Finch Manor Nursing Home

Finch Manor Nursing Home provides accommodation for up to 89 people who need help with nursing or personal care. At the time of the inspection 82 people lived in the home. The majority of the people living in the home lived with dementia or other complex health need.

People’s experience of using this service and what we found

The last 5 CQC inspections of the home have continually identified serious concerns with the safety and quality of the service provided for people. There continued to be multiple breaches of the regulations which continued to place people at significant risk of avoidable harm.

People needs were still not adequately assessed or met, with significant gaps and failings in the care they received. Clinical care was ad hoc and poorly delivered which meant risks to people’s health were not always picked up and addressed. Care was not person centred, did not meet their individual needs, or protect their dignity.

Accidents and incident of a similar nature kept repeating. This indicated that the system in place to learn from and prevent injuries, care failures and safeguarding events happening again was not robust. This meant people continued to be exposed to preventable harm.

Medicines were not managed safely. People did not receive the medicines they need to keep them and did not receive them in a safe way to prevent medicines related harm. Diabetes management was poor. Insulin designed to control blood sugars was administered without the relevant checks in place to ensure it was safe to do. This placed people at serious risk of harm.

There was no safety equipment in place to help people clear their airways in the event of a choking episode and not all staff had completed first aid training.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People’s consent was not sought in line with the principles of the Mental Capacity Act 2005.

Satisfactory pre-employment checks were not always completed when staff were recruited to work in the home. This meant the provider could not be assured they were suitable to work with vulnerable people.

Staffing levels were not safe and did not ensure people’s needs were met. The provider relied heavily on agency staff to staff the service. People told us agency staff did not always know what their needs were or how to support them. One person told us, “My heart sinks if it’s ad hoc agency staff. Some don’t speak English well, so don’t understand my needs and what I’m asking for”. Everyone we spoke with said that there were not enough staff on duty. Some people said they waited a long time for staff to come when they pressed their call bell for help.

Systems in place to monitor the quality and safety of the service were not effective and did not ensure risks to people’s health, safety and welfare were identified and managed. Managerial and clinical oversight by the provider and registered persons was not thorough and risks to people remained.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was inadequate (published 17 August 2023).

At this inspection, we found that the quality and safety of the service continued to be inadequate. Multiple breaches of the regulations were found, resulting in a continued rating of inadequate. At this inspection, breaches of regulations 9 (Person centred care); 11 (Need for Consent); 12 (Safe care and treatment); 17 (Good governance); 18 (Staffing) and 19 (Fit and proper persons) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

Why we inspected

This inspection was prompted by the inadequate rating given at the last inspection. We also had concerns about a number of safeguarding incidents reported to us by both the provider and the Local Authority which raised concerns about the safety of people’s care and the management of the service. As a result, we undertook a comprehensive inspection of the service.

Enforcement

We have identified breaches in relation to the safety of people’s care, assessment and risk management, accident and incidents, the management of medicines, the implementation of the Mental Capacity Act 2005, staffing levels, staff recruitment, staff training, staff supervision, the delivery of person centred, responsive care and the overall governance of the service.

Immediately after the inspection, we asked the provider to submit an urgent and immediate action plan for improvement. The local authority were also informed about our concerns to ensure people were safeguarded from potential harm.

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.

Follow up

We will work alongside the provider and Local Authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

Finch Manor Nursing Home a residential care home providing personal care and nursing care for up to 89 people. The service provides support to older people and younger people requiring nursing care. At the time of our inspection there were 87 people using the service. Accommodation is provided on the ground floor of the building which was accessible to all.

People’s experience of using this service and what we found

People's safety was not always appropriately managed. Identified risks to people were not always considered or planned for. Medicines were not always managed appropriately. Staff supporting people were not familiar with individuals' needs and there was a lack of guidance and support available to these staff. Cleanliness and infection prevention and control procedures were not effective, with many areas of the service requiring cleaning. There was a lack of management of staff and no effective oversight of staff recruitment and information relating to agency workers.

Detailed information about people's eating and drinking needs and preferences was not always available. This resulted in staff supporting people who were not aware of people's dietary needs and preferences. Newly recruited staff and agency staff were not aware of people's needs and wishes.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Information available to staff was limited and failed to give sufficient guidance on how to engage with people. This was reflected in staff carrying out task based work and not involving people in making choices or decisions. Food choices were not always available or consistent for everyone.

People's care and support was not planned in a person-centred way which promoted their choice, control or preferences. Staff supporting people did not have access at all times to effective, person-centred care plans. Records were not always fit for purpose and put people at serious risk of not receiving the care, treatment and support they needed. Audits and checks in place had failed to identify areas of improvements needed identified during this inspection. Staff were not always clear about their roles and the support people needed. No systems were in place to ensure that people were supported by staff who had information and guidance to meet the needs of people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published 19 January 2023)

At this inspection we found the provider remained in breach of regulation.

