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The provider of this service changed - see old profile

We are carrying out checks at Lound Hall using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 May 2017

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.

Before the inspection, feedback we had received from people using the service, their relatives, advocates and professionals, which raised concerns over the leadership and governance of the service. They told us the systems in place to monitor the quality of the service people received were not effective enough to independently identify and address shortfalls. Where people told us they felt the service had not effectively listened, and responded to their concerns in a timely manner, it had impacted on their confidence in the ability of the management to address them. This had resulted in the service being required to put in ‘action’ plans to reduce risk to people living in the service, and being given support to improve in areas including care planning and infection control. This had led to improvements in these areas. Work was being undertaken by the provider to gain people’s confidence back. The provider told us they were in the process of recruiting to a new clinical lead to oversee the quality of the nursing being provided. Relatives spoke about feeling more reassured by a more visible presence of the provider’s representative. However, further work was still needed to instil confidence in the daily management of the service, as part of driving continuous improvement.

People told us they felt safe living in Lound Hall, and spoke about the improvements they had seen in the standard of cleanliness within the service.

We found improvements were needed in the management of medicines and staffing levels. This is to ensure people received their medicines as prescribed, and that there were enough staff to monitor, support and respond to people’s individual needs.

Staff received training in core skills to support them providing a safe service. However some infection control and health and safety training needed to be embedded in practice. We found shortfalls in staff’s knowledge of supporting people living with dementia; we have made recommendations around training to support staff in gaining these skills.

People told us they did not have enough access to stimulating activities, linked to their individual interests and needs, to occupy their time. Where people were spending long periods of time without quality interaction, this put people at risk of becoming socially isolated.

People were not always supported to have maximum choice and control of their lives and to ensure staff supported them in the least restrictive way possible; the policies and systems in the service did not always support this practice. There was a lack of forums to support people in voicing their views and experiences, and be influential in driving improvements.

Improvements were required to ensure all staff’s interactions with people were caring and empowering so all people feel valued. This included looking how routines can be changed to support the person, not the other way round; more supportive of person centred care. Systems had been put in place to check the contents of people’s care plans were accurate and reflected their needs and preferences. This needed to be developed further, to ensure the person and all staff involved in their care are aware of the contents, so any missing information / inaccuracies are quickly identified.

People complimented the quality of the food. However, we found people were not always supported to ensure that they had enough food and fluid to support their health needs. Records were incomplete and not assessed to make sure that people had enough to eat and drink. Where people of low weight turned down food, or had a low appetite, this was not always being effectively managed. This included offering nutritious, high caloric snacks in-between meals, or as an alternative where people had declined. This put people at risk of losing, or not maintaining their weight gain. We made a recommendation to support staff in improving people’s meal time experiences, especially for people living with dementia.

We found multiple breaches 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 this report

Inspection areas

Safe

Requires improvement

Updated 6 May 2017

The service was not consistently safe.

Staffing levels were not always sufficient to meet people’s needs.

People were not always receiving their medicines as prescribed.

Improvements were needed to ensure staff were consistently monitoring for any potential risks during care delivery which could impact on people’s welfare.

Effective

Requires improvement

Updated 6 May 2017

The service was not consistently effective

Staff received training but they did not always put into practice what they had learnt. We found shortfalls in staff’s knowledge of supporting people living with dementia.

Not all people were being effectively monitored and supported by staff to ensure they were given enough to eat and drink to support their health and welfare.

People were supported to maintain good health and had access to appropriate services which ensured they received on-going healthcare support.

Caring

Requires improvement

Updated 6 May 2017

The service was not consistently caring.

Improvements were needed to ensure all staff’s interactions were caring and compassionate, so all people felt listened to and valued.

People were treated with respect and their privacy, independence and dignity was promoted and respected.

Responsive

Requires improvement

Updated 6 May 2017

The service was not consistently responsive.

Improvements were needed to ensure all people had access to stimulating occupation / activities, linked to latest research, which met their individual needs.

Concerns and complaints were not always acted on and responded to in a timely manner and used to learn from, as part of driving continual improvement within the service.

Well-led

Requires improvement

Updated 6 May 2017

The service was not consistently well led.

Improvements were needed in the quality monitoring systems to ensure they are robust enough to independently identify and address shortfalls, and embedded to drive continual improvements.

Improvements were needed in the leadership of the service. This is to ensure they have good oversight of the service to be able to address concerns before they escalate / impact on the quality of people’s care.