CQC report explained · a nursing home
What the CQC found at Adult Pathways 1
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, November 2020
Requires Improvement; inspectors found concerns about risk checks, restrictive practice and quality monitoring, although people generally felt safe and supported.
This was a focused inspection carried out over visits from 5 to 15 October 2020. Inspectors looked at Safe, Effective and Well-led, spoke with people, relatives, staff and professionals, observed care, and checked records. The inspection was prompted by concerns about culture, staff practice and people's safety.
The home was not always safe or effective. Fire drills had not been carried out regularly, some risk assessments were out of date, and inspectors found restrictive practice where the Mental Capacity Act principles had not been followed. Medicines were given by trained staff, but some medicines practices needed review.
Quality monitoring had not reliably identified or fixed problems. The report also found positive areas. People and relatives generally said people felt safe, staff were trained, health needs were supported, and infection control measures were being used.
The overall rating changed from Good at the previous inspection, published in November 2018, to Requires Improvement. The home was in breach of Regulations 11, 12 and 17, and CQC said it would require an action plan and monitor progress.
People generally felt safe
People and relatives told inspectors that people felt safe living in the home.
“I do feel safe here and think it is the right place for me to live” from the report
Trained staff
Staff received training in a wide range of care topics, and relatives generally felt staff were well trained.
“Staff received training in a wide range of health and social care topics.” from the report
Health support
People had access to the home's multi-disciplinary team and a dedicated GP service. Professionals gave positive feedback about the support provided.
“People were supported to maintain their health and wellbeing with access to the provider's extensive multi-disciplinary team resources.” from the report
Infection control
Inspectors were assured that the home was using protective equipment, testing and social distancing measures safely.
“We were assured that the provider was using PPE effectively and safely.” from the report
Fire safety and risk assessments
seriousRegular fire drills had not been completed, some staff were unclear about evacuation, and risk assessments were not always up to date. This increased the risk that people might not be protected in an emergency.
“Regular fire drills had not been carried out as required by fire risk assessments.” from the report
Restrictive practice and consent
seriousInspectors found restrictive practice affecting one person where the Mental Capacity Act principles had not been followed. Staff had not questioned the practice, and the matter was referred to the local authority under safeguarding procedures.
“We identified restrictive practice taking place in respect of one person's care and support and the principles of the MCA had not been followed.” from the report
Quality checks did not work reliably
seriousAudits did not always lead to the required actions being completed. This meant the home missed opportunities to identify problems and improve care.
“Systems to assess, monitor and improve the service had not always been effective and had not identified the issues highlighted during our inspection.” from the report
Some medicines records and processes needed review
needs fixingInspectors found no evidence of harm, but identified areas where medicines practice needed improvement and recommended a review against best practice guidance.
“We recommend that the registered provider undertakes a review of medicines practice to ensure compliance with best practice guidance.” from the report
Institutional features
needs fixingSome larger houses had a less homely, more institutional feel. Inspectors also saw less dignified practice at mealtimes and found that one house needed refurbishment.
“The fact that the accommodations varied considerably in size resulted in a differing experience for people living there” from the report
- 01What action has been taken to ensure every person’s restrictive practice is lawful, in their best interests and the least restrictive option?
- 02How often are fire drills now carried out, and how do you check that every staff member understands evacuation procedures?
- 03Which risk assessments were updated after the inspection, and how are changes in people's risks now recorded?
- 04What changes have been made to medicines checks and records following the recommended review?
- 05How do managers check that audit actions are completed and that problems are not repeated?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not assessed during this visit and the ratings for questions not looked at carried over from the previous comprehensive inspection. This explanation was written from the published report of 18 November 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2018
Pathways and Community - Warford was rated Good; inspectors found safe, kind and personalised care, with some management systems needing improvement.
This was an unannounced inspection on 12 and 13 September 2018. Inspectors visited all 16 homes on the site. They spoke with people, relatives, staff and healthcare professionals, and reviewed seven care plans.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were safe, medicines were managed well, staff were kind, and people were supported to make choices and stay independent.
The overall rating stayed Good, as it had been at the previous inspection published in June 2015. Inspectors did identify that staff rota systems could be more efficient and that quality audits were not consistent across all the homes.
Safe care and medicines
Inspectors found detailed risk assessments, suitable staffing and safe recruitment. Medicines were managed appropriately, with regular audits and advice from an on-site pharmacist.
“We saw that medicines were managed appropriately and safely.” from the report
Kind and respectful staff
Staff knew people well, respected their preferences and made time to talk. Inspectors saw kindness and compassion across all 16 homes.
“Throughout the two day inspection the team visited all 16 homes on the site and without exception found staff to treat people with kindness and compassion.” from the report
Choice and independence
People were supported to make choices, take part in activities and work on the site or in the community. Families were involved in care reviews and decisions.
“People were treated as individuals and as so many people received one to one care staff were able to respond to people's needs and preferences as they were established.” from the report
Access to health support
The home used a multi-disciplinary approach. People could access an on-site clinic and professionals including nurses, therapists, psychologists, a GP, a dentist and a podiatrist.
“The service operated a multi-disciplinary approach to care.” from the report
Rota records were spread across systems
minorThere were enough staff and people were not left unsupervised unless it was safe and wanted. However, rotas were not kept on one central system, which inspectors said could reduce efficiency.
“The rotas were not stored on one centralised system.” from the report
Quality audits were inconsistent
needs fixingThe home had audit and governance arrangements, but the quality audits were not consistent across the 16 homes. Inspectors advised that they should be streamlined so managers could keep oversight of the whole service.
“At the time of inspection the quality audits had become inconsistent between the separate homes on the site.” from the report
- 01How have you improved the consistency of quality audits across all 16 homes since this inspection?
- 02Are staff rotas now held on one shared system, and how do you check that staffing levels meet each person's needs?
- 03How would you support my relative to choose activities, work or community involvement that suit their preferences?
- 04How are families involved in care reviews and multi-disciplinary team meetings?
- 05What on-site clinical support would be available for my relative's specific health needs?
This was an unannounced inspection covering the premises and care across all five questions and all 16 homes; the report used a shorter format because the overall rating remained Good. This explanation was written from the published report of 2 November 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Adult Pathways 1
3 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- November 2020Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- June 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 4 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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