CQC report explained · a nursing home
What the CQC found at Symphony House Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Safeguarding notifications were not made properly when people arrived with significant pressure wounds. Risk controls, recruitment records and medicines guidance also needed improvement, although people felt safe, staffing levels were considered sufficient and infection control was good.
- Effective?
- Good
- This key question was not inspected during this visit, so its previous rating was carried forward.
- Caring?
- Good
- This key question was not inspected during this visit, so its previous rating was carried forward. People and relatives nevertheless spoke positively about their relationships with staff.
- Responsive?
- Good
- This key question was not inspected during this visit, so its previous rating was carried forward.
- Well-led?
- Requires improvement
- Management systems did not consistently identify or resolve problems with medicines, risk controls and recruitment records. The provider could not show regular auditing and action planning that gave effective oversight of quality and safety.
What inspectors found, July 2022
Requires Improvement; inspectors found safeguarding and management problems, although people felt safe and staff were caring.
The CQC made an unannounced visit on 25 May 2022 and reviewed records, medicines, staff files and how the home was run. The inspection activity continued until 17 June 2022. It spoke with people living there, relatives and staff.
The home was rated Requires Improvement overall. Safe was rated Requires Improvement because safeguarding reports were not made properly, some risk controls were missing, recruitment records needed improvement and medicines records were not always complete. The home was clean, had enough staff and followed infection control measures.
Well-led was also rated Requires Improvement. Audits had not picked up or fixed repeated problems, and the provider could not show regular enough oversight of quality and safety. People and relatives spoke positively about staff, and the home worked with healthcare professionals.
The previous overall rating was also Requires Improvement. The home was no longer in breach over notifying deaths, but it was still in breach over safeguarding and good governance. CQC asked for an action plan and said it would continue to monitor progress.
People felt safe
People told inspectors they felt safe and could speak to the manager if they were worried.
“People told us they felt safe.” from the report
Clean and infection controlled
The home was clean and free from odour. Staff used protective equipment appropriately and infection prevention arrangements were in place.
“The home was visibly clean and odour free.” from the report
Enough staff
Inspectors found there were enough staff to meet people's needs. People and relatives said staff responded quickly when help was needed.
“There were enough staff to meet people's needs.” from the report
Supportive relationships
People, relatives and staff described a supportive culture. People were helped to remain independent and relatives were involved in care.
“People and their relatives had developed good relationships with staff and were leading their own care.” from the report
Learning from incidents
Accidents and incidents were reviewed for patterns, and referrals and care plan changes were made when needed.
“Accidents and incidents were recorded and monitored for trends and patterns to prevent future incidents.” from the report
Safeguarding was not reported
seriousWhen people arrived with significant pressure wounds, the manager did not report concerns to the local authority safeguarding team and CQC as required. This was a breach and increased the risk of harm to people in other care settings.
“The registered manager had not understood their responsibility to report to the local authority safeguarding team and Care Quality Commission (CQC).” from the report
Risk assessments lacked clear controls
needs fixingSome identified risks did not have enough guidance for staff. For example, fluid charts did not state a target amount or total the amount drunk by people at risk of dehydration.
“Some measures were not in place to mitigate risks.” from the report
Medicines records were incomplete
needs fixingStaff did not always have clear instructions for medicines given when needed. Reasons for giving these medicines were not always recorded, so their effectiveness could not be properly monitored.
“Recording of PRN medicine was inconsistent and when PRN medicines were administered staff had not always recorded the reason why.” from the report
Weak management oversight
seriousAudits had not identified problems with medicines and risk controls, and repeated errors continued. The provider could not show regular auditing and action planning, which was a breach of good governance.
“The provider was not able to evidence regular auditing and action planning for the service to identify issues and support the service and registered manager with improvement.” from the report
Recruitment records needed improvement
needs fixingSome staff files did not explain gaps in employment history, and health declarations had not consistently been checked and signed off.
“When a staff member had a gap in their employment history this had not been explored and health declarations had not consistently been checked and signed off by the registered manager.” from the report
- 01What action has been taken to ensure pressure wounds and other safeguarding concerns are reported to the local authority and CQC?
- 02How are fluid targets and other risk controls now recorded and checked for each person?
- 03What written guidance is available for medicines given when needed, and how do you check that reasons and outcomes are recorded?
- 04What regular audits are now completed, and how do you make sure repeated problems are resolved?
- 05How have recruitment checks been strengthened, including unexplained employment gaps and health declarations?
This was a focused inspection of Safe and Well-led; the ratings for Effective, Caring and Responsive were not inspected and were carried forward from the previous inspection. This explanation was written from the published report of 22 July 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.
What inspectors found, November 2020
Symphony House Nursing Home was rated Requires Improvement; inspectors found safe care but serious failures in reporting deaths and oversight.
This was a focused inspection on 10 September 2020. One inspector spoke with two people and seven staff, and checked care records, medicines records, staff recruitment files, audits and other records.
The home was rated Good for Safe. Inspectors found enough trained staff, safe medicines practice, suitable risk plans, safe equipment and good infection control. People told inspectors they felt safe.
The home was rated Requires Improvement for Well-led. The manager and provider had not told the CQC about 21 deaths since October 2018, although they knew this was a legal requirement. The overall rating fell from Good to Requires Improvement because of this breach.
People felt safe
People told inspectors they were safe, and staff knew how to recognise and report abuse or other safety concerns.
“People told us they were safe, and we saw people looked relaxed and happy around staff.” from the report
Safe staffing
Inspectors found enough trained staff, and recruitment checks were completed before staff started work.
“There were enough staff to provide consistent safe care and support to meet people's needs.” from the report
Medicines managed safely
Medicines were stored, given and disposed of safely. Staff had their medicines skills checked regularly and audits were completed.
“Medicines systems were well organised, and people were receiving their medicines when they should.” from the report
Infection control
Inspectors were assured that the home had suitable infection control procedures, protective equipment and arrangements for testing and managing outbreaks.
“People were protected by the prevention and control of infection.” from the report
Supportive culture
Staff said they felt valued, listened to and supported. Inspectors also found positive feedback from relatives.
“Staff felt valued and listened to. The registered manager continued to run an annual awards ceremony” from the report
Deaths not reported
seriousThe home failed to notify the CQC about 21 deaths since October 2018. Inspectors said this was a breach of regulation and the second time this offence had occurred.
“The registered manager and provider had failed to notify the commission about 21 deaths of people living at the home since October 2018.” from the report
Weak management oversight
seriousThe manager had not been open with the provider about the missing notifications and had said they had been completed. This led to the Well-led rating falling to Requires Improvement.
“The registered manager had not been transparent with the provider about the failure to submit notifications and had offered assurances this had been completed.” from the report
- 01What steps have you taken to make sure every death is now notified to the CQC without delay?
- 02How do you check that required notifications are actually sent and recorded?
- 03What action has been taken because this was the second time the notification offence occurred?
- 04What were the findings and ratings for Effective, Caring and Responsive at the previous comprehensive inspection?
- 05How will you show families that the weaknesses in management oversight have been fixed?
This was a focused inspection of Safe and Well-led only; the other three key question ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 21 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.
Every inspection of Symphony House Nursing Home
6 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- July 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2020Requires improvementdown from GoodSafe: GoodWell-led: Requires improvement
- September 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- September 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 21 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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