CQC report explained · a nursing home
What the CQC found at The Pastures
Rated Inadequate: inspectors found the home performing badly and the CQC has taken enforcement action.
- Safe?
- Inadequate
- Inspectors found repeated safety incidents, medicines errors, missed care and unsafe or inconsistent practice. They were not assured that people always received safe care in line with their assessed needs.
- Effective?
- Good
- This question was not inspected during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Well-led?
- Inadequate
- Inspectors found widespread shortfalls in leadership and quality checks. Admissions, staffing risks, people's experiences and learning from incidents were not managed well enough.
What inspectors found, July 2024
Rated Inadequate and placed in special measures; inspectors found serious risks involving staffing, medicines, safe care and management.
This was an unannounced focused inspection after concerns about safeguarding. Inspectors visited the home, reviewed care and medicines records, observed care, spoke with staff, managers and relatives, and checked the environment.
The home was rated Inadequate for Safe and Well-led. Inspectors found 106 incidents affecting health and safety between May and October 2023, including missed care and medicines errors. There were 17 full-time vacancies, and many staff were new or temporary. Care was not always provided in line with people's needs, communication plans or preferences.
There were some positive findings. People's needs were documented and reviewed, safeguarding concerns were raised, the environment was clean, and recruitment checks were robust. However, inspectors found that the systems for learning from incidents, checking quality and ensuring suitable staffing were not effective enough.
The overall rating changed from Good at the previous inspection to Inadequate. The home is in special measures, so CQC will monitor it and normally re-inspect within six months to check for significant improvement.
Care records
People's needs were documented and reviewed. Changes in needs were followed up with relevant professionals.
“People's needs were clearly documented, kept under review and where changing needs were identified these were followed up with relevant professionals.” from the report
Infection control
The home was clean and well maintained. Staff followed good hygiene practices and had infection control training.
“There were good infection control procedures in place and the environment was well maintained and clean.” from the report
Recruitment checks
The provider had recruitment procedures designed to check that staff were suitable before employment.
“Recruitment processes were robust to help ensure only suitable staff were employed and records included pre-employment checks” from the report
Openness about concerns
The manager was open with CQC, the local authority and relatives when incidents affected people's wellbeing or safety.
“They were open, transparent, and quick to deal with things.” from the report
Medicines errors
seriousInspectors found 60 medicines errors in six months. These included recording errors, medicines being out of stock and medicines being given incorrectly, putting people at risk of avoidable harm.
“60 medicine errors had occurred in the last 6 months which were divided into different categories including medicine recording errors, medicines being out of stock and medicines being administered incorrectly.” from the report
Unsafe and inconsistent care
seriousCare plans and risk assessments were not always followed. Inspectors also found that staff did not always follow people's diet, communication or sensory plans.
“We were not assured that people always received safe care in line with their assessed needs This was a breach of regulation 12” from the report
Staffing continuity and experience
seriousThere were 17 full-time vacancies and 30 staff had been in post for a year or less. The use of temporary staff meant some workers did not know people's needs well enough.
“There were 17 full time staffing vacancies at the time of our inspection and 30 staff (more than half the staff team) had been in post for a year or less.” from the report
Restrictive practices
seriousInspectors found examples where restrictive practice was not clearly shown to be in a person's best interests or the least restrictive option. Previous safeguarding concerns about physical restraint were also being addressed.
“However, in one instance we could not see how this had been agreed it was in their best interest or the least restrictive.” from the report
Weak quality monitoring
seriousAudits and surveys did not focus enough on people's experiences and safety. The provider had not effectively assessed and reduced risks linked to staffing, admissions and care quality.
“This was a failure to effectively assess, monitor and mitigate the risks relating to people's health, safety, and welfare.” from the report
Care not always person-centred
seriousActivities were not always individualised, and staff did not always communicate in ways suited to people's needs. Some people experienced repeated group activities or limited support to take part.
“We were not assured that people always received care and support in line with their preferences. This was a breach of regulation 9” from the report
- 01What action has been taken to reduce the 60 medicines errors, and how are the causes now recorded and reviewed?
