Archived: Lauriston House

Rating at last inspection: At our last inspection on 5 November 2018 we found breaches of regulations because risks relating to people’s care and support were not always managed safely. Care plans were not reflective of people’s care needs and were not being followed by staff. Staff had not always referred people to health care services where they had identified concerns with their health. Staff had not always followed the instructions of health care professionals when supporting people. Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not always deployed at the home to meet people’s care and support needs. The home relied heavily on agency staff, some of whom were not fully aware of people’s needs.

The principles of the Mental Capacity Act 2005 (MCA) had not always been adhered to where people lacked capacity to make decisions for themselves. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Staff did not always treat people with respect, or in a caring way. People were not consistently provided with a range of appropriate social activities that met their needs. We identified one incident that was a safeguarding concern which had not been properly reported or recorded. The home’s quality monitoring systems were not effective.

The home was rated inadequate overall and was placed into ‘Special Measures’.

At this inspection we saw that the registered manager and the management team had addressed these breaches and were compliant with the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Whilst we found improvements had been made in safe some areas required further improvements. The systems and processes that have been implemented in well led had not been operational for enough time for us to be sure of consistent and sustained good practice. We will look at these systems again at our next inspection of the service.

People’s experience of using this service: Risks to people using the service were assessed, reviewed and managed appropriately. People’s care and support needs were assessed before they moved into the home. They had care plans in place that reflected their needs, and these were followed by staff. Staff referred people to health care services when they identified concerns with their health. Staff followed the instructions of health care professionals when supporting people. The home had recruited more full-time staff and were no longer reliant on agency staff.

The principles of the MCA were adhered to where people lacked capacity to make decisions for themselves. Staff treated people with respect. People were provided with a range of social activities that met their needs. Safeguarding concerns were reported to the appropriate authorities when required. There were effective systems in place to assess and monitor the quality of the service.

People’s medicines were managed safely. Appropriate recruitment checks were carried out before staff started working at the home. There were procedures in place to reduce the risk of the spread of infections. Staff had received training and support relevant to people’s needs. People were supported to maintain a balanced diet.

People’s wishes relating to their end of life care needs had been discussed with them or their relatives [where appropriate] and recorded in their care files. People and their relatives [where appropriate] had been consulted about their care and support needs. The home had a complaints procedure in place.

The registered manager had worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people, their relatives and staff views into account through meetings. Staff enjoyed working at the home and said they received good support from the registered manager and management team.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

As the provider has demonstrated improvements and the service is no longer rated inadequate for any of the five key questions, it is no longer in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The home had a registered manager in post. 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.

At this inspection we found breaches of regulations 9, 10, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Risks relating to people’s care and support were not always managed safely. Care plans were not reflective of people’s care needs and were not being followed by staff. Staff had not always referred people to health care services where they had identified concerns with their health. Staff had not always followed the instructions of health care professionals when supporting people. Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not always deployed at the home to meet people’s care and support needs. The home relied heavily on agency staff, some of whom were not fully aware of people’s needs.

The principles of the Mental Capacity Act 2005 (MCA) had not always been adhered to where people lacked capacity to make decisions for themselves. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Staff did not always treat people with respect, or in a caring way. People were not consistently provided with a range of appropriate social activities that met their needs. We identified one incident that was a safeguarding concern which had not been properly reported or recorded. The home’s quality monitoring systems were not effective.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There were safe systems in place for storing and administering medicines, and for monitoring controlled drugs. However, the daily medicine audits and balance checks required improvement because they were not always accurate. Robust recruitment checks were carried out before staff were employed to work at the home. The provider had infection control policies and procedures in place which provided staff with guidance on how prevent or minimise the spread of infections. Staff received training relevant to people’s care and support needs. They told us they had regular training which had enabled them to perform their role efficiently.

People’s privacy was respected. Staff received training on equality and diversity, and they supported people according to their diverse needs. People knew how to complain if they needed to. Information was available to people in different formats which met their needs. None of the people living at the home required immediate support with end-of-life care. The service worked with health care professionals in providing end-of-life support to people when required. The provider sought the views of people and their relatives through surveys and meetings. They had acted on some of the suggestions people had made. The registered manager was aware of the legal requirement to display their current CQC rating which we saw was displayed at the home.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

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.

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 key questions it will no longer be in special measures.

The home did not have a registered manager in post. 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. The previous registered manager left employment in April 2017. The current manager had been working at the home for four weeks at the time of this inspection. They demonstrated good knowledge of people’s needs and the needs of the staffing team. They were in the process of applying to the CQC to become the registered manager for the home.

