Lister House Nursing Home

We found the following examples of good practice.

A robust screening process was in place for all visitors. This included a COVID-19 questionnaire, temperature checks and proof of a negative lateral flow devise test. Checks were also made of visiting professionals vaccination status. There was clear signage at the entrance to the home and access to personal protective equipment (PPE) and hand sanitiser.

The home was clean and enhanced cleaning schedules were maintained. Communal areas were well ventilated and had been adapted to promote social distancing. This reduced the risk of cross infection.

Safe visiting was taking place with consideration of individual’s needs and preferences. The home had also created a visitor’s pod in the grounds.

The provider had policies and procedures in place to ensure infection prevention and control measures were followed. Staff had recently completed refresher training which included observations of doffing and donning PPE and effective hand washing. The registered manager promoted a culture of ongoing learning and improvement and worked closely with the local authority and clinical commissioning group.

Lister House Nursing Home is a 31 bedded service providing nursing or personal care to older people, people living with dementia and people with physical disabilities. At the time of our visit there were 26 people using the service.

People’s experience of using this service:

We found no breaches of regulations at the inspection in January 2018 but identified some improvements needed to be made in relation to medicines management and quality assurance systems needed to be embedded and tested over time. On this inspection we found improvements had been made.

Staff were caring. People we spoke with were complimentary about the service and said they would recommend the home. There was a culture within the service of treating people with dignity, respect and compassion.

Activities were on offer to keep people occupied both on a group and individual basis.

Medicines were being administered safely and people’s dietary and healthcare needs were met.

Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training which was good and relevant to their role. Staff were supported by the manager and were receiving formal supervision where they could discuss their on-going development needs.

Care plans were up to date and detailed the care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to the safeguarding team when this had been necessary.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The manager, who was in the early stages of registering with CQC, provided staff with leadership and was described as being very approachable. Audits and checks were carried out and used to drive continuous improvements to the service people received.

People’s feedback was used to make changes to the service.

Quality audits had been maintained, but we identified some additional areas which needed to be included as part of these audits.

More information in Detailed Findings below:

Rating at last inspection:

Requires improvement (report published 9 February 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection and the service has met the characteristics of Good in four areas and requires Improvement in Well- Led.

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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The home 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.

Lister House Nursing Home is a 31 bed nursing home in the Heaton area of Bradford, providing nursing and personal care to older adults with a range of support and care needs. At the time of the inspection there were 21 people living at the home. The home provided accommodation over two floors with lift access.

The provider had safeguarding procedures and staff were aware of the procedures. Staff had received training and people were protected from abuse. Potential risks to people's health had been identified and assessed. The provider had effective recruitment processes in place and there was sufficient staff to support people safely. People received the medicines they needed and as prescribed although we found some minor recording errors on medication administration records (MAR). The environment was well maintained, clean and free from odour.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people's safety. Staff had the training and support they needed to care for people using the service. Staff understood their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff would gain people's consent before they provided any care or support to them. The meals provided were well presented, nutritious, appetising and respectful of people’s wishes, needs and preferences.

People were treated with kindness and supported by caring and respectful staff who knew them well. Their privacy and dignity was upheld and they were supported to maintain their independence. People received personalised care and had opportunities to take part in a variety of suitable activities.

The provider assessed people's care and support needs and developed person-centred, detailed plans of care for staff to follow. Although care plans were regularly reviewed, there was a lack of evidence people and/or their relatives were involved in regular care plan review. The registered manager said they were working with the nursing staff to better evidence this in the future. A system was in place to log, investigate and respond to complaints. Information on how to complain was on display throughout the premises complaint and said they would feel comfortable doing so. Activities were available on an individual and group basis to help meet people’s social needs. People spoke positively about the activities provided by the home and said there was always plenty to do.

There was an open and transparent culture within the service. Staff told us that they felt supported by the registered manager and they would deal with any concerns they may have. The provider had systems in place to monitor the quality of the service. The manager completed several audits such as medication, infection control, staffing, building and premises, and health and safety. The registered provider needs to ensure audits are frequent and robust so that improvements to the service continue. Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance.

Lister House Nursing Home provides accommodation and nursing care for up to 31 people. On the days we inspected there were 31 people in the home, one of whom was receiving respite care.

There was a registered manager in post and they were available on the second day of the 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe and we saw evidence of appropriate interventions when safeguarding concerns were raised. However, we found risks were poorly managed with a lack of suitable assessments, unclear and contradictory instruction for staff and limited personalised assessments. This was especially in regards to moving and handling as we observed numerous poor procedures with staff lacking confidence in their knowledge and judgements. Specific equipment had not been provided for individuals where required.

Staffing levels were not always appropriate for people’s level of need. Some people required one to one support which staff were not always able to give and many people remained in their rooms. It was not clear if this was their choice as there were no records to indicate this.

