Archived: Loudoun House Care Home

Loudoun House provides accommodation for up to 35 people who require personal care and support. There were 34 people using the service at the time of our inspection including people living with dementia.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Concerns had been raised with us prior to our visit regarding staffing numbers at the service. During our visit it was evident that there were insufficient numbers of staff on duty to meet the care and support needs of the people using the service and to keep them safe from avoidable harm.

There were systems in place to audit the medicines held at the service and appropriate records were being kept. However, people did not always receive their medicines as prescribed.

There were monitoring processes in place to monitor the quality and safety of the service. However these had not identified the shortfalls that we identified during our visit.

The provider’s recruitment process had not been consistently followed, this was because up to date references had not always been collected.

People told us they were treated with respect by the staff team and they were kind and caring. Whilst this was observed, the actions of some staff members meant that people were not always treated in a caring or dignified manner.

People told us they felt safe living at Loudoun House Care Home. Relatives we spoke with agreed what they told us. The staff team were aware of their responsibilities for keeping people safe from harm and knew what to do if they felt someone was being abused. We did however observe practices that didn’t always keep people safe from harm. This included two people being transferred in a wheelchair without the use of footplates.

Risks associated with people’s care and support had been assessed. Where risks had been identified these had, where ever possible, been minimised to better protect people’s health and welfare. We did note however that the staff team did not always follow the information contained in people’s risk assessments or plans of care to keep people safe.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors, community nurses and opticians and they received ongoing healthcare support.

People had been involved in making day to day decisions about their care and support. Where people lacked the capacity to make their own decisions, these had been made for them in their best interest and in consultation with others.

People’s nutritional and dietary requirements had been assessed and a varied and balanced diet was being provided. For people assessed to be at risk of not getting the food and fluids they needed to keep them well, records were kept. We noted that these were not always completed accurately.

People’s needs had been assessed before they moved into the service and plans of care had been developed from this. People’s plans of care did not always include the actions the staff members should take to meet people’s needs.

Observation records were not always completed accurately. This meant that staff could not demonstrate that they had observed people, as required within their plan of care or risk assessment, to keep them safe.

The staff members we spoke with felt supported by the management team. Though concerns were raised with regard to staff deployment. They were provided with opportunities to meet regularly with them to discuss how they were progressing within the staff team.

Staff meetings and meetings for the people using the service had been held. These meetings provided people with the opportunity to be involved in how the service was run.

We found the service was in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

As part of our initial three day inspection we spoke with 15 people who used the service, five people's relatives, all care staff on duty at the time of inspection, the registered manager and the providers representatives. During our inspection concerns were raised to us by people who used the service and staff members. We alerted the local authority in all cases as the lead authority for investigating allegations of abuse. The safeguarding investigation is ongoing.

We looked at a number of records including people's personal care records, staff records, medication records and records in relation to the management of the service. This is a summary of what we found and more detailed evidence can be found in the full report.

Where areas of non-compliance have been identified during the inspection, these will be followed up and we will report on any action when it is complete.

Is the service safe?

We spoke with 15 people who used the service about their experiences at the home. Eight people told us about information of concern which we have passed onto the local authority and the police for investigation. Other people told us about shortfalls in the care they were receiving. One person's relative was concerned about care practices at the home and told us that staff did not always interact with people in a positive manner. They said, 'I think if people have limited verbal communication they are more vulnerable. My mum's okay as she is able to speak up for herself. It is a job to find staff; they never seem to be about'.

Staff we spoke with had some understanding of how to protect people from the risk of abuse but most were unaware of the appropriate body they should refer safeguarding matters to outside of their own organisation. The provider's safeguarding policies and procedures were unclear and were not in line with national guidance about the protection of vulnerable adults.

We found evidence within staff supervision records and team meeting minutes about concerns or allegations in relation to staff practice at Loudoun House. We saw no evidence to show that these concerns or allegations had been addressed or escalated. These events had not always been referred to the local authority for investigation and neither had CQC received the relevant notification as required by law.

As part of our inspection we looked at a number of people's individual risk assessments. We found these to be inadequate and risks to people had not always been properly identified. When risks had been identified, actions that should have been taken in order to protect people from harm were not always followed.

