This unannounced inspection took place on Wednesday 19 April 2017. We returned to the home to complete the inspection on Monday 24 April and this was announced in advance of our visit.Polefield Nursing Home provides accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is over two floors and has a passenger lift. There is a communal lounge and dining room on each floor. The home is set back off a main road, with level access grounds. There is a large garden area which people can access. At the time of our inspection, 35 people were living at the service.
Our last inspection of Polefield Nursing was in October 2016 where the service was rated overall as ‘Requires Improvement’ and in four of the five key questions against which we inspected. These included Safe, Effective, Caring and Responsive, with Well-led rated as ‘Inadequate’. There were three breaches of the regulations identified at that time with regards to safe care and treatment, good governance and staffing. This inspection was carried out to ascertain whether improvements had been made since our last inspection.
At this inspection in April 2017, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, meeting nutritional and hydration needs, safeguarding people from abuse, good governance and staffing. We are currently considering our enforcement options and course of action.
At the time of the inspection the home did not have a registered manager in post. This meant the service were failing to comply with the requirements of their registration. 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.
People were not safe as they were not protected from the risk of aspiration. People assessed as being at risk from an ‘unsafe swallow’ were given foods by staff which could cause them to choke or aspirate. Some of these had been listed as foods to avoid when they had been referred to SALT (Speech and Language Therapy). The supplement ‘Thick and easy’ was also left accessible around the home which presented the risk of people consuming this accidently and placing themselves at risk.
We found the kitchen area was left unsupervised early in the morning when we arrived at the home, with large kitchen knives and a boiling hot water dispenser accessible to people living at the home. The risk assessment implemented following our first inspection visit was not followed and control measures were not adhered to which placed people at continued risk of harm.
Medication was not always given to people safely and we found instances where people had not received their medicines as prescribed. PRN (when required) protocols had still not been implemented which had been raised as a concern at our previous inspection visit.
People living at the home said they felt safe and staff had a good understanding about how to report any safeguarding concerns.
Staff recruitment was robust, with appropriate checks carried out before staff began working at the home.
The building and necessary equipment such as hoists were maintained regularly, with certificates of work completed held in an organised file.
We identified gaps in staff training in areas such as infection control, safeguarding dementia awareness, fire safety and health and safety. The manager was in the process of ensuring staff had access to appropriate equipment such as laptops, to be able to undertake this training during quieter periods of their working day.
People were not always protected from the risk of losing weight and we identified two people whose food was not being fortified with additional calories as advised by the dietician service following referral. There were also concerns with the recording of weekly weights and people being offered snacks in between meals. These measures could have helped peoples weight to increase over time.
The home was not working in accordance with the MCA (Mental Capacity Act). For instance, we found staff at the home did not carry out assessments of peoples capacity when they had been identified as having a severe cognitive impairment. One person was asking to leave the home during the inspection and in this case, an MCA assessment had been carried out, however an appropriate DoLS (Deprivation of Liberty Safeguards) referral had not been made. This meant people were being detained without lawful authority.
We saw evidence of supervision and appraisal being undertaken, with a staff induction programme in place to support staff in their roles.
Due to the wide spread failings found within the service, people living at the home did not always benefit from a caring culture. This was in relation to people being at risk of choking and weight loss due to recommendations not being followed and legislation not being followed when people lacked the capacity to make their own decisions.
The feedback we received from people living at the home was that they received a good level of care and they were happy. We saw staff treating people with dignity and respect and promoting people’s independence where possible.
We found accurate and contemporaneous records were not always maintained. This included re-positioning charts, weight monitoring, oral hygiene, nail care, fluid consistency and life history information for people living at the home.
There were systems in place to investigate and respond to complaints appropriately. The people we spoke with said they would speak with staff or the manager if they were unhappy with the service they received.
There were also systems in place to seek feedback from people living at the home and their relatives. This included residents/relatives meetings and satisfaction surveys. The results of these were then analysed, with action plans put in place to drive improvement.
The systems in place to monitor the quality of service being provided were ineffective. For example, there were no governance systems to monitor nutritional intake, people at risk of weight loss, staff training and MCA /DoLS. These had been some of the areas of concern that we identified during the inspection. There were also continuing breaches of the regulations and a failure to improve the overall rating of the home.
The overall rating for this service is 'Inadequate' and the service is therefore 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, we will be inspecting 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 in 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.