A nursing home in Manchester, which was part of a pioneering deal with a local hospital to provide care prior to discharge, has been rated inadequate and placed in special measures. Despite advertising luxurious, high-quality surroundings, it was still heavily criticised in a CQC inspection due to the lack of safeguards and potentially poor standard of care.

Darnton House Nursing Home was built by L&M Healthcare as a luxury care home, and was also intended to act as a pioneering "Transitional Care Unit" for local Tameside Hospital, where part of the home would be used by the hospital for patients too unwell to be discharged, but no longer requiring hospital care. It was registered with the CQC in March 2015 and the CQC carried out an unannounced inspection in November.

The CQC inspection report was released in February and found that, while the home was very well furnished and presented, there were several failures in the services it provided and many breaches of the Regulated Activities Regulations 2015, which set out the fundamental standards for care. In particular, there was no registered manager, inadequate care records and plans to ensure patients' needs were met, and medication was not being provided in accordance with instructions. Deprivation of Liberty Safeguards (DoLS) applications had also not been made in every situation where they were required. In addition, while the inspectors acknowledged the high quality of the furnishings, they noted that these were often unsuitable for residents, such as low level lighting reducing visibility for residents with sight problems, and identical doors making it harder for those with dementia to recognise their rooms or bathrooms.

CQC will now keep Darnton House under close review and re-inspect in six months. While it is not unusual for a care home, even a 'luxury' one, to be placed into special measures, this case demonstrates that money needs to be spent in the right places to ensure that a care home meets the fundamental standards. When building a new care home, developers are keen to be innovative in a quest to attract privately paying residents, by offering something more luxurious than their competitors. Whilst this is understandable from a marketing and commercial view, what is far more important in the long-term is compliance with fundamental standards, the welfare of the service users and the ability to risk assess your business.

In addition, while high-end decoration and furnishing are of course desirable, they (like everything else) must be pragmatically designed with residents in mind. This is where there must be a collective vision that incorporates a clinical viewpoint. This case also highlights the importance of monitoring compliance with CQC standards from the beginning, rather than reacting to problems once they are discovered.

Another interesting point in this case is the concept of the transitional support unit. There has been considerable coverage recently of 'bed-blocking', where patients who no longer require hospital care cannot be discharged due to care needs which cannot currently be provided at home. Such support units could offer a useful 'halfway house', freeing up hospital space while ensuring that patients get the care and support they need until it can be provided elsewhere. While Darnton House may need to make substantial improvements, we would expect this innovative concept to be further developed and, if successful, rolled out in other areas, as discussed in a recent ResPublica report.