people at risk of harm.

There were systems in place to try to ensure that medicines were given appropriately but these systems were not being followed or being monitored. This raised concern whether the systems in place were fully effective in ensuring people requiring medicines were receiving their prescribed medication at the appropriate times or at the appropriate dosages. There were inconsistencies in the systems of administering creams on both floors within the care home. We found creams in people’s bedrooms which were not labelled and therefore we couldn’t be sure who the cream was for. This presented a risk of creams being contaminated if staff were applying the same cream to more than one person or of applying a cream to the wrong person. Staff were unable to locate creams for people and did not have a system in place to ensure people’s prescribed creams were securely stored. In one person’s room we observed a tin of prescribed thickener with the lid open which posed an infection control/contamination risk to the person who it was prescribed for.

There was not enough staff at the home to meet people’s needs. We spoke with qualified and unqualified staff as part of our inspection. All the staff we spoke to demonstrated during conversation that they had a caring nature and manner. However, some staff said they were short staffed and were unable to provide the care people required all of the time.

We looked at staff recruitment files and found an induction process had been followed. Staff had not received regular supervision or appraisals. Staff told us they had received training on the Mental Capacity Act but the staff we spoke to were unable to articulate what the mental capacity act is. The care plans included a mental capacity form related to consent to care and treatment which had tick boxes for staff to tick if a person had capacity or not or whether it was variable. We found inconsistencies in the documentation we looked at regarding a person’s mental capacity and we only found one person with a decision specific mental capacity assessment and evidence that the best interest’s process had been followed.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.