CQC finds ‘risk of harm’ due to nurses working ‘excessive hours’ at care home

A care home in Birmingham has been placed into special measures after inspectors found nurses and residents at risk of harm because of staff fatigue caused by excessive hours and unsafe staffing.

The Care Quality Commission (CQC) has downgraded Fountain Nursing and Care Home Limited from ‘good’ to ‘inadequate’ following an inspection in April and May.

Inspectors found that the care home – which provides nursing and personal care for up to 27 older adults – was in breach of several regulations relating to person centred care, dignity and respect, consent, risk management, nutrition and hydration, safe premises and equipment and staffing.

The health watchdog said that at the time of inspection the provider did not ensure there were enough qualified, skilled and experienced staff and that those working in the care home did not always receive effective support, supervision and development opportunities.

Concerns were raised around ‘staff fatigue’ and the hours that some nurses were required to work.

‘We found one staff member was working without a day off for several weeks and this included working long days,’ the CQC report published this month said.

‘We also found that three other staff, which included nurses, were scheduled to work excessive hours without the correct length of time between shifts.’

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Inspectors saw one example where a nurse ‘worked the late shift, the night shift then the late shift the same day of which the night shift ended’.

The report added: ‘The provider failed to have an emergency plan in place for ensuring the service was suitably and safely staffed.

‘This placed the staff member and people at risk of harm due to staff fatigue.’

Serious concerns were also identified regarding the home’s recruitment systems – with examples of a lack of background checks, reference checks and a failure to ensure the suitability of all staff employed.

‘The provider’s recruitment systems were not robust. Safe recruitment practices were not always followed,’ the report said.

‘People were at risk of harm from receiving care and support from unsuitable staff.’

In addition, the CQC said the provider had failed to ensure all staff received appropriate training to meet the needs of people and their health conditions.

Other issues identified included that staff did not always manage people’s nutrition and hydration needs effectively, and that both leaders and staff did not consider people’s individual needs and preferences when delivering care.

Inspectors also said that the care environment was not maintained at a ‘safe and hygienic’ standard and that the premises and equipment was also not at an acceptable standard.

The report also said that staff ‘didn’t consistently respect people’s privacy or dignity and didn’t always seek their consent’ and that leaders did not match people with staff who could speak their language or understand their cultural and religious needs.

And overarchingly, the CQC said leaders did not provide ‘clear information and guidance for staff on supporting people with their known health conditions or managing the risks they faced’.

Having reviewed 10 people’s cases, inspectors found leaders had not assessed ‘some known risks’.

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More positively, inspectors highlighted that residents and their relatives ‘felt comfortable raising concerns’ and that the manager of the service was ‘approachable, listened to people’s concerns and supported staff’.

Amanda Lyndon, CQC deputy director of operations in Birmingham, said: ‘We were disappointed to find that the quality of care at Fountain Nursing and Care Home had deteriorated considerably since our previous inspection, as the quality of leadership had declined.

‘Our experience tells us when a service isn’t well-led, they find it difficult to provide good care in the other areas we look at, which is what we found here.’

She said that while people at the home and their relatives were ‘generally positive about the care they received’ inspectors found ‘this failed to meet expected safety standards’.

‘We have told Fountain Nursing and Care Home where urgent improvements are needed and will continue to monitor the service to ensure people remain safe while this happens,’ she added.

The CQC has downgraded the care home’s ratings for how safe, effective and well-led the service is from ‘good’ to ‘inadequate’.

How responsive the service is has also dropped from ‘good’ to ‘requires improvement’, while how caring the service is remains rated as ‘requires improvement’.

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With the home being rated as ‘inadequate’ overall, the CQC has also placed the service in special measures, which means it will be kept under close review while improvements are made.

Latest workforce data from Skills for Care suggests the number of social care nurses in England has risen by around 2,000 posts in the last year, but long-term retention remains an issue.

Meanwhile concerns also remain around the impact of the government’s plans to ban the recruitment of care workers from overseas.

Fountain Nursing and Care Home Limited has been approached for comment.