Coombe Dingle Nursing Home provides nursing care and treatment for up to 42 people, most of whom are living with dementia. The home is divided across three floors. On the day of our inspection 31 people were living in the home.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was present during our inspection.
We carried out this inspection on 22 September 2015. This was to follow up on three breaches in regulation from our inspection in January 2015. As there had been a period of time between inspections we carried out a fully comprehensive inspection on this occasion.
People lived in an environment that was not well maintained or clean. Staff did not follow suitable infection control procedures and the provider had not made the improvements required of them from the last inspection.
Safe medicines management procedures were not always followed by staff and we found this was a continued breach of regulation from our last inspection. People had access to external health services however we found people may not always be provided with responsive care by staff.
Staff had not followed legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) in respect of restrictions or decisions made on behalf of people.
Up to date, contemporaneous and accurate records for people were not held which meant new or agency staff may not be working to the latest information. Staff had not taken the time to read care plans or information about people in order to get to know them to ensure they provided appropriate care and support.
Quality assurance checks were carried out by staff as well as the provider and feedback was sought from relatives. However, we found these checks had not identified areas that required improvement and the provider had not acted on areas we had identified at our previous inspection in relation to the ensuring they were providing a high quality, safe service.
Staff provided activities for people, however people who spent a lot of time in their room did not receive much social interaction from staff at times. Staff were not observed as always being proactive in engaging with people. Staff did not always treat people as though they mattered or with respect and people’s privacy was not always upheld.
People were not offered a choice of meals in a way they would be able to understand and people who required a pureed food did not get a choice. Although people’s dietary requirements were known by staff some information was contradictory or not provided to the chef in a way they would be able to easily identify these people.
Staff were not provided with training specific to the needs of people. Despite staff telling us no-one living in the home had capacity we found staff did not have a good understand of dementia and had not been given access to training.
Complaints procedures were in place and we saw most complaints had been resolved. One complaint was on-going as the complainant was not happy with the initial response from the registered manager.
There were a sufficient number of staff deployed in the home. We did not see people wait to be assisted and observed there was always someone around for people who were sitting in the lounge area.
We did observe some staff displaying kind, compassionate care to people and it was clear staff knew visitors to the home well. A complaints procedure was available for people or relatives if they had any concerns.
Staff had identified risks for people to demonstrate people were safe living at Coombe Dingle and we saw evidence staff had received manual handling training since our last inspection. Staff demonstrated good practices when lifting and moving people.
Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event. And in the case of an emergency people’s care would not be compromised because the provider had contingency plans and suitable arrangements if people needed to be evacuated.
Staff felt supported by the registered manager. They had the opportunity to meet with their individual line managers on a regular basis and contribute towards the running of the home through staff meetings. Appropriate checks were carried out to help ensure only suitable staff worked in the home.
During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘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.