Finch Manor Nursing Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Our rating for the key question has changed from inadequate to requires improvement. We identified two breaches of the legal regulations. Insufficient improvements had been made in the areas of medicines management and governance since our last inspection. Aspects of medicines management were still not fully safe. Frequent changes within the management team had impacted on the providers oversight of reporting events which occurred to the local authority and to the CQC in a timely manner. Systems needed to be more robust with regards to making applications to deprive people of their liberty. Care plans and risk assessments had been updated which protected people from the risk of poor care. The service was generally clean, and equipment regularly serviced and well maintained. Staff were safely recruited and received the training they needed to support people. There were enough staff on duty however, staff deployment and staffing levels in parts of the service at busier times of the day needed to be reviewed. This was to better ensure people’s needs were responded to in a timely manner.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Family members told us they were generally kept informed about incidents which occurred at the service. One family member told us, “[Name] has had one fall whilst in here. They fell in the garden, and they phoned to tell me straight away and provided an update on their condition.” One person described the action staff took after they fell. The person said, “They check on me. I was lying on the floor and couldn’t reach my bell. The door was shut, but they found me and checked on me, and the doctor came.”

Staff were able to describe the process for reporting and recording incidents and accidents and demonstrated an understanding of the processes they needed to follow to ensure peoples safety in an emergency. This included seeking appropriate medical assistance. However, the manager told us there had been some confusion about roles and responsibilities to report events externally to other agencies which had resulted in some delays.

Systems were in place to record and report events which occurred at the service. However, ongoing management changes since our last inspection meant the processes had not been consistently followed. Roles and responsibilities had not always been clearly understood or defined which meant assumptions had been made by the management team about external reporting of events. As a result, some events had not been reported in a timely manner. Work had been undertaken to address this prior and during this assessment, however the system needed to be more robust. Information was recorded which evidenced the actions taken in response to individual events which had occurred. For example, following a fall, or following the identification of an injury. Weekly meetings had been introduced between the providers clinical team and the service’s clinical team. However, due to ongoing changes with the nursing leads, these improved systems had not been fully embedded.

People told us they had been involved in decision making whether they wished to transfer between services, for example, if a hospital admission was needed. One person told us, “I have been in hospital but have signed a form to say that if I get an infection I don’t want to go into hospital. I’m now on antibiotics as a precaution.”

Staff were able to describe how they supported people through periods of transition. This included when people were supported to and back to the service following hospital admissions. Staff told us systems were in place to communicate changes in peoples care needs. Comments included, “We have handovers, twice a day at the beginning of every shift” and “There is a handheld device which gives a summary.”

We received positive feedback on how the provider worked effectively with other agencies through periods of transition. One agency told us, “When new residents arrive, we are informed in a timely manner of their arrival. Any queries or recommendations that arise are communicated to the senior or nurse and they are acted upon in a timely manner.” We read recent feedback from another professional about how a staff member made a prospective family member visiting the home feel assured about the care their loved one would receive.

Systems were in place to ensure appropriate care records were maintained by staff when people moved between services. This included when referrals to other agencies needed to be made. For example, one person had recently returned to the home from hospital following a fall. The person’s risk assessments and care plan had been updated. External professional healthcare support had been sought to ensure the person received an appropriate level of care.

People told us they felt safe living at Finch Manor Nursing Home and felt able to speak with staff members if they had any concerns. Comments included, “I feel safe here. I am in bed a lot because of my health issues. The staff are good and respectful”, “I feel safe enough, I would talk to one of the girls if didn't” and, “I would speak to the manager, but I've never had any problems.”

Staff told us they knew what to do if they witnessed or suspected a safeguarding incident and demonstrated an understanding of the different types of abuse. A staff member told us, “I understand the whistleblowing policy. I would report anything I wouldn’t like my family to go through. I would report to the manager.” Staff were confident that appropriate action would be taken by the management team if they did raise a concern. However, the manager told us due to some confusion about roles and responsibilities to report safeguarding events externally to other agencies, there had been some delays.

