We carried out an unannounced inspection of Polefield Nursing Home on Tuesday 21 August 2018. We returned for a second day to complete the inspection on Friday 24 August 2018, however we announced this in advance.

Polefield Nursing Home is a service providing accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is situated over two floors and has a passenger lift between the upper and lower level. The home is set back from the main road, with level access grounds. There is a large garden area which people can access.

We last inspected Polefield Nursing home on 27 September 2017 where the home was rated as Good overall and for each key question, safe, effective, caring and responsive. The well-led key question was rated as Requires Improvement to ensure the improvements made were sustained.

At this inspection in August 2018, we found several areas had since declined and identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) relating to safe care and treatment, safeguarding people from abuse and improper treatment (two parts of this regulation), good governance (two parts of this regulation) and staffing. We have also made two recommendations relating to staff recruitment and handling complaints.

You can see what action we have asked the home to take at the end of this report.

We looked at how the service managed risk. Some people living at Polefield Nursing Home required the use of bedrails to help keep them safe whilst they were sleeping and prevent them from falling from bed and hurting themselves. However, we found appropriate risk assessments were not always in place to demonstrate how risks such as entrapment in the bedrails would be mitigated.

We looked at the systems in place to prevent pressure sores and keep people’s skin safe. We saw equipment was used such as pressure relieving mattresses and cushions, however we saw one person’s airflow mattress was not being maintained at the correct setting and in line with their body weight as required. This could have placed this person at risk of skin breakdown.

We looked at the systems in place to safeguard people from abuse and improper treatment. One person living at the home told us they had been roughly handled by a member of staff and that the registered manager was aware of this incident. This had not been reported as a safeguarding concern however and we requested this was done during the inspection.

Accidents and incidents were monitored and body maps completed to identify any injuries. One person had been found with some bruising to their stomach area when they moved into the home, however information had not been accurately recorded about what had happened to the person and if further investigation was required.

Medication was given to people safely, however we found a number of discrepancies with running totals, particularly on the upstairs residential unit, where staff were not accurately recording the correct number of tablets people had left once they had been administered. Cream charts were being completed on the nursing unit to show they were being applied as prescribed, however cream charts were not being completed on the residential unit.

The home was generally clean and tidy, however we noted some carpets and chairs, particularly on the residential unit were stained and would benefit from being replaced.

Effective systems were not in place regarding deprivation of liberty safeguards (DoLS) and the mental capacity act (MCA). Applications for DoLS were not always made in a timely way and mental capacity assessments were not always carried out when concerns were identified regarding people’s decision-making abilities.

Not all staff received timely supervision and appraisal to support them in their role effectively.

We looked at how people were supported to maintain good nutrition and hydration. People’s body weight was kept under review, although

This unannounced inspection took place on Tuesday 26 September 2017.

Polefield Nursing Home is a service providing accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is situated over two floors and has a passenger lift. There are four rooms on each floor which are double occupancy and a communal lounge and dining room on each floor. The home is set back from main road, with level access grounds. There is a large garden area which people can access.

We last inspected Polefield Nursing Home in April 2017. At this inspection, the home was rated as Inadequate overall and was also given an inadequate rating in three of the domains in which we inspect. These areas were Safe, Effective and Well-Led. The further two domains which are, Caring and Responsive were rated as Requires Improvement. As a result, the home was placed into special measures. This meant we would keep the service under further review and potentially take further enforcement activity improvements were not made. We also issued an urgent NOD (Notice of decision), informing the home that they were unable to admit any new residents into the home without the prior agreement of the CQC (Care Quality Commission). Following the inspection, the provider sent us an urgent action plan detailing the immediate action they had taken based on the concerns identified. We took this into account when planning this inspection to ensure these actions had been completed.

At the last inspection, we found people had been placed at risk because staff were not always providing the correct consistency of diets such as soft or fork mashed, placing people at risk of choking. These specific diets had been advised by the SALT (Speech and Language Therapy) team and their guidance was not being followed. This area of concern had now been addressed.

The kitchen area was safe and secure whereas at the last inspection it had been easily accessible which could have placed people at risk. The supplement, ‘Thick and easy’ was also being stored securely meaning it could not be consumed in an unsafe manner by people living at the home.

Appropriate recruitment checks were undertaken including seeking references and undertaking DBS (Disclosure Barring Service) checks before staff commenced employment.

There were enough staff working at the home to meet people’s care needs, however due to the restriction on admissions, the home was not at full occupancy. The provider said this would be reviewed when more people moved into the home.

At the last inspection, people living at the home were not always being protected from the risks associated with poor nutrition and hydration and guidance from services such as dieticians was not being followed. We saw improvements in this area at this inspection, with good systems in place to ensure people’s nutritional needs were not compromised. People also made positive comments about the food and drink available.

Staff training had improved since our last inspection which was clearly documented on the homes training matrix. Additional training completed included dysphagia, safeguarding and infection control. Staff told us the home provided enough training to support them in their roles with an induction, supervision and appraisal also available and we saw evidence of relevant documents relating to these discussions.

At the last inspection we found DoLS (Deprivation of Liberty Safeguards) applications were not being made to the local authority where people lacked the mental capacity to make their own choices and decisions. This was now being done consistently and we saw staff had followed these applications up with the local authority to check their progress if they had not yet been granted.

People living at the home and visiting relatives made positive comments about the care provided. People said they felt they were treated with dignity and respect and had their independence promoted as

This unannounced inspection took place on Wednesday 19 April 2017. We returned to the home to complete the inspection on Monday 24 April and this was announced in advance of our visit.

Polefield Nursing Home provides accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is over two floors and has a passenger lift. There is a communal lounge and dining room on each floor. The home is set back off a main road, with level access grounds. There is a large garden area which people can access. At the time of our inspection, 35 people were living at the service.