We found that medicines were not always stored or managed safely. We therefore informed the management team that appropriate arrangements were not always being undertaken in order to manage the risks associated with the unsafe use and management of medicines.

Our inspection of 25 July 2014 found that improvements had been made to areas of immediate concern to ensure that people who used the service were safe. These included reviewing people's risk assessments and ensuring staff had received safeguarding training. The service was co-operating fully with the local authorities' investigation.

Is the service effective?

We spoke with people who used the service and many told us about shortcomings in their care. We found one person worrying because they had been told they were not allowed to use the toilet. Other people told us they felt bored and isolated. One person said, 'I feel very cut off here, very lonely. There are some activities, like they paint your nails but no stimulation. I am unhappy here. There is nothing to do and if it wasn't for my family I would have no outside contact.' Throughout our inspection we drew aspects of people's care to the attention of the staff team. For example, people were using broken wheelchairs, had poorly fitting dentures, looked unkempt and had watery eyes which needed medical attention.

We found some instances where people did not have a plan of care for relevant health conditions. In other instances, people's care plans were up to date and had been reviewed. However, we found the planning and delivery of people's care to be inadequate. Care plans did not contain sufficient information about how staff should meet people's needs to ensure their safety and welfare. In addition, we could not always evidence that people had received the care they required as individual charts had not been completed consistently or reliably. For example, we found that people at risk of developing pressure sores had not been turned as regularly as they should have been.

People had not been supported to maintain good health and referrals to appropriate health professionals had not always been made when necessary. People with health conditions such as diabetes had not been monitored as they should have been. There was no overall review of people's care which meant that any changes to their well-being were not detected. This meant that people did not receive effective care.

Our inspection of 25 July 2014 found that improvements had been made to areas of immediate concern to ensure that people's care was being delivered effectively. This included referrals to appropriate health professionals and ensuring people's day to day care was carried out appropriately.

Is the service caring?

We asked people about the care they received from the staff team. The response was very mixed. Some people told us they received good care from some staff and told us about staff members who were kind and attentive. Other people told us they had experienced or witnessed unpleasant treatment by some members of staff. They gave examples where they had been shouted at or treated unkindly.

Staff were trained to administer medicines before they were given the responsibility. Medication administration records we looked at were completed accurately to show people had received their medicines.

The provider had made improvements to the standard of d'cor and maintenance at Loudoun House Care Home. All the bathrooms and toilets were now in working order. All areas of the service including the bathrooms were decorated, clean, tidy and well maintained. There was suitable storage for equipment. A system was in place to ensure repairs were carried out promptly. Regular checks were carried out on the premises to make sure it was safe and adequately maintained.

People were asked for their views and how to make comment or complaint about the quality of care and support they received. Regular audits and checks were carried out to make sure it was safe for everyone.

People's personal confidential information were reviewed and kept up to date. Staff records and other records relating to the management of the service were also kept secure and up to date.

People received their medicines on time. The arrangements for recording medication administered was unreliable and improvements were needed to ensure people's health was maintained.

People lived in a clean and tidy environment. Bedrooms were of a good size and personalised with ornaments and family photographs. Some improvements were needed to the premises to make sure it was safe, adequately maintained and suitable storage was available for equipment.

People were confident to make comments about the quality of service received. However, several people told us they were not always asked whether they were satisfied with the support they received and that their concerns were not always listened to or acted on. The system in place to assess and monitor the quality of service was ineffective. Improvements were needed in relation to auditing and monitoring, record keeping and records and acting on comments or concerns and communication. Improvements were needed to protect the health, safety and welfare of people using the service.

People told us they were treated with respect and their care needs were met safely. People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people's health and care needs were monitored and reviewed regularly. People told us they received their prescribed medicines on time. Arrangements were in place to support people safely and to deal with foreseeable emergencies.

People were protected because there were effective staff recruitment and selection processes in place. Records showed appropriate checks were undertaken before staff began work. Staff received training which enabled them to meet people's care needs safely.

People told us they were satisfied with the meals provided. People had opportunities to comments and give their views about the quality of services experienced including the meals.

Information about how to make a complaint was available to people using the service. People told us they were confident to raise concerns with the registered manager. One person said 'I've had grumbles in the past and they've addressed it quickly.'