We observed some positive relationships between staff and people. However, we did feedback our observations of how staff responded to an incident we had raised. We had raised a concern about how the actions of one person could have caused a risk to themselves and others. We observed multiple members of staff, including members of the management team, approach the person to tell them their actions were not appropriate. This caused the person a level of distress at the time. The management team told us they would reflect on their practice.

Systems to ensure safeguarding concerns were promptly identified and addressed were not fully robust. A safeguarding policy was in place and safeguarding logs were completed routinely which demonstrated the actions taken in response to concerns being identified. However, ongoing management changes since our last inspection had resulted in some confusion about roles and responsibilities to report to external agencies. Several events had not been reported in a timely manner to either the local authority or the CQC. This had been identified and rectified by the provider prior to our inspection and several statutory notifications had been sent retrospectively to the CQC. Several people were being deprived of their liberty following decisions which had been made in their best interests. This process is knowns as an authorisation under deprivation of liberty safeguards (DoLS). Again, ongoing changes in management had resulted in insufficient oversight of the DoLS process at times which meant not all DoLS applications or renewals had been made in a timely manner. Systems had improved by the time of our assessment.

Some family members told us they had not seen their relatives' care plans, however, they felt reassured as they were kept informed about any risks. One family member commented, "Yes, I do feel that [Name] is as safe as anywhere being here."

Staff confirmed they had read risk assessments and care plans for people, and these were available electronically. One staff member commented “If I feel the care plan is not right or needs have changed, I note this and speak with families also.” Staff were able to explain how they responded to risk situations, such as supporting a person through a period of distress or following a fall. The chief executive told us about improvements they had made since our last inspection. This included improved competency-based training for nursing and senior care staff to manage people’s risk.

Since our last inspection we observed equipment to assist people during a choking episode had been purchased and was accessible throughout the service. We observed staff ensuring agency workers understood peoples risks regarding aspiration. However, we observed examples when peoples risk was not always suitably mitigated. For example, one person’s care plan stated they needed to wear well fitted shoes or slippers. At one point we observed this person walking around in socks. We observed one occasion when staff did not use a safety strap on equipment used by people to mobilise. This was immediately raised with and addressed by the regional manager.

We reviewed several peoples risk assessments and care plans. Since our last inspection, significant work had been undertaken to improve the quality of these. Detailed plans were now in place to ensure people received appropriate nursing care. Care plans were monitored and reviewed on a regular basis. However, we identified further improvements were needed in care plans to guide staff how to successfully support a person through periods of confusion or distress. Further detail was needed in some peoples care plans to ensure moving and handling equipment was sufficiently detailed. We highlighted all these shortfalls to the manager and the provider for action.

People told us the home was generally maintained. One family member told us they had been able to decorate their relative’s room as they wished. We were told, “I asked if I could decorate and revamp [Name’s] room, and I have made it really nice.”

Staff told us they have access to all the equipment they needed to assist people. We were told, “Maintenance are very good, next day for most things unless it is something major.”

On our first day of the assessment, we observed the provider was displaying an incorrect food safety rating. We raised this as there was a requirement to display the correct rating. When we returned the correct rating was displayed. We observed people had the equipment they needed to keep them safe. Equipment was clean and, where applicable, servicing stickers were prominently displayed.

Routine checks on the environment and equipment were up to date and certificates were in place to demonstrate this. Records confirmed actions had been taken to address the shortfalls identified at the recent food safety inspection. The provider told us they were waiting for a reinspection. Easily accessible and up to date information was available regarding the safe evacuation of people in an emergency.