This service has been in Special Measures since 19 January 2023. During this inspection the provider demonstrated that improvements have not been made.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about staffing; management of the service and the quality of care delivered to people. A decision was made for us to inspect and examine those risks.

The overall rating for the service has remained inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe; effective; caring; responsive and well-led sections of this full report.

Following feedback during this inspection the provider took action to address the most serious risks identified through this inspection process.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Finch Manor Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person-centred care, dignity and respect, consent, risk assessments, nutrition and hydration, staffing and governance at this inspection.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review.

Finch Manor Nursing Home a residential care home providing personal care and nursing care for up to 89 people. The service provides support to older people and younger people requiring nursing care. At the time of our inspection there were 84 people using the service.

People’s experience of using this service and what we found

People’s safety was not always appropriately managed. Identified risks to people were not always considered or planned for. Equipment needed by people was not always available or not used effectively. Staff supporting people were not familiar with individuals’ needs and there was a lack of guidance and support available to these staff. Cleanliness and infection prevention and control procedures were not effective, with many areas of the service requiring cleaning.

Detailed information about people’s eating and drinking needs and preferences was not always available. This resulted in staff supporting people not being aware of people’s dietary needs and preferences. Newly recruited staff and agency staff were not aware of people’s needs and wishes, and the majority of staff had not completed their updated training for their role.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Information available to staff was limited and failed to give sufficient information on how to engage with people. This was reflected in staff carrying out tasked based work and not involving people in making choices or decisions. Food choices were not always available or consistent for everyone.

People’s care and support was not planned in a person centred way which promoted their choice, control or preferences. Staff supporting people did not have access at all times to effective, person centred care plans.

Records were not always fit for purpose and put people at serious risk of not receiving the care, treatment and support they needed. Audits and checks in place had failed to identify areas of improvements needed identified during this inspection. Staff were not always clear about their roles and the support people needed. No systems were in place to ensure that people were supported by staff who had the skills to meet the needs of people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 May 2021).

At this inspection we found the provider was in breach of regulations and rated inadequate.

Why we inspected

We undertook a focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing and the management of the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern, so we widened the scope of the inspection to become a comprehensive inspection which included all 5 key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care; staffing; safe care and treatment; safeguarding; meeting nutritional needs and good governance at this inspection.

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.

We have also made a number of recommendations to the provider to improve the quality of care people receive with regards to safe management of medicines, assessment and review of care, assisting people to orientate around the service and to ensure full compliance with the Mental Capacity Act 2005.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

The home had measures in place to minimise the risk of spreading infection on entering the premises. Examples included staff checking for proof of a negative COVID-19 test, vaccination status and health screening questionnaires. There was also a hand sanitising and PPE station in the reception area.

The provider had safe systems in place to facilitate and support visiting at the home in line with the national guidance.

Staff donned, doffed and disposed of personal protective equipment (PPE) safely and in line with the relevant guidance. Staff were wearing the required levels of PPE during our inspection.

The provider had an effective COVID-19 testing programme in place for staff, residents and visitors. The frequency and type of testing carried out was in line with the national guidance.

The provider had systems in place to ensure it was meeting the COVID-19 vaccination requirements for staff and people visiting the service.

Finch Manor is a care home providing personal care for up to 85 older people. The service is purpose built and the accommodation is in five units over one floor, although at the time of the inspection, only four units were in use. Each of the units supports people living with different conditions such as dementia and nursing needs. There were 55 people living at the service at the time we inspected.

People's experience of using this service and what we found

At the last inspection, we found concerns with the safety and quality of care being provided at this service. People living at Finch Manor did not benefit from a service that was safe or well-led and we found multiple breaches of regulation.

As this inspection, we checked to see whether improvements had been made and found they had.

Since the last inspection, a new registered manager had joined the service, and the management team had been restructured. Both people and staff spoke positively about the new manager and the changes they had made.

We found that the service had improved their systems and processes to ensure that care provided to people was safe, and the quality of care and support was consistently monitored.

People spoken with and their relatives told us they were happy with the care being provided and valued the staff.

Parts of the service had been reconfigured and we observed people were calm and at ease in their environment as a result. People were supported to have maximum choice and control of their lives, and staff supported people in line with preferences.

The appearance of the physical environment had improved since the last inspection. New bathrooms, satellite kitchens and flooring had been installed and most areas had been newly painted.

Although significant improvements had been since the last inspection, further time was required to ensure that new systems were fully embedded, and consistency of improved practice was evidenced.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 11 September 2020) and there were multiple breaches of regulation. In line with our enforcement procedures, we issued Warning Notices in respect of Regulation 12 and 17.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found enough improvement had been made and the provider was no longer in breach of regulation and the Warning Notices had been met.

This service has been in Special Measures since 19 October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 23 July 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Finch Manor Nursing Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Finch Manor is a care home providing personal care for up to 85 older people. The service is purpose built and the accommodation is in five units over one floor. Each of the units support people living with different conditions such as dementia and nursing needs. At the time of the inspection there were 78 people living at the service.

