Archived: Lansdowne Retirement Home

On the day of the inspection there were 12 people using the service. As part of this inspection we spoke with four people, three staff and a visiting health professional. The registered manager, who was also the registered provider, was not available on the day of the inspection; however, we spoke with them by telephone. We also reviewed records relating to the management of the home which included, four care plans, daily care records and medication records.

When we last inspected this service on 19 May 2014 we found that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

During this inspection we found people's welfare and safety had been met through appropriate care planning and delivery. We found people had been protected against the risks of malnutrition. The service used appropriate screening tools to promote people's health and welfare. Arrangements were in place with health services to ensure that the risks to people that they could not weigh were assessed.

People were protected against the risk of developing pressure sores as the service used appropriate screening tools to assess the risks to people. Records were kept of how often people had been re-positioned.

There was evidence that people's consent had been sought for the use of bedrails where they had been assessed as in need of them.

There was improved documentation in relation to how the service ensured that people's social and emotional needs had been met. People we spoke with were satisfied with how their social needs had been met. One person told us 'Staff do my nails. Staff are very good and have a chat.'

People we spoke with told us that they received their medication as needed and safely. One person commented 'I get my medication as I need it.' Staff had clear guidance about the application of creams as they were recorded on separate body charts. The amounts of medication received and carried forward had been recorded consistently. Stock checks took place so that the service knew what medication they had in their charge. A risk assessment had been introduced to assess the risks to people if they wished to self-medicate. Staff had been provided with written guidance about the administration of medicines to people which they took 'as required.'

As part of this inspection we spoke with eight of the twelve people who use the service, two visiting health professionals, the registered manager ' who was also one of the providers, the second provider and five care staff. We also reviewed records relating to the management of the home which included, four care plans and daily care records.

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

Is the service safe?

We reviewed the bathing facilities and information provided to people about them. As at the previous inspection the service had not met the regulatory requirements for this essential standard. The walk-in baths were unsuitable for people with mobility issues to use. The providers had ensured that people had been made aware of the limitations of the bathing facilities available before they decided to move into the service. Those people who could not, or chose not to use the baths, had been provided with strip washes. If a person had been identified as having a clinical need for a bath, and experienced mobility issues that prevented them from negotiating the step into the bath, the home was unable to meet their needs. The provider informed us that in these cases the person would not be offered accommodation. People were satisfied with the facilities available. One person told us 'I am quite happy with the facilities.' Another said 'There is a walk-in bath. I can get in it if I wanted to but a strip wash is fine.'

We found that there were not robust processes in place to ensure that the risks to people from medicines had been managed properly. The system to account for medicines in the service was not sufficiently robust. When people self-medicated, risk assessments had not been completed. There was a lack of guidance for staff in relation to the administration of 'as required' medication. We have set a compliance action and asked the provider to tell us what action they intend to take to demonstrate how and when they will become compliant.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the registered manager who demonstrated that they were aware of the recent case law in relation to DoLs although they had not undertaken any specific training in this area. They informed us that they would arrange to complete training in this area.

Is the service effective?

The service did not have processes in place to effectively assess risks to people's health or welfare. For example, they did not have a process in place to assess the risk to people of developing a pressure sore. However, where people had been identified as being at risk appropriate equipment was in place. One person was being turned regularly but their care plan and documentation did not provide staff with written guidance in relation to this care. The service had engaged the district nurses to help them monitor the weight of people whom they could not weigh. However, they had not pro-actively obtained this data to enable them to assess the risk to people of low weight. We have set a compliance action and asked the provider to tell us what action they intend to take to demonstrate how and when they will become compliant.

Is the service caring?

Staff were seen to be caring towards people. They treated people with respect and dignity. People told us that the staff treated them well. One person told us 'Staff are kind. They do all they can.' Another commented 'Staff treat me very well.' People had each been allocated a keyworker to be responsible for their care plan. We noted that people appeared relaxed in the company of the staff and pleased to see them. We observed staff and saw that although at times they were quite busy, they listened to people and responded positively to them. One person told us 'Staff are good at listening.'

Is the service responsive?

People had care plans in place that provided staff with guidance about people's wishes and preferences. These had been reviewed regularly. We saw that the service engaged with health professionals in order to meet people's needs.

People told us that the service had been responsive to their needs. One person told us 'Yes, they respond if I need something.' Another person told us 'They have encouraged my independence.' There was evidence that the service had responded appropriately when people had made comments about the service.

Is the service well-led?

Staff understood their roles and responsibilities. The registered manager was on-site three days a week which enabled them to monitor the quality of the service delivery. People we spoke with told us that they could raise issues if they needed to. One person told us 'If I wanted to I could give feedback' and another told us 'Yes, the manager speaks with me on occasions.'

Staff had a lot to do, and both residents and staff themselves told us that they were always very busy. We observed this to be the case during our visit. The pressure on staff time was compounded because some people's level of dependency had increased recently. We did not see any evidence that this had compromised any person's care although staff did not have much time to talk with residents. Allocated staff hours had been increased during the afternoons to help to address the increased need. Staff received a good range of training to help them to carry out their jobs effectively.

We found that current bathing equipment was unsuitable for most people and we have told the provider that they need to be improved to ensure that they met the needs of people who lived at the home.

We spoke with nine people who lived at Lansdowne. We also spoke with four staff and the manager. People told us that they were satisfied with the care provided. Some said that there was not much to do but most people told us that this was often because there was not a lot of consensus about the use of communal rooms. People were given information about the service and about what could and could not be provided. This enabled them to make an informed decision about whether the service would be appropriate for them. People were given choices in their about their daily routines. Their wishes and preferences were recorded and understood by staff.

People said that the staff were good and said that they looked after them well. Staff liaised appropriately with health care professionals to ensure that people's health needs were met. Everyone said that they felt safe at Lansdowne.

Staff received regular training and support to help them to carry out their responsibilities. Staffing levels were such that at times staff struggled to attend to all of their duties. However, we did not see any evidence that this had any significant impact upon the care or welfare of people who lived at the home. The manager had made some alterations to the staffing rotas to try to ease the pressure at particularly busy times. There were a number of auditing and monitoring systems within the service to ensure that the service met it's aims and objectives.