CQC report explained · a nursing home
What the CQC found at Douglas Bank Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, July 2023
Requires Improvement overall; inspectors found unsafe medicines and fire-risk systems, and rated leadership Inadequate.
This was an unannounced focused inspection on 10 and 12 May 2023. Inspectors spoke with people, relatives and staff, and checked care plans, risk assessments, medicines records, staffing records, policies, audits and health and safety documents.
The home was rated Requires Improvement overall. Safe was Requires Improvement because medicines records, fire safety risk assessments and some health risk records were not reliable. Well-led was rated Inadequate because the provider's checks had not found or fixed repeated problems.
There were also positive findings. Inspectors found enough staff, safe recruitment, protection from abuse, good infection control and a positive culture. The home had made some improvements since the previous inspection, but the changes were not yet consistent or lasting.
The inspection only assessed Safe and Well-led. Ratings for the other three questions were carried forward from the previous inspection.
Enough staff
Inspectors found enough staff to meet people's needs. Recruitment checks, including references and DBS checks, had been completed.
“Staff were recruited safely and there were enough staff to meet people's needs.” from the report
Protection from abuse
People were protected from abuse. Staff had up-to-date safeguarding training and could explain what they would do if they were worried.
“People were protected from the risk of abuse.” from the report
Infection control
Inspectors were assured that the home had current infection control arrangements and supported safe visiting and admissions.
“We were assured that the provider was responding effectively to risks and signs of infection.” from the report
Positive staff culture
Inspectors found a positive culture and staff who enjoyed their work. The manager also encouraged training and worked with other agencies.
“People were supported by staff that enjoyed their jobs and we found a positive culture.” from the report
Learning from incidents
Incidents were recorded, reviewed by the manager and considered at governance meetings to help prevent mistakes being repeated.
“People were protected from the risk of mistakes being repeated as the manager examined incidents.” from the report
Medicines records
seriousStaff did not record how much thickener was added to drinks or when topical creams were opened. Inspectors could not be sure medicines were given and disposed of as required.
“Whilst staff documented they had added thickener, they did not record the amount added, and so we could not be sure people received this medicine as prescribed.” from the report
Fire safety
seriousThe home could not provide an up-to-date fire risk assessment and action plan. The fire service later issued an enforcement notice requiring action by December 2023.
“The provider was unable to produce an up-to-date fire risk assessment and action plan following a risk assessment undertaken in 2021 where actions were identified.” from the report
Health risk records
seriousSome weekly weight checks and post-fall observations were not recorded. This meant inspectors could not be assured that risks to people's health and safety were being monitored.
“Therefore, we were not assured that people would be kept safe following a fall.” from the report
Weak quality checks
seriousThe provider's audits had not found or addressed problems that had appeared in earlier inspections. Inspectors identified concerns in similar areas at eight previous inspections.
“The registered provider's audits were ineffective and had not addressed the issues found at this inspection.” from the report
Family involvement
needs fixingSome relatives said they were not involved in care planning, invited to meetings or kept informed about concerns and falls.
“People and their relatives did not always feel that they were fully involved in care planning and were not invited to relatives meetings.” from the report
Personal care consistency
needs fixingSome people did not appear to receive personal care effectively, and relatives gave similar feedback. The manager responded by introducing staff checklists.
“We observed that some people did not appear to have been supported effectively with their personal care and we received similar feedback from relatives.” from the report
- 01How are you now recording the amount of thickener added to drinks and the opening dates of topical creams?
- 02What actions have been completed in response to the fire service enforcement notice, and can we see the current fire risk assessment?
- 03How do you record weekly weights and observations after a fall?
- 04How are your audits checking that medicines, fire safety and care plan risks are fixed and stay fixed?
- 05How will relatives be involved in care planning, feedback meetings and notification of incidents such as falls?
This was an unannounced focused inspection of Safe and Well-led only; the other ratings carried over from the previous inspection. This explanation was written from the published report of 15 July 2023 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, August 2022
Rated Requires Improvement; inspectors found kind care but unsafe medicines management put people at risk.