Medication was administered, stored and recorded appropriately.

Staff’s knowledge of person-centred care appeared lacking and they did not appreciate the significance of a Deprivation of Liberty Safeguard (DoLS). Mental capacity assessments were in place for most people unable to make decisions but these were not evident for every decision. 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; the policies and systems in the service did not always support this practice.

People were supported to eat and drink and we saw appropriate records kept of their intake. However, due to the staff pressures and the number of people requiring assistance people had to wait for some time before receiving their meals.

External health and social care support was accessed as needed.

We observed staff interactions to be mixed. Some staff were very caring and attentive but others displayed brusqueness and irritation at times. We saw some people were ignored and staff did not actively engage with people.

Privacy and dignity was not always respected as some people had to wait for support to access the toilet and their needs were not kept confidential as staff shouted to each other requesting assistance.

Care records were mostly person-centred but did not always reflect people’s current needs and were complex to navigate. One care worker admitted to not reading them which meant care tasks could be missed.

Activities were arranged but not everyone engaged in them and there was little evidence of one-to-one interaction, especially for people in their rooms.

Complaints were handled promptly and effectively with apologies given where required.

Although some people expressed their satisfaction at living in the home, we found the atmosphere strained and tense at times, as staff struggled to meet people’s needs. There was limited evidence of senior leadership.

There was limited evidence of quality assurance which focused on individual concerns rather than overall practice issues. We found breaches of regulations in relation to dignity and respect, safe care and treatment, good governance and staffing. 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 key questions it will no longer be in special measures.

This was an unannounced inspection which took place on 30 and 31 March 2016. On the date of the inspection there were 29 people living in the home. As part of this inspection we checked whether action had been taken to address breaches in regulation we identified during the last inspection on 7 and 8 September 2015.

A registered manager was in place. 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 the last inspection in September 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 regulations in relation to staffing, management of risks and record keeping.

At this inspection we found improvements had been made to staffing levels, to help ensure safe care and treatment. Staff told us the increase had been positive and made for a more pleasant experience within the home.

We found improvements had been made to care records with better populated care plans and more robust evidence care was delivered in line with plans of care. However further improvements were required to documentation surrounding medicine management. We identified this was of minor risk and the registered manager assured us it would be addressed.

Following the last inspection, the home had utilised assistive technology to reduce the frequency and impact of falls within the home. We saw evidence this was being utilised and had been effective in reducing the frequency of falls. However documentation following incidents was not always appropriately completed and did not demonstrate a fully robust falls prevention strategy.

Medicines were safely managed. People received their medicines in a timely manner. Medicines were stored appropriately within the home.

People told us they felt safe within the home. Staff demonstrated they understood safeguarding procedures. We saw evidence these had been utilised to help keep people safe.

Safe recruitment procedures were in place to ensure staff were of suitable character to care for vulnerable people.

People had access to a good choice of food. Staff understood how to meet people’s individual nutritional needs .

The service was acting with the legal frameworks of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People and relatives generally told us staff were kind and caring and treated them well. We observed care and support and saw staff knew people well and interacted with them in a positive manner.

People’s individual needs were assessed and clear plans of place put in place for staff to follow. We saw examples of staff following plans of care to help ensure appropriate care.

Systems were in place to assess, monitor and improve the service. We saw the manager undertook frequent audits and checks of the computerised care system and took action where records provided insufficient evidence that people were receiving the required care and support.

Mechanisms were in place to listen to people’s views and use these views to make changes to care and support provision.

We found a breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. You can see what action we asked the provider to take at the back of this report.

We spoke with a visiting health professional who told us 'It is a very good home, I would recommend it for nursing care. People come here with pressure sores and they always improve, the pressure area care is very good. The nurses are clinically very good, staff are sensible and refer people appropriately. I have never seen anything in the home which makes me uncomfortable.'

We found interactions between staff and people who used the service were generally positive and staff treated people with dignity and respect.

We found care records were adequate. This supported the provider and staff to deliver safe and appropriate care to people who used the service.

We also found that although the care plans were detailed, the care people who used the service received did not always correspond with the care plan.

We also found the provider lacking in infection control areas particularly in the laundry and general cleanliness.

Staffing was found to be at an appropriate level.

During our inspection we spoke with three people using the service and they told us they were very happy with the care they received at Lister House. One person using the service told us "I would give them 100% for cleanliness, 100% for the food and 100% for the care." and another said "They really look after me here."

Appropriate arrangements were in place in relation to obtaining medicine, recording of medicine and medicines were prescribed and given to people appropriately. There were enough qualified, skilled and experienced staff to meet people's needs and there was an effective complaints system available. Comments and complaints people made were responded to appropriately.