We received mixed feedback from people and their family members about staffing levels at the service. Some family members expressed concerns there was a high turnover of staff. We were told, “Staff changes are a concern. Staff change regularly, [the management team] move staff to another section once [Name] gets comfortable with some staff members. However, that cannot always be helped” and “Staff are nice and doing their best but they don’t know [Name]. There is a high staff turnover.” Not all family members knew who the current manager was. One person who lived at the home told us they felt staff did their best, however. due to the turnover told us, “They don’t know me like they used to.” We received mixed feedback about the number of staff on duty and how responsive they were to people when needed. One family member told us, “There are not enough staff for [Name] to receive the care she needs.” However, we were told by another family member, “There are always lots of staff, sometimes more than residents.” Regarding how quickly staff respond, one person said, “Any problems I ring my bell. 24/7 they are on the ball. They come within 5 minutes”, but another person said, “I’ve waited 40/45 mins. I have very poor skin and if I get wet, I break down.”

Some staff felt the home was well staffed, other staff told us more staff were needed in parts of the home where people required assistance with mobilising or to eat and drink. Comments included, “Staffing is okay now, it wasn’t very good, but it has gotten better and there is more support around” and “There are not enough staff, a lot of stress for me lately. Sometimes they [the management team] want too much.” Most staff felt the busiest times were in the morning when they would benefit from additional staff. We shared all this feedback, and the feedback from people and their family members with the regional manager who told us they would undertake a review. Staff confirmed they had received an induction when they commenced employment and felt they received the training they needed to undertake their role effectively. We were told, “Yes, we are trained enough, they are spot on” and “Yes, training is regular, up to date. It is a mixture of face to face and online.”

We observed staff presence across the home. Staff maintained a presence throughout our assessment in communal areas to respond to people’s needs. We did observe however, in some cases this had an impact on the ability of staff to respond to people in their bedrooms in a timely manner who had used their call bell to seek assistance.

At our last inspection we were concerned about safe nursing levels and competencies at the service. Planned rotas demonstrated this concern had been addressed and systems had been introduced to ensure the competency of nurses were assessed and to ensure nurses received an appropriate level of supervision. Some work was still needed to embed these new systems. Staff were recruited safely. Appropriate checks were in place to ensure staff suitability for their role. Systems were in place to demonstrate agency workers received an induction when they attended the service to work.

Family members told us staff consistently wore personal protective equipment (PPE) when providing care to people and generally were satisfied with the cleanliness of the home. Comments included, "[Name] room is always spotlessly clean,” "It’s spotless" and "It’s very clean." Family members told us they were updated if there were any infection outbreaks at the service.

Staff told us they received training regarding infection prevention and control and had access to adequate supplies of PPE. Staff were able to describe how they promoted good hygiene through regular handwashing.

We observed the home to be clean and tidy. We observed supplies of PPE were well stocked around the service and appropriately worn by staff. In one case, PPE was placed outside a person’s bedroom for staff to follow enhanced practices due to an ongoing infection.

Systems were in place to protect people from the risk of infection. Cleaning rotas were maintained. The provider worked in partnership with the local infection control team to monitor and improve their practice. A recent audit demonstrated the provider had responded promptly to some recommendations and improvements which had been identified.

People were not always given their medicines safely because the prescribers’ and manufacturers’ directions for administration were not always followed. When people were prescribed medicines which were to be taken ‘when required’ or with a choice of dose the information recorded to guide staff how best to administer the medicine was not always detailed. This meant staff did not always have enough information to tell them when someone may need the medicine, how much to give or which medicine to give if more than one medicine was prescribed to treat the same condition.

The senior managers had ensured improvements had been made in the way medicines were managed since the last inspection. This included completion of regular audits. However, the audits had not identified all the ongoing concerns regarding the safe management of medicines found during this assessment. Staff did not always manage people’s medicines safely although they had received training and had been assessed as competent to do so.

Some people needed to be given their medicines covertly which meant they had to be hidden in food or drinks. There was information available for staff to follow about the safest way to disguise each individual medicine and how to administer medicines covertly, but the advice was not always followed. This meant the medicines may not be effective or people may not have received the full doses of their medicines. The diabetic pathway in place to treat people if their blood sugars were too low or too high did not provide clear and accurate guidance for staff to follow which meant people may not have had their diabetes managed safely. Some people needed their fluids thickened to help them swallow safely. The records did not always show all their drinks had been thickened or thickened to the right consistency.