At our last inspection of the home on 2 and 4 August 2016 we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in that there was a lack of activities provided to people that met their needs and preferences. During this inspection we found that people were being provided with a range of activities that met their needs.

There were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Procedures were in place to support people where risks to their health and care needs had been identified. There were safe staff recruitment practices in place. Medicines were managed, administered and stored safely.

The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they received supervision and training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.

People’s privacy was respected. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. People received appropriate end of life care and support when required. Care plans and risk assessments provided guidance for staff on how to support people with their needs. People and their relatives were aware of the home’s complaints procedure and records showed that complaints were responded to appropriately.

There were appropriate arrangements in place for monitoring the quality and safety of the service that people received. The provider took into account the views of people using the service through residents and relatives meetings and satisfaction surveys. The provider carried out unannounced visits to the home to make sure people where receiving appropriate care and support. Staff said they enjoyed working at the home and they received good support from their colleagues and the manager.

Following the inspection we served a warning notice on the provider and registered manager requiring them to comply with the regulations. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 02 and 04 August 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements.

At this inspection we found that the service was now compliant with the regulations that had been previously breached. However there was one new breach identified because of a lack of activities designed to meet people’s needs and preferences.

The home did not have a registered manager in post. 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. The service was in the process of recruiting a permanent manager. At the time of our inspection there was an interim manager in place at the home.

Lauriston House provides residential and nurse care for up to 39 older people most of whom are living with dementia. At the time of our inspection there were 33 people using the service.

Staff training required improvement to ensure that staff were up to date with training courses to meet people’s needs at the home.

Medicines were managed effectively. Regular medicine audits were conducted. Staff had completed medicines training and the home had a clear medicines policy in place which was accessible to staff. The home maintained adequate staffing levels to support people in the home. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. Staff demonstrated an understanding of types of abuse to look out for and knew how to raise safeguarding concerns. Risks to people using the service were assessed reviewed, recorded and managed appropriately.

We saw friendly, caring and supportive interactions between staff and people using the service and staff knew about peoples the needs and preferences. Care plans were person centred and regularly reviewed.

Staff received regular supervisions and these were scheduled across the year. Staff were safely recruited with necessary pre-employment checks carried out.

People’s capacity and rights to make decisions about their care and treatment where appropriate were assessed in line with the Mental Capacity Act 2005 (MCA 2005).

People were provided with sufficient amounts of nutritional food and drink to meet their needs. People were consulted about menu choices and supported to maintain a balanced diet.. People were supported to maintain good health and have access to healthcare services.

Concerns and complaints were investigated and responded to in a timely and appropriate manner. There was evidence of medicines and overall compliance audits and issues identified were actioned promptly. The manager was accessible to people, and staff spoke positively about the support available to them.

Lauriston House provides nursing and personal care for up to 39 people, some of whom have dementia. At the time of this inspection the home was providing nursing care and support to 35 people.

There was a registered manager in post. 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.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s medicines were not managed safely. Appropriate information was not always available for the safe management of medicines and systems were not always in place for the safe recording of people’s medicines. Staff training and competency assessments were not completed for all staff to ensure they had the appropriate skills and knowledge for the safe management of medicines. Medicines errors had not been identified and reported promptly. Systems and processes in place for auditing medicines were not robust in identifying issues to improve on the quality of the service.

CQC is currently considering appropriate regulatory responses to address these breaches in legal requirements. We will report on this at a later date.

Staffing levels were not always appropriate to meet people’s needs in a timely manner. The provider had a complaints policy in place however this had not been followed in all cases to ensure that complaints and concerns raised were address appropriately. The provider had monitoring checks in place but these were not effective in identifying the concerns we found at our inspection. Records were not always kept to demonstrate that the care delivery was in line with the care and treatment planned for.

We found that some other areas required improvement. Each person using the service had a care and treatment plan in place which included guidance on how they should be cared for; however relatives felt more could be done to meet people’s personal care needs. The provider had a part-time activities coordinator in post however people and their relatives told us there was not enough to do at the home. There were systems in place to monitor the safety of the premises and equipment used within the home; however this required improvement because faulty equipment was impacting on the care delivery.

People told us they felt safe living at Lauriston House Nursing Home and we found that the provider had safeguarding adults and whistleblowing policies in place and staff were aware of action to take to protect people in their care. There were safe recruitment protocols in place. Assessments were undertaken to identify the level of risk to people and appropriate actions were in place to prevent or mitigate these risks.