This was an unannounced inspection on 23 June 2022. One inspector and an Expert by Experience spoke with people living at the home, relatives and staff. They reviewed care plans, risk assessments, medicine records, policies, recruitment records and audits.
The home was clean and people said they felt safe and well cared for. Staff knew people well, treated them kindly and kept relatives informed. There were enough care staff to keep people safe, although people and staff said more staff would help with activities and trips out.
The main problem was medicines management. The medicines room had been left unlocked, medicine records had missing signatures, some as-required medicines lacked guidance, and some creams and eye drops did not show their opening dates. The report found no harm, but said people were put at risk.
The overall rating was Requires Improvement. Safe remained Requires Improvement, while Well-led fell from Good to Requires Improvement. The provider breached Regulation 12 because systems did not ensure medicines were managed safely.
Kind, familiar care
People and relatives were positive about the care. Staff were described as friendly, caring and knowledgeable about the people they supported.
“People were well cared for by staff that enjoyed their jobs.” from the report
People felt safe
People and relatives said they felt safe and well cared for. Staff had safeguarding training and knew what to do if they had concerns.
“People and their relatives told us they felt safe and well cared for.” from the report
Clean environment
The home was clean and comfortable, with communal areas and a garden. Infection prevention arrangements were judged satisfactory.
“A relative told us, "The home is clean and there are no smells.” from the report
Good communication
Staff and managers kept relatives informed about changes or problems. The home also involved people, relatives and staff in feedback and planning.
“Staff and managers kept relatives up to date and informed them of any changes or issues.” from the report
Enough staff for safety
Inspectors found adequate care staffing numbers and safe recruitment checks. Temporary agency nurses were being used because of long-term sickness among permanent nursing staff.
“People were protected as the provider used safe recruitment processes and there were enough staff on duty to keep people safe.” from the report
Medicines were not always managed safely
seriousThe medicines room was left unlocked, several medicine records lacked signatures, some as-required medicines lacked guidance, and some topical medicines did not have opening dates recorded. Inspectors said this placed people at risk of harm.
“Although we found no evidence of harm, systems were not in place to ensure the safe management of medicines.” from the report
Health and safety work was unfinished
needs fixingSome actions linked to emergency lighting, legionella, fire and kitchen safety were still in progress or awaiting sign-off. Inspectors recommended completing these actions.
“Some work was still in progress or waiting for sign off to show they had met the required health and safety standards.” from the report
Audits did not find medicine problems
needs fixingManagers carried out regular audits, but medicine audits had not identified issues that inspectors found, such as missing signatures. The provider was asked to improve how audits identify and address problems.
“However, the medicine audits had not identified issues we saw during the inspection, such as missed signatures.” from the report
Limited activity opportunities
minorAlthough staffing levels were enough for safety, people and staff said higher staffing numbers would support more one-to-one activities and trips into the local area.
“However, people and staff told us people would benefit from higher staffing numbers for one to one activity and going out in the local area.” from the report
- 01What changes have been made to ensure the medicines room is always locked?
- 02How do you now check that medicine administration records have all required signatures?
- 03How are staff given the correct guidance for people's as-required medicines?
- 04Have the outstanding emergency lighting, legionella, fire and kitchen safety actions been completed and signed off?
- 05What is the current position on the application for a registered manager?
This was a focused inspection of Safe and Well-led, including infection prevention and control; the report does not give new ratings for Effective, Caring or Responsive. This explanation was written from the published report of 17 August 2022 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 Douglas Bank Nursing Home
9 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- July 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Inadequate
- August 2022Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- October 2021Goodup from Requires improvementSafe: Requires improvementWell-led: Good
- February 2021Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2020Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2018Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2017Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- July 2016Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2014
Report published without a new overall rating.
- August 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- January 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 25 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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85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
“She understands the needs of an elderly person in the early stages of dementia and has treated my mother with great kindness and skill.”
“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.