Staffing shortages, a lack of training for employees, problems with administering and managing medicines and an over-reliance on district nursing teams were among the issues identified in the latest round of care home inspections by regulators.
The Care Quality Commission has published 132 reports on adult social care organisations based in central England in the past week, with 11 being rated “inadequate”. Among the 11, inspectors noted concerns about staffing levels in nine.
At Rose Villa Nursing Home in Dudley, which provides care for up to around 30 residents, a shortage of nursing staff meant the manager had to cover shifts. As a result, at the time of inspection in June, when there were 11 residents, she said she had worked 12-hour shifts for the previous seven days.
“One side [of the house] we get up Monday, Wednesday and Friday. The other side we get up Tuesday, Thursday, Saturday”
Staff comment to CQC
The manager told inspectors that the owner of the home had initially agreed to use agency staff following a meeting with the local authority. However, “when he saw the bill the owner said ’no more agency’”, added the manager.
In the CQC’s report on the provider, it also found people were not receiving medicines as prescribed and there was insufficient guidance on how to prepare and administer medication.
“We saw that for one person, their antibiotics were being administered with their lunch, instead of an hour prior to eating, thus making them ineffective,” said inspectors.
They concluded that “quality was not an integral part of the home”, and “there was no evidence of investment” in it.
At the 120-bed Chilton Meadows Residential and Nursing Home in Suffolk, run by Bupa Care Homes, inspectors found “significant shortfalls” in the care provided to people across all four homes within the service, which they said was linked to a lack of oversight from management.
In three of the four homes, inspectors noted many people remained in bed all day with no rationale behind it. This was due to low staffing numbers, inspectors were told by employees.
“Their antibiotics were being administered with their lunch, instead of an hour prior to eating, thus making them ineffective”
CQC report on Rose Villa
“We spoke with a staff member who commented, ‘One side [of the house] we get up Monday, Wednesday and Friday. The other side we get up Tuesday, Thursday, Saturday,” inspectors noted in their report on the provider.
In addition, the nurse in charge of one of the homes said they did not have time to provide the direct care they should be giving, and so had to rely on support workers to deliver this instead.
Staff, including registered nurses, did not receive regular meaningful supervision or appraisals that focused on their development within their role, said the regulator.
A Bupa spokeswoman said immediate action had been taken to address the concerns.
”Since May, we have invested heavily in training for our staff, and hired a new management team. We have also reinvigorated our activities programme.
”The health and wellbeing of our residents is our top priority and we will continue to embed best practices at the home,” she said.
At Harmony House in Nuneaton, which provides nursing care for up to around 60 people living with physical frailty, inspectors found people did not always have their prescribed medicines because staff had not ensured adequate stocks were available.
During the visit in June, a nurse told inspectors that they were ordering new medicine on the day because there was none left, while records showed one resident had missed eight doses of their medicine due to stock running out.
In addition, “people felt there were not always enough staff available on shift to meet their needs when support was requested,” said the CQC in its report on the home, adding: “Some people felt staff were positive towards them but this was not consistent and care was not personalised”.
“Some people felt staff were positive towards them but this was not consistent and care was not personalised”
CQC report on Harmony House
However, at a later unannounced visit to check what had been done to tackle immediate concerns, inspectors noted that the care home had introduced a daily medicine audit checklist and had brought in supervision meetings to address poor care practice.
A spokeswoman for the home told Nursing Times it was disappointed with the report and had an action plan in place to address the concerns raised. She said the manager of the home was receiving support from a local operations team.
Meanwhile, at Bearnett House in Wolverhampton problems were uncovered around a reliance on district nurses to refer residents to specialist services.
In one example noted by the regulator, a person who was losing weight was only referred to a dietician after they had been seen by a district nurse. The home’s management team said staff had not known about the weight loss.
Meanwhile, at The Cottage Nursing Home Limited in Wellingborough, the CQC found that while staffing numbers were sufficient to meet peoples basic care needs, the deployment of them “did not ensure people’s emotional and social care needs were met consistently and in a timely manner”.
There was also no formal induction programme in place and gaps in staff training to develop their skills and knowledge.
All of the providers rated “inadequate” by the CQC have now been placed in its special measures regime for struggling providers, which means they will be kept under review by the regulator.