Archived: Lickey Hills

The provider of Lickey Hills is registered to provide accommodation with personal and nursing care for up to 82 people. Care and support is provided to people with dementia, personal and nursing care needs. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining rooms. At the time of this inspection 63 people lived at the home.

There was a registered manager in post who was present during the three days of our inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our inspection in May 2017 we found two breaches in regulation 9 Person Centred Care and regulation 17 Good Governance. At this inspection we found the provider had not made significant and sustained improvements. Therefore there were continuations in breaches Regulation 9 and Regulation 17.

People's daily records were not completed promptly. They did not monitor people’s fluid intake to ensure they were not at risk of dehydration. People were not always given a choice of food. The monitoring of people’s fluid and food intake was not always completed in a timely manner. Relatives were concerned their family member did not have sufficient drinks offered throughout the day.

We found medicines were not being managed safely. We found medicines not stored securely and left in a corridor which could put people at significant risk of harm. Although medicines were stored in medicine trolleys we found on two occasions either the door was left open or the medicine keys were left on top of the trolley so anyone could have accessed them.

Staff reported accidents and incidents to the office however; the management team did not review them to ensure appropriate action had been taken and to reduce the risk of incidents happening again.

Accurate records of people’s care were not always maintained. People's care plans did not contain the detail needed to keep people safe including guidance for staff about how to reduce the risk of pressure sores. photographs of the wounds had not been taken to record the healing progress.

People were not supported to maintain their hobbies and interests. There was a lack of specialist activities available for people living with dementia.

People were asked for their consent for care and were provided with care that protected their freedom and promoted their rights. Staff asked people for their permission before care was provided. Staff were well meaning and had good relationships with those they supported. However interactions were largely based around the completion of tasks.

Care plans did not provide sufficient guidance to staff on people's needs. We identified gaps in how people's needs were monitored in order to help people maintain their health and wellbeing.

People were kept safe from potential abuse and harm by staff who understood how to identify the various types of abuse and knew who to report any concerns. Although these incidents had been reported to the local authority the provider had failed to notify safeguarding incidents to the Care Quality Commission.

Auditing systems in place to monitor the quality of services provided were not robust and effective.

The provider had failed to ensure there was sufficient and sustained improvement following our last inspection. During this inspection we found significant shortfalls in the quality of the care being provided. We found the registered provider to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five questions it will no longer be in special measures.

The provider of Lickey Hills is registered to provide accommodation with personal and nursing care for up to 82 people. Care and support is provided to people with dementia, personal and nursing care needs. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining rooms. At the time of this inspection 63 people lived at the home.

The registered manager had stopped working at the service in October 2016. We were accompanied during this inspection by the new manager who came into post in March 2017. At the time of this inspection the manager was not registered with us but would be sending in an application to us. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in June 2015 the provider was required to make improvements as the support provided to people with dementia to eat their meals was not consistently effective and impacted upon their dignity. At this inspection people’s meal time experiences remained mixed and as at our previous inspection not everyone was supported effectively to eat and enjoy their meals.

Staff did not always incorporate their knowledge around best practice to assist people with dementia so care was personalised and effectively met each person’s needs. People's meals were often interrupted by staff carrying out medicine tasks which did not reflect an approach of recognising the importance of providing care centred on the needs of the person. Staff practices were inconsistent in always carefully recording what people had eaten and drank so any risks to people’s health were effectively reduced.

People were supported to make their own choices and decisions. Although there was an occasion where some staff did not support people to make a choice but we saw many other times when staff did support people in making their everyday choices known. There were arrangements in place so people were not restricted unlawfully and staff had knowledge of these so they were able to support people’s safety and meet their needs.

People had opportunities to follow their own interests and socialise as things to do for fun and interest were planned. However, staff missed opportunities to introduce into their caring roles time to spend socialising with people and having spontaneous moments of fun. There was also times when people’s needs were not consistently responded so people feelings were not impacted on and staff provided care in a timely manner.

People enjoyed staff company and had built positive relationships with staff members they knew well. Staff showed they cared about people and reflected this in how they respected people’s diverse needs. Staff supported people to be involved in their care. People had been assisted to personalise their own rooms with items they cherished and made sure people’s privacy was maintained.

People needs were identified and risk plans were in place to guide staff in providing the support and care people needed so their safety and welfare was not compromised. There were developed medicine management arrangements to ensure people’s medicines were always available. There was a checking system to spot any discrepancies so these could be quickly rectified.

