Fleetwood Nursing home provides support for up to 30 people who require residential or nursing care. The home has two floors. A lift is available for access to both floors; some rooms are en-suite.

Fleetwood Nursing home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 had a registered manager. 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.

This inspection took place on 02 and 04 October 2018 and was unannounced on the first day.

The last inspection of this service took place in January 2018. During that inspection, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), and Regulation 17 (Good governance). We also found a breach of Regulation 18 (Notification of other incidents) CQC (Registration) Regulations 2009, because the provider had not notified CQC of important events which affected the health and safety of people who lived at the home.

Following the last inspection, we met with the provider to discuss our concerns and asked them to complete an action plan to show what they would do and by when to improve the all the key questions to at least good. At this inspection we found the provider had made improvements in all areas. You can see more information about this in the detailed findings of the report.

However, as some key questions were rated as ‘Inadequate’ at the last inspection, although the provider has made improvements, we need to see improved practice, sustained over time, in order to award a rating of ‘Good’ for these key questions.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Staff assessed risks to the health and well-being of people who lived at the home and plans were put in place to lessen these risks. Environmental risk, for example around fire safety, had been assessed and appropriate plans put in place to lessen risks. The service promoted positive risk taking in order to help people maintain as much independence as possible.

The provider had systems to safeguard people against abuse or improper treatment. Staff had received training to spot abusive or inappropriate practices and knew how to report them. The service followed a robust recruitment process to ensure only suitable candidates were employed.

The service ensured a sufficient number of staff were deployed at all times. Staff recruitment and retention had improved and use of agency staff had decreased significantly. The registered manager reviewed staffing levels against people’s needs to ensure there were always enough staff.

The provider had systems which recorded any adverse incidents or events. We saw analysis of accidents and incidents was undertaken in order to make positive changes to reduce the risk of recurrence.

The service followed best practice in relation to the safe and proper management of medicines.

Staff had received training to reduce the risks related to the spread of infection. We obs

Fleetwood Nursing home provides support for people who require residential or nursing care. The home has two floors a lift is available for access to both floors; some rooms are en-suite.

Fleetwood Nursing home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Fleetwood Nursing home was last inspected February 2016 and received an overall rating of Good. This inspection took place on 18 January 2018 and was unannounced. A further inspection site visit to conclude the inspection took place 01 February 2017 which was announced.

There was a registered manager in place during the first inspection visit. However the registered manager was not in post from October 2017 and had stepped down and de-registered as of 31 January 2018. There was a new manager appointed who had not yet registered with us. 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.

We asked the registered manager how they monitored accidents within the home. We were told all accidents were reported using accident forms. We reviewed the records and found no oversight of the accidents and no action taken following these to lessen the risk of accidents happening again.

We viewed three care records to look how risks were identified and managed. We found inconsistencies in individualised risk assessments and the plans in place to mitigate these. The documentation did not always contain information to adequately mitigate the risks to individuals.

From the documentation reviewed we saw fire safety equipment audits had not been completed at the home since September 2017. Therefore we could not be assured that the fire safety equipment at the home was safe, this put people at risk.

We looked at how the service managed medicines. We found that there were gaps in peoples records. There was no documentation in the care plan to guide staff around how the medicines should be given to individuals. We found people did not have support plans to guide staff when giving medicines which are taken “as needed”. Therefore staff did not have all the relevant and necessary information to give the medicines appropriately and safely.

We found people had been assessed for the use of moving and handling equipment. However, people did not have personalised equipment such as the correct slings in place.

The above matters were in breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2008 (Safe care and treatment).

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; the policies and systems in the service did not support this practice. We found people’s capacity to consent to care had not always been assessed and information was, at times, conflicting. For example, in one person’s care file their next of kin had signed for the consent to the service where the person’s mental capacity had not been considered. In another person’s care file the next of kin had given consent to medical treatment without the legal authority to do so. The MCA stipulates that if a person lacks capacity to consent to a decision then a best interests process needs to be carried out. Therefore the correct processes had not been followed.

This failure to follow the MCA code of practice amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent.)

We spoke with the registered manager to assess their understanding of their responsibili

The inspection visit took place on 02 February 2016 and was unannounced.

Fleetwood Nursing Home provides care for people who require residential or nursing care. The home has two floors a lift is available for access to both floors, some rooms are en-suite. Registered for 30 people. The home is located near Fleetwood town centre. Car Parking is available at the front and side of the home. At the time of the inspection visit there were 23 people living at Fleetwood Nursing Home

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection of the service in April 2014, we found the provider was meeting all the requirements of the regulations inspected.

During this inspection people told us they felt safe at Fleetwood Nursing Home. There were sufficient numbers of staff deployed to meet people’s needs and provide a flexible service. We found a registered nurse was on duty 24 hours a day.

The registered manager had systems in place to check people’s safety, including the safe management of accidents and incidents. Staff demonstrated they had a good understanding of protecting individuals from potential harm or abuse. Staff we spoke with told us they had received training in safeguarding adults.

We observed people’s medicines being administered at lunch time. They were dispensed in a safe manner and people received their medicines on time. Nursing staff only gave out medicines. The registered manager and local pharmacy had carried out checks to ensure processes were completed safely.

The home was maintained, clean and hygienic when we visited. No offensive odours were observed by the inspection team. People we spoke with said they were happy with the standard of accommodation provided.