- 02How many permanent staff vacancies remain, and how do you ensure temporary staff understand each person's communication, sensory and care needs?
- 03How do you make sure care plans, diet plans and risk assessments are followed on every shift?
- 04What changes have been made to the admission process so that new admissions do not put existing residents or staff at risk?
- 05How are people and their families now able to influence care, activities and improvements at the home?
This was an unannounced focused inspection of Safe and Well-led only; the other key-question ratings were carried forward from the previous inspection, and the report gives conflicting dates for the second visit. This explanation was written from the published report of 6 July 2024 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 2022
Rated Good; inspectors found safe and well-led care, but some cleaning needed improvement and agency staffing affected consistency.
This was an unannounced focused inspection on 13 September 2022. Inspectors looked mainly at whether people were safe and whether the home was well managed. They spoke with staff and relatives, observed care, and checked care records, medicines records, staff files, rotas, incidents and maintenance records.
The home was rated Good for Safe and Well-led. Inspectors found that staff understood people's risks, medicines were given as prescribed, recruitment checks were completed and there were enough staff to keep people safe. The home used agency staff, however, and this sometimes made it harder to have a consistent team with the right mix of skills.
Inspectors found that some bedrooms needed more regular hoovering and that bathrooms needed updating and deeper cleaning. They made a recommendation about infection prevention and cleanliness. The home remained Good overall, as the other areas were not inspected during this visit and their previous ratings were carried forward.
Choice and independence
Staff supported people to make choices and live as independently as possible, using the least restrictive approach and best-interest decisions when needed.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests” from the report
Safe medicines
Medicines were given as prescribed, stored securely and checked. Errors were reported and used to improve staff practice.
“Medicines were administered as prescribed, and any incidents relating to medicines errors had been recorded and reported appropriately.” from the report
Risk management
Staff knew people's individual risks and records showed that risks were assessed and managed carefully.
“Staff understood risks to individuals well. These risks were carefully and thoroughly assessed, recorded and appropriately managed.” from the report
Improving leadership
The home had checks and an action plan, and the manager acted when improvements were needed. The report says the Well-led rating improved from Requires Improvement to Good.
“There was a clear action plan which we reviewed; this showed recent improvements to the service had been made in various areas including care plan records, staff files and updating the environment.” from the report
Cleanliness
needs fixingSome bedrooms needed more regular hoovering. Bathrooms needed updating and deeper cleaning, and damaged upholstery was difficult to keep clean.
“The home required more regular hoovering in some bedrooms. The bathrooms also required some updating and more deep cleaning.” from the report
Agency staffing
needs fixingThere were enough staff to keep people safe, but the high use of agency staff sometimes made it difficult to provide a consistent team with the right skills.
“However, staff reported a high number of agency staff working in the service, which meant at times it was difficult to allocate staff on a shift who both knew people well and had an appropriate skill mix.” from the report
Bedroom cleaning checks
minorThe home's quality checks did not always examine bedroom cleanliness in enough detail.
“However, more detailed checks of the cleanliness of people's bedrooms would benefit the home.” from the report
- 01What changes have been made to hoovering, bathroom cleaning and damaged upholstery since the inspection?
- 02How often are bedroom and bathroom cleanliness checks now completed, and who reviews them?
- 03How many agency staff are currently working at the home, and how are they trained in each person's needs?
- 04How does the home make sure agency staff have the right skills and information when working shifts?
- 05What improvements from the action plan have been completed since this inspection?
This was a focused inspection of Safe and Well-led only; the other key question ratings were not inspected during this visit and previous ratings were used to calculate the overall rating. This explanation was written from the published report of 11 November 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 The Pastures
4 rated inspections over 8 years: the service has slipped, from Good to Inadequate.
- July 2024Inadequatecurrent ratingdown from GoodSafe: InadequateEffective: GoodCaring: GoodResponsive: GoodWell-led: Inadequate
- November 2022Goodstayed GoodSafe: GoodWell-led: Good
- May 2019Goodstayed GoodSafe: GoodWell-led: Requires improvement
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- April 2011
Registered with the Care Quality Commission on 9 April 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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13 live-in carers within about an hour of Norfolk
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 £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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.