Health and social care professionals were involved in people's care to ensure they received the care and treatment which was right for them.

Staff had the knowledge to identify potential harm and abuse people could be at risk from so action could be taken to investigate this. Staffing levels were determined by the management team and they did this by taking into account people’s individual care needs. The manager was actively recruiting for staff as there was reliance upon agency staff which did not support staff to consistently provide good quality effective care.

Staff had not always felt supported in their roles because there had been inconsistencies in the manager position at the home. However, staff had faith in the new manager and deputy manager so were hopeful improvements would be made to enhance their experiences and benefit those of people who lived at the home. Staff were looking forward to the recruitment of permanent staff and having the opportunities of taking higher training qualifications.

The provider had developed clear policies and procedures for dealing with people’s complaints. The manager had listened to people who lived at the home and their relatives as they were taking action to resolve any issues people had and use any learning gained to continue to further improve the care people received. There were improvement plans but time was needed to fully implement these and see how effective these had been in driving up standards of care.

The provider and management team had arrangements to monitor the quality of the service but these were not as effective as they could be. People continued to receive care which was not consistently effective to meet their individual needs which had also been the case at our previous inspection. The service people received was under internal scrutiny by the senior management team to ensure the provider’s required standards were achieved and people received high quality care.

You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People we spoke with told us that they felt their relatives were safe living at the home and their needs were met by staff that knew them. Staff also told us that they felt people were safe and their needs were met.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

We observed that people received appropriate care to meet their physical needs and maintain their comfort. All of the staff we spoke with told us about the individual needs of the people that lived there. At the last inspection it was found that not all the people that lived there had their needs met in a timely way. During this inspection we found that improvements had been made. Staffing levels had been improved and this meant that more staff were available to meet people's needs.

Is the service caring?

We observed that staff were kind and polite. We found that staff treated the people that lived there with dignity and respect. All the staff we spoke with were able to tell us about people's individual likes and dislikes. People's wishes had been respected. For example we saw where one person indicated through their movements that they wanted to move to a particular area of the home. We saw that staff respected this.

Is the service responsive?

We found that the care records showed that people that lived at the home saw other professionals including the psychiatrist and doctors when their health needs changed. The provider had acted appropriately to guidance from other professionals when people's needs changed. People told us that they felt if their relative's needs changed the staff were always quick to respond and contact other professionals. For example following a change in a person's mood we found that a referral for a psychiatrist had been made to provide additional support around the person's individual needs. This had been following a period of monitoring by the staff.

We found that the provider took action to address concerns that were raised during the inspection. This showed that the provider responded appropriately to ensure that people's needs continued to be met.

Is the service well led?

We found that the provider had effective systems in place to monitor the quality of the service. Regular audits and analysing risks and incidents meant that the quality assurance systems now in place enabled the provider to highlight and address shortfalls in a timely manner. We found that where incidents that occurred, the provider had assessed the risk and actioned it appropriately.

At the time of inspection the provider had appointed a new manager. This manager told us that they were in the process of becoming registered with the CQC. We found that staff felt that the changes made to the management of the home were positive, and staff told us that they felt supported in their roles.

We saw that staff treated people with kindness. Staff interacted positively with people but there were some occasions where people's choice and needs were compromised, namely through lengthy waits for assistance.

People's needs had been assessed by a range of health professionals. We also saw that people who lived at the home had their medicines as prescribed at the right time and in the right way. This made sure people's health needs were effectively met.

People who needed dietary supplements were being given these in the recommended way to meet their health and wellbeing. There was some evidence that everyone had choices regarding what they ate and drank.

The arrangements in place did not provide enough assurance that there were adequate staffing levels, as we saw people frequently had to wait for support. Staff knew how to meet people's needs, and mostly understood the needs of people living with dementia.

People's complaints were listened to and resolved to their satisfaction.

One family member told us that they felt involved in any decisions that needed to be made and these were done with their relation's best interests at heart. This family member told us that staff always let them know if their relation was unwell and needed any medical treatment. They also said that staff involved them in the planning and delivery of care to meet their relation's needs.

Staff had been recruited in an appropriate way and checks had been undertaken to ensure that they were suitable to care for vulnerable people.

In this report the name of one registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still the registered manager on our register at the time.