Background to this inspection
Updated
29 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The first day of the inspection was carried out by two inspectors and a medicines inspector. The second day was carried out by two inspectors.
Service and service type
Knowsley Manor Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
Both days of this inspection were unannounced.
What we did before the inspection
We reviewed all the information we held about the service since it registered with the Commission. We also obtained information about the service from the local authority and local safeguarding teams.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with a number of people about their experience at the home; however due to the nature of people’s care needs these conversations were not in depth. Throughout the course of the inspection we spoke with some people’s relatives, care, nursing and ancillary staff, acting managers and other senior managers within the organisation.
We reviewed a range of records. This included nine people's care records and 12 people's medication records.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance and recruitment records.
Updated
29 March 2022
About the service
Knowsley Manor Nursing Home is a care home providing accommodation along with personal and nursing care in one purpose-built building, for up to 50 people. At the time of our inspection there were 36 people living in the home.
People’s experience of using this service and what we found
The home’s environment was unclean and unsafe. Infection prevention and control practices were inadequate and did not protect people from the risk of infections.
Risks to people’s safety and wellbeing was not effectively managed. The risk assessment process in place for assessing and reducing risks for people had not been effectively used for several months. This meant that people’s care plans were out of date, contradictory, did not contain accurate information and did not reflect the care they were receiving.
People were not receiving personal care in line with their care plans. Records showed that some people had not received a bath, shower or had their hair washed for a number of weeks.
There were not enough staff available to keep the home safe and meet people’s needs in a safe and timely manner. One staff member told us, “There is never enough staff. We run around like headless chickens.” One person’s relative told us, “The carers are fantastic; there is just not enough of them”.
People relatives told us that staff members had a kind and caring approach towards their family members; but described a staff team overstretched and under stress. One staff member told us, “Today we are one staff member down, but it is tight every day; so, it makes a big difference being one staff member down.”
People’s medication was not safely managed. There were significant gaps in the systems that the provider used to ensure the ongoing safety and quality of the service being provided for people. These systems had failed to pick up on and address the concerns highlighted during this inspection.
The provider had not promoted a positive culture that achieved good outcomes for people. A despondent culture that had lost sight of safe and appropriate care had been allowed to develop within the home. The home’s environment had been allowed to become unsafe and unpleasant for people to live in.
During our inspection the provider arranged for additional management support at the home; alongside a review of each person’s care and took steps to improve the home’s environment.
During the inspection process, we raised or a whole service safeguarding with the local authority regarding the safety of medication administration and further safeguarding alerts for six people about possible neglect.
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 requires improvement (published 27 September 2019).
You can read the report from our last inspection, by selecting the 'all reports' link for Knowsley Manor Nursing Home on our website at www.cqc.org.uk.
Why we inspected
The inspection was prompted in part due to concerns received about people not receiving safe and appropriate care, safe administration of medicines, infection control and staffing. A decision was made for us to inspect and we undertook a focused inspection to review the key questions of safe and well-led only. Please see full details in the individual sections of this full report.
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.
Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
During our inspection the provider took action to mitigate the risks identified.
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches at this inspection in relation to infection prevention and control, safe environment, managing risks, sufficient numbers of staff and good governance of the service.
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 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.
Special Measures
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.