People's experience of using this service and what we found

People living at Finch Manor did not benefit from a service that was safe or well-led.

People did not always receive their medicines safely. Medication was not managed, stored and administered in a safe way.

Care plans were not consistent and did not contain the most up to date information about people's health care needs and requirements. Care records lacked person centred detail. Risk assessments were not always in place or adequate to minimise risks to people. Care records were not maintained so people’s care, support and treatment had not always been accurately documented and monitored.

The service did not always identify and report accidents and incidents appropriately and refer incidents to safeguarding for investigation when necessary. Incidents were not analysed effectively meaning that people were exposed to a risk of harm.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. There were no assurances that people made their own decisions about their care and treatment.

Assurance and auditing processes did not assess, monitor and drive improvement in the quality and safety of the service being provided. Governance systems were ineffective and did not mitigate risk to the health and welfare of people living at the service.

Systems in place to monitor the physical environment had improved since the last inspection, although it was not evident that a major recommendation made by the fire service had been implemented.

The appearance of the physical environment had improved since the last inspection. New bathrooms and flooring had been installed and corridor walls had been newly painted. It was recognised that the service was still in the process of a full refurbishment.

Safe recruitment practices were in place for staff. People's relatives spoke positively about the staff and care received by their loved one.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 21 October 2019) and there were multiple breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found not enough improvement had been made and the provider was still in breach of regulation. We also identified new breaches of regulations, meaning that the service had further deteriorated.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Inadequate. The service is therefore in 'Special measures'. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Finch Manor Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified repeated breaches in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) at this inspection. We have also identified new breaches of Regulation 11 (Need for consent), Regulation 13 (Safeguarding service users from abuse) and Regulation 14 (Meeting nutritional and hydration needs).

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

As the service remains in ‘special measures’, we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Finch Manor is a care home providing personal care for up to 85 older people. The service is purpose built and the accommodation is in five units over one floor. Each of the units support people living with different conditions such as dementia and nursing needs. At the time of the inspection there were 78 people living at the service.

People's experience of using this service and what we found

People did not always receive their medicines safely. Medication was not managed and administered in a safe way.

Care plans were inconsistent and did not contain the most up to date information about people’s health care needs and requirements. Care records lacked person centred detail. Risk assessments were not always in place or adequate to minimise risks to people.

The safety of the environment was not routinely monitored or assessed. Many areas of the service appeared worn and tired. Bathrooms were not maintained and appeared unclean. The service was in need of a full refurbishment.

Systems in place to monitor, assess and improve the safety and quality of the service being provided were not effective. The safety and oversight of the service was inadequate.

Not all staff had received the necessary training to help them carry out their role in a safe and competent manner.

Safe recruitment practices were in place for staff. People and relatives spoke positively about the registered manager and the staff. We observed some positive interactions between staff and people living at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published March 2019) and there were multiple breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Finch Manor on our website at www.cqc.org.uk.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

People’s experience of using this service: People living in the home told us they felt safe. Most people felt there were enough staff to meet their needs. However, two people and some relatives told us there was not always enough staff and during these times response to call bells was slow. During the inspection we observed staffing levels to be adequate, with staff able to support people in a timely way.

People were not always receiving their medicines safely. Staff were not following the service medication policy when administering medicines. Staff had not been appropriately checked for competence with administering medication.

The service was not compliant with the Mental Capacity Act (MCA) 2005 and the associated Deprivation of Liberty Safeguards (DoLS). People had not always had an appropriate assessment when they were deemed to lack capacity for a specific decision. People were being restricted without the lawful process being followed.

Care plans were inconsistent and lacked detail.

The service failed to ensure staff were suitably trained and supervised in their roles.

Risk assessments were not fully completed or adequate for the management of people’s risks. Environments risks were also not well managed. We found medicine rooms, maintenance rooms and other areas that posed a danger to people, unsecured. We also found concerns with hot water temperatures. These issues were addressed during the inspection.

People told us they had enough to eat and drink. We saw snacks being offered throughout the day. However, we raised concerns with the lack of drinks offered throughout the day. We also raised concerns with the lack of monitoring for people's fluids. Although fluid consumption was recorded in people's notes, there was no oversight of this to ensure people were having adequate fluids. The provider has since put new governance systems in place to address this.

Safe recruitment practices were in place for staff. People were complimentary about the staff that supported them. We observed caring, familiar interactions between staff and people living in the home.

Standards of cleanliness were poor in some parts of the home. Some communal areas appeared dusty and dirty. The home was in need of a refurbishment as it was ‘tired’ looking in parts..

The service did not have robust and effective systems in place to monitor, assess and improve the safety and quality of service being provided. Management oversight of the service was inadequate.

You can see more information in the Detailed Findings below.

Follow up: Following the inspection, we asked the provider to detail how they planned to deliver the required improvements. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

Rating at last inspection: This is the first inspection for this provider.

Why we inspected: This was a planned comprehensive inspection.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.