The registered manager had completed an assessment of people’s support and nursing needs. This was before they moved into the home. People who lived at the home said they were happy with their care and support provided to them by caring staff. One person said, “Lovely staff.” Also, “I feel safe here.”

Safe recruitment procedures were in place and appropriate checks made before new staff commenced their employment. Sufficient staffing levels were in place to provide support and nursing care people required.

Staff told us access to training courses was good and training records we looked at confirmed this. Staff told us they were encouraged by the registered manager to further their skills by obtaining professional qualifications.

People who lived at the home were happy with the variety and choice of meals available to them. The service employed cooks who prepared homemade meals and comments were positive about the quality of food. Regular snacks and drinks were available between meals to ensure people who lived at the home received adequate nutrition and hydration.

We found examples where the service had responded to changes in people’s care needs. We found evidence in records where referrals had been made to external professionals.

People who lived at the home were encouraged and supported to maintain relationships with their friends and family members. People told us they were also encouraged to take part in activities of their choice. One person said, “We have singers come in now and then I enjoy that.”

Staff we spoke with had a good understanding of how people should be treated in terms of respect and supporting people with dignity. We observed examples of staff respecting people’s privacy and dignity.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were comfortable with complaining to staff or management

On the day of our visit we spoke with the manager, staff, relatives visiting the home and residents. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, staff supporting them, relatives and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Fleetwood Nursing Home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required. The manager said, “This training is ongoing for all staff to complete.”

People were treated with respect and dignity by the staff. People told us they felt safe. One relative said, “Mum is well cared for here I am confident she is kept safe and looked after by caring staff.” Relatives we spoke with said their family members were receiving safe and appropriate care which was meeting their needs. One said, “I come here often and take mum out, there is no place better.”

The environment was safe, clean and hygienic. Equipment was maintained and serviced regularly therefore not putting people at unnecessary risk. Records we looked at confirmed this. One staff member said, “It is important to ensure all checks are carried out on the building and fire safety equipment is up to date.”

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in developing their plans of care where possible. Relatives views were also sought to ensure people receive the right care to meet their needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

The manager and staff members we spoke with had an awareness of people’s care needs. We discussed with staff the individual needs of people and one said, “We all get involved in the care plans so we have a good understanding of each individual.”

Is the service caring?

We spent part of the day observing staff interaction with residents. People were supported by kind and attentive staff. We saw staff and the manager showed patience and gave encouragement when supporting people. Comments from people living at the home included, “I cannot fault the place it feels like home. The manager and staff are always checking to see if we are ok. They are wonderful.”

Is the service responsive?

People completed a range of activities in and outside the home regularly. We saw evidence of daily activities in place and delivered by various staff. They were in the process of employing an activities co-ordinator to support people to undertake chosen interests and activities. One resident we spoke with said, “I do like to go out in the summer and if there are enough staff around I do. Also my family take me out often.” Another resident said, “The violinist is really good I do enjoy entertainers when they come into the home.”

Is the service well-led?

We had responses from external agencies including social services .They told us they had a good working relationship with the manager and staff to make sure people received their care and support they required.

There were a range of audits and systems put in place in by the manager and provider to monitor the quality of the service being provided.

On the day of our visit we spoke with the manager, staff, relatives and residents. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Fleetwood Nursing Home.

During the inspection we looked at care planning, recruitment and staff induction training records. We also observed care practices during the day and talked with residents and relatives about the home. Comments were positive and included from relatives, “This has to be the best place around. “ Also, “I come and see mum twice daily and I am very picky. However I have to say this place is brilliant the staff and manager are so caring.”

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved people to ensure they received the right care and support. One resident we spoke with said, “Yes I am asked about my health and how I would want staff to treat me.”

There were a range of audits and systems in place to monitor the quality of the service being provided.

Prior to our visit we contacted Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We spoke with a range of people about the home. They included the deputy manager, nurses, staff, relatives and people who lived at the home. We also had responses from external agencies including social services. This helped us to gain a balanced overview of what people experienced living at Fleetwood Nursing Home.

During our inspection we looked at care records and the homes staff duty rota. We did this to confirm people were well supported and staffing levels were sufficient to meet peoples needs. Residents and relatives we spoke with said they were receiving safe and appropriate care which was meeting their needs. They told us the staff were polite, caring and respectful when undertaking their work. Comments received were all positive and included:

“The staff are wonderful”.

“No complaints the staff are kind, helpful and nothing is too much trouble.”

“When I need help I press the alarm and I never have to wait more than a moment or two.”

“Plenty of staff around to make me feel safe and comfortable.”

A relative we spoke with said, “No complaints the people are so friendly and helpful my husband could not be in a better place.”

We spoke to the nurse in charge, staff, relatives visiting, and received comments from other professional agencies such as social services and the environmental health agency.

Responses we received were good and positive and reflected how well the home is run, comments from people living at the home included,

"The care is very good and they do look after you" .

"I stayed at another home for a while which was good, but this home is much better the staff are always on hand and know what my care needs are all about".

"The food is wonderful, plenty of choice, I can have it in my room if I request it and always enough to eat".

"I have put my weight back on since living here with the food, the cook is very good".

We spoke to staff and relatives about care provided and how they felt the management of the home helped the people who live and work here. One relative spoken to said, "I get on well with each and every one of the staff and manager very caring people". A staff member spoken to said, "Most of the staff have been here for years that speaks volumes".

Both residents and staff spoke well of the management team and how the home operates. One staff member said, "The manager is caring and very approachable".