Our last inspection of Polefield Nursing was in October 2016 where the service was rated overall as ‘Requires Improvement’ and in four of the five key questions against which we inspected. These included Safe, Effective, Caring and Responsive, with Well-led rated as ‘Inadequate’. There were three breaches of the regulations identified at that time with regards to safe care and treatment, good governance and staffing. This inspection was carried out to ascertain whether improvements had been made since our last inspection.

At this inspection in April 2017, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, meeting nutritional and hydration needs, safeguarding people from abuse, good governance and staffing. We are currently considering our enforcement options and course of action.

At the time of the inspection the home did not have a registered manager in post. This meant the service were failing to comply with the requirements of their registration. 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.

People were not safe as they were not protected from the risk of aspiration. People assessed as being at risk from an ‘unsafe swallow’ were given foods by staff which could cause them to choke or aspirate. Some of these had been listed as foods to avoid when they had been referred to SALT (Speech and Language Therapy). The supplement ‘Thick and easy’ was also left accessible around the home which presented the risk of people consuming this accidently and placing themselves at risk.

We found the kitchen area was left unsupervised early in the morning when we arrived at the home, with large kitchen knives and a boiling hot water dispenser accessible to people living at the home. The risk assessment implemented following our first inspection visit was not followed and control measures were not adhered to which placed people at continued risk of harm.

Medication was not always given to people safely and we found instances where people had not received their medicines as prescribed. PRN (when required) protocols had still not been implemented which had been raised as a concern at our previous inspection visit.

People living at the home said they felt safe and staff had a good understanding about how to report any safeguarding concerns.

Staff recruitment was robust, with appropriate checks carried out before staff began working at the home.

The building and necessary equipment such as hoists were maintained regularly, with certificates of work completed held in an organised file.

We identified gaps in staff training in areas such as infection control, safeguarding dementia awareness, fire safety and health and safety. The manager was in the process of ensuring staff had access to appropriate equipment such as laptops, to be able to undertake this training during quieter periods of their working day.

People were not always protected from the risk of losing weight and we identified two people whose food was not bein

The inspection was carried out on 05 and 10 October 2016 and the first day was unannounced.

The previous inspection took place in April 2016 where eight breaches of the Health and Social Care Act 2008 were identified. The provider was rated as Inadequate and placed into special measures by CQC. We took enforcement action after the last inspection. This inspection was carried out to check on the improvement actions identified in the provider’s representations.

Polefield Nursing Home is a service providing accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is over two floors and has a passenger lift. There were four rooms on each floor which are double occupancy rooms. There is a communal lounge and dining room on each floor. The home is set back off a main road, with level access grounds. There is a large garden area which people can access. At the time of our inspection, 31 people were living at the service, 13 on the nursing floor and 18 on the residential floor.

At our last inspection we found the service to be in breach of some of the regulations, at this inspection we found the service was still in breach of some of these regulations. Due to these continued breaches the service continues to be inadequate in well led. This meant the service remains in special measures.

During this inspection we found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The service did not have a registered manager. There had been no registered manager in post since March 2016. The provider intended to register as manager, but at the time of the inspection had not yet begun to undertake this role. 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.

When we arrived at the service, we found the service was not displaying their rating from our previous inspection. All services are required to display this rating both within the service and online if they have a website.

People felt safe with the care and support they received. Staff were aware of the safeguarding process and how to report any concerns they had. However not all staff had received up to date training in safeguarding adults and we found the policies and procedures staff were required to follow, remained out of date.

Risk assessments were in the process of being updated and becoming person centred. However not all of the identified environmental risks were being monitored as required which meant people were still at risk from harm.

Staff sought consent from people before providing care or support. The ability of people to make decisions was being assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people when necessary and the service were completing assessments on people’s capacity.

Care plans were being updated at the time of the inspection. The care plans we viewed were more person-centred and had been reviewed. However, it was not clear if people had been involved in writing the updated care plans. Pre-assessments included people’s likes and preferences and staff knew the people well.

Medicines were not always administered safely. We found staff on the nursing floor were not always signing when they had offered medicine which was ‘as and when required’. Some of the staff had recorded when people had refused the medicine, but this was not consistent and they had not recorded a reason why the person had declined it. The manager of the service had already identified this during

The inspection was carried out on 18 and 20 April 2016 and was unannounced. We also made a return visit on the 4 May 2016 to check the provider had taken immediate actions to the concerns we raised.

Polefield Nursing Home is a service providing accommodation and support with personal care to a maximum of 40 people who may require nursing or residential care. The home is over two floors and has a passenger lift. There were four rooms on each floor which are double occupancy rooms. There is a communal lounge and dining room on each floor. The home is set back off a main road, with level access grounds. There is a large garden area which people can access. At the time of our inspection, 31 people were living at the service, 13 on the nursing floor and 18 on the residential floor.

The service did not have a registered manager as they had left a few weeks prior to the inspection. The provider intended to register as manager, but at the time of the inspection had not yet begun to undertake this role. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspecting 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 in 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

People felt safe and supported by the care staff. However, not all safety checks had been completed, meaning people were at risk from harm.

Staff sought consent from people before providing care or support. The ability of people to make decisions was not always assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were not always taken in the best interests of people when necessary as bed rails were being used without completing assessments on the person’s capacity.

Risk assessments were not always up to date. Care plans were not written with the person or their families. People had not been supported to be involved in identifying their support needs. Pre-assessments included people’s likes and preferences and staff knew the people well.

Medicines were not always administered safely. We saw evidence staff signing before the medicines had been administered and medicines being potted up and left on the top of the trolley for a period of