Archived: Friars Hall Nursing Home

Updated 17 January 2017

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 comprehensive rating inspection took place on 16, 17, 21 and 30 November and 19 December 2016, all our visits were unannounced.

The inspection of 21 November commenced at 3 am due to concerns regarding people’s safety during the night.

The inspection team varied over the four day period but in total consisted of three inspection managers and three inspectors.

Before the inspection, we reviewed all of the information we held about the service, this included the notifications we had received. A notification is information about important events which the service is required to send to the Commission by law. We also reviewed the provider’s action plan and information from the local authority safeguarding team and commissioners of care.

During the inspection we spoke with eight people who used the service. Because not everyone could tell us their views we spent time observing interactions between people and care staff.

We spoke with two relatives who visited during the inspection.

We reviewed fourteen care plans and other records which related to people’s care.

We spoke with the provider, the manager, four nurses, head of care, two senior carers, six care staff and the chef.

We looked at documents associated with the management of the service such as staff recruitment and training records and staff rotas.

Updated 17 January 2017

This inspection was unannounced and carried out over 16, 17, 21, 30 November and 19 December 2016.

Friars Hall Nursing Home provides personal care and nursing for up to 54 older people. There were 39 people living in the service at the time of this inspection.

There was not a registered manager in post at the time of our inspection. The new manager had applied to the Care Quality Commission (CQC) to be registered; however following our inspection they withdrew their application.

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.

Friars Hall is in Special Measures, which resulted from an Inadequate rating following the previous comprehensive inspection carried out in August 2016. At that time we also identified several breaches of legal requirements. There was poor management and leadership and no clinical oversight of the service which led to people receiving poor care and not being adequately protected from risk to their health and welfare.

Services in Special Measures are 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.

Following the inspection in August 2016 we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they were going to do immediately to address them. An action plan was returned to us the following day.

This inspection was undertaken within the six months timescale because it was prompted in part by notification of an incident following which a person died. This incident is subject to a criminal investigation and as a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk from falls and moving and handling.

We also received information from the local authority and a whistle blower which related to poor staffing levels, staff training, poor care, poor leadership and governance.

This inspection was initially carried out during various times of the day and night over a three day period to get a full picture. We found no improvements had been made to the overall quality of the service. Management and clinical oversight was failing, there was not enough trained, skilled and experienced staff which resulted in a continued poor quality of service which placed people at potential risk. There were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We took immediate enforcement action to restrict admissions and increase nursing staff. We revisited on 30 November 2016 to see if the enforcement action taken had made an effect. We found that even though the provider had increased the amount of nurses on each shift the clinical oversight, quality of the service and delivery of care to people remained poor. When we returned again on 19 December 2016 we found that more permanent staff had left or had given their notice.

The service relied heavily on temporary staff with basic training and some experienced difficulty with command of English language which meant they could not always understand or recognise people’s needs.

People's dignity, privacy and independence was not always respected. The service was not working within the principles of the MCA and in some cases people were presumed to not have capacity when they in fact had. Therefore choice, preference and consent was also not respected and people were not safeguarded from improper treatment.

We immediately shared our concerns with commissioners (local authorities and Clinical Commissioning Group) because of the very poor care we had observed and because of the registered provider’s lack of ability to demonstrate they were capable of taking effective action to address it. As a result commissioners started to find alternative care providers for some people.

The registered provider informed us that they did not know what they could do to improve and made a decision to close the service entirely on 23 December 2016.