Archived: Loughton Hall

People’s experience of using services and what we found

People were safe. Staff knew what their responsibilities were about keeping people safe from the risk of abuse. There were enough staff and the provider followed safe recruitment practice.

People received the support they needed to stay healthy and to access healthcare services. Each person had an up to date care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Medicines were managed safely, only trained staff gave medicines and their competency to do this was checked regularly.

People continued to receive care from staff who were well supported. Staff received one to one supervision and annual appraisals together with induction and ongoing training. A member of staff told us, “The manager is always approachable,” and, “The owner asks us if we have any problems and we can email them, but I have not needed to.”

Staff understood the importance of promoting people’s choices and provided the support people required as well as promoting and maintaining their independence. This enabled people to achieve positive outcomes and promoted a good quality of life. One person told us, “I have had some health problems and they understand and they get the GP straight away. That’s reassuring, I get the support I need.”

Staff were caring and knew people, their preferences, likes and dislikes well. We received good feedback from people, relatives and healthcare professionals about the quality of care provided by staff. A visiting healthcare professional commented that they had no concerns about the support people received.

People’s rights, dignity and privacy were respected. People continued to be supported to maintain a balanced diet. Staff monitored nutritional needs and supported people to eat safely and at their own pace.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People participated in activities, pursued their interests and maintained relationships with people that mattered to them. One person told us, “I have been down to the local coffee house to have a coffee, you can go out here when you want.”

The service continued to be well led. Effective quality audits remained in place and continuous improvement and learning were embedded in the day to day running of the service. Everyone we spoke with were positive about the registered manager and staff.

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

Rating at last inspection

The last rating for this service was Good (Report published on 02 September 2017).

Why we inspected

The inspection was prompted in part due to concerns received about aspects of care planning, risk assessments and staffing. A decision was made for us to inspect and examine those risks as part of a comprehensive inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe section of this full report.

Follow up

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

Loughton Hall provides care and accommodation for up to 33 older people some of which had dementia. On the day of our inspection there were 31 people using the service.

At our last inspection, audits to assure the quality of service people received was not always carried out. The previous inspection also found that staff and the registered manager had gaps in their knowledge and required additional training. The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed because signed consent to care was not always obtained and applications to authorise deprivations of people’s liberty (DoLS) had not always been made by the registered manager. People’s medicines were not always managed safely and risk assessments did not always accurately assess the level of risk for some people. The registered manager did not have a robust system for raising safeguarding concerns with the local authority. At this inspection we found that improvements had been made.

At our last inspection, we found that staffing levels were too low. At this inspection, we found that staffing levels had been increased, but because of the number of people who needed two people to assist them at night had also increased, that staffing numbers needed to be increased further.

The registered manager was present during 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 in the Health and Social Care Act 2008 and associated regulations about how the service is run.

A programme of induction, training, supervision and appraisals for staff were in place and they had the knowledge and skills to care for people effectively. Specialist training was now being provided to staff.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice.

People's health needs such as their weights and nutritional and hydration needs were now recorded. People could access health services and their involvement was recorded.

Medicines were provided safely and when required. Staff carried out regular audits to ensure processes were reviewed and monitored for effectiveness.

Staff were caring, considerate and treated people with dignity and respect. People had developed caring and meaningful relationships with the staff that supported them.

Feedback was obtained from people who used the service, their families, representatives and staff and this was used to improve the service. People knew how to make a complaint and we saw that complaints had been dealt with appropriately.

Loughton Hall provides care and accommodation for up to 33 older people some of which had dementia. On the day of our inspection there were 31 people using the service.

The registered manager was present during 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 in the Health and Social Care Act 2008 and associated regulations about how the service is run.

We found a number of 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 told us they did not always have their needs and requests responded to promptly.

The service did not always have enough staff on duty to meet the needs of people, because some people’s dementia meant that they showed behaviours that required greater levels of staff input to manage them and the service struggled to recruit and retain some care staff.

Staff received a thorough induction and had access to regular supervision meetings with the manager. Staff and the registered manager had gaps in their knowledge in some areas and some staff required some additional training.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed in regard to obtaining signed consent to care. Applications to authorise deprivations of people’s liberty (DoLS) had been made by the registered manager.

Medicine was not always managed safely and on occasions people received the wrong dose. The registered manager conducted regular audits but these did not include loose medication. The medicine dosage error had not been picked up by staff until we brought this to their attention.

Risks to people’s safety and welfare had not always been appropriately addressed and there was not a robust system for raising safeguarding concerns with the local authority, because the registered manager did not fully understand all the types of incidents or events that should be reported.

Accidents and incidents were appropriately recorded and investigated.

Risk assessments were in place for people who used the service but these did not always accurately assess the level of risk for some people.

Staff were caring and considerate and treated people with dignity and respect. We saw that people had developed caring relationships with the staff that supported them.

A quality assurance process was in place, and people who used the service, family members and staff were consulted about the quality of the service they received. Auditing remained ineffective in highlighting shortfalls in the quality and safety of the service. We noted the provider had recently introduced a new quality assurance system but this had not been fully completed.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service did not provide group activities to regularly access the community.

People’s needs were met by external health professionals who visited the home. The food on offer to people was nutritious.

People who used the service, family members and visitors were made aware of how to make a complaint and there was a complaints policy and procedure in place.

The registered manager sent us a report on 18 December 2013 to tell us the actions that had been taken to address the shortfalls.

On 19 December 2013 we reviewed the information provided and found that the organisation's safeguarding policy contained all the relevant information to promote the safety of people who used the service.

The service took account of people's rights under the Mental Capacity Act 2005 (MCA). We saw from records that, where people had been assessed as lacking mental capacity, a relative or representative was consulted before making any decisions about the care offered to the person.

Care Plans were detailed, personalised and supported by risk assessments and guidance. Information was recorded in a clear format. Staff were able to describe people's needs and demonstrated a good knowledge of their individual preferences.

Although staff had a good awareness of their responsibility to safeguard people from abuse, the provider's policy was not sufficient or accurate. This did not protect people from the risk of abuse.

Staff had regular support and guidance. There was an induction process in place and good opportunities for training. This meant that people were supported by staff that had been given the appropriate information to support them safely.

People told us that they felt well cared for and that they could talk to staff and share their views.

The manager had taken steps to ensure that risks were assessed and monitored and that incidents were learned from. This ensured that people's needs were met safely.

We observed the interactions between people using the service and the staff working at the home and listened to everyday events and activities during the course of the day. People using the service initiated interactions, approached staff with confidence and were responded to in a warm and respectful way.

People who used the service told us they were happy living at the home and they were well looked after. One person told us, 'I'm happy living here.' Another person told us 'Everything is fine here. It's nice and peaceful.' One person said, 'It's a very nice home.'

We saw medication being given to people who use the service. This was undertaken to a good standard and with regard to people's dignity.

We spoke with two visitors to the home during our visit to the service on 11 October 2012 and after that visit, we spoke on the telephone with two other relatives who frequently visited the service. They all told us that they felt that people were provided with good care and had support for social and leisure activities. They said that people were well cared for by adequate numbers of competent staff, were supported to make decisions, were listened to and were safe living in Loughton Hall.