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Archived: Lower Farm Care Home with Nursing Inadequate

Reports


Inspection carried out on 4 July 2016

During a routine inspection

Lower Farm Care Home with Nursing provides accommodation and care for a maximum of 46 people with varying healthcare and support needs. At the time of our inspection there were 39 people living in the home. People were accommodated over two floors.

At the time of the inspection there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the previous inspection in October 2015 we identified two breaches of the regulations. Improvements were needed to the quality assurance system and the care plans. The registered manager provided an action plan stating that they would take the action necessary to become compliant with the regulations by 29 February 2016. However, the system to monitor the quality of the care being provided and to drive improvement was still not effective and this impacted on all areas of the service. Work had commenced to improve the care plans so that staff had the information they required to meet people’s needs.

Risks had not always been managed to keep people as safe as possible. The necessary fire procedures were not in place to keep people safe in the event of a fire.

We could not be confident that people received their medication as the prescriber had intended. Staff competence to administer medication had not been undertaken. Current legislation was not being followed regarding the storage and recording of administration of medication. Medication audits were not being completed regularly to identify any areas for improvement.

Staff had been employed without the necessary checks being completed. Staff had not all completed the necessary training or competency assessments. This meant that people could be cared for by staff who did not have the right skills, knowledge or competency.

Staff were not always aware of the procedure to follow if they thought someone had been harmed in any way. This meant that concerns may not be investigated appropriately and the appropriate action may not be taken. There was ineffective monitoring of care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was not acting in accordance with the requirements of the MCA including the DoLS. The required assessments and decisions had not been completed to ensure that people continued to be able to make as many decisions as possible. Some people may have been unlawfully deprived of their liberty.

Adequate food and drink was provided. People had access to the relevant healthcare professionals.

There were not enough staff to ensure that people always received the care and support that they needed and in a timely manner.

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

Inspection carried out on 5 and 6 October 2015

During a routine inspection

This inspection was undertaken by two inspectors on 5 and 6 October 2015 and was unannounced.

Lower Farm Care Home with Nursing provides accommodation and care for a maximum of 46 people with varying healthcare and support needs. At the time of our inspection there were 39 people living in the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The registered manager had returned to their post after being away for several months.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The deputy manager and nurses were knowledgeable about when a request for a DoLS would be required following changes in case law. Not all staff had received training regarding this subject and their understanding was variable. The registered manager had a good understanding and had appropriately made applications for DoLS.

Appropriate recruitment processes were in place, although sufficient improvements to the staffing situation had not taken place. People had to wait too long for their call bells to be answered and to receive assistance with their meals and personal care. The use of agency staff remained high as there were ongoing difficulties in recruiting nurses.

The majority of staff knew the needs of individual people well and how to meet their needs. People felt that the staff were kind and caring. Relatives were also made to feel welcome by the staff. Staff did not have time to support people with their hobbies and interests. Referrals were made appropriately to healthcare professionals as people required them. People’s medicines were managed safely.

The standard of record keeping needed to improve to ensure that staff had clear, consistent guidance about how to meet people’s needs.

The processes for assessing the quality of the care provided had improved but further improvements were needed. There was a lack of clear action taking place after issues were identified during audits.

This inspection identified two breaches of the Health and Social Care Act 2008, Regulated Activities (2014)

You can see what action we have told the provider to take at the back of the full report.

Inspection carried out on 03 March 2015

During a routine inspection

This inspection was undertaken by three inspectors on 3 March 2015 and was unannounced.

Lower Farm Care Home with Nursing provides accommodation and nursing care for a maximum of 46 people with varying healthcare and support needs. At the time of our inspection there were 37 people living in the home.

The home had a registered manager in post, although CQC had been notified of their absence, for which the deputy manager was covering. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The deputy manager and nurses were knowledgeable about when a request for a DoLS would be required following changes in case law.

Staff had a good understanding with regard to identifying abuse and knew the reporting procedure, if they suspected people were experiencing abuse. Staff had also received appropriate training in respect of protecting people.

Everyone living in the home confirmed that they felt safe and relatives also confirmed that they had no concerns about their family members’ safety.

Appropriate police checks were undertaken and suitable references were obtained to ensure new staff were suitable to work in the home.

There were insufficient qualified nurses on duty and staffing levels were not matched to the demand for the care and support of the highly dependent people living in the home. Ideas for better deployment of staff had not been considered by the provider. Care staff did not receive regular supervisions and appraisals.

Identified risks to people’s safety and welfare were not being managed appropriately because, where risks had been identified, some reviews of those risks were out of date.

The nurses were proficient with regard to the safe handling and administration of medication.

People’s individual dietary needs were catered for in line with their care plans and people were supported to have sufficient quantities to eat and drink.

People had access to external healthcare professionals, as needed. However, some people’s care and review records were not being kept up to date. People’s care plans were not always effective or reflective of people’s current needs and there was a lack of clear and accessible guidance regarding people’s needs for new, temporary or agency staff.

The care staff were kind, skilled and supported people in a courteous manner, Staff also consistently respected people’s dignity. However, they did not have the time to offer individual or personalised care, due to the high level of people’s needs.

People living in the home and their relatives were included in the ‘pre-admission’ assessment and care planning process. However, people’s care plans were not user friendly and not truly ‘person centred’.

People living in the home and their relatives knew how to make a complaint and there was information displayed around the home telling people how and who to complain to. However, this required updating. Some staff felt unable to question practice and contribute ideas for improvement.

There was a lack of clear and visible leadership, particularly whilst the manager was absent from the home.

Although people’s concerns were dealt with, the systems used to monitor the quality of the service did not pick up concerns on a regular basis.

CQC had not been officially notified of incidents within the home that were required to be reported.

We found that the provider was in breach of six regulations.

You can see the action we have told the provider to take at the back of the full version of the report.

Inspection carried out on 5 November 2013

During a routine inspection

People's plans of care that we reviewed evidenced to us that people had signed to confirm that they had been made aware of their care and support needs. We saw that reviews of people's care and support needs had been completed on a regular basis. We also saw that changes had been made as a result of these reviews. One person said, “The staff look after me so well. Staff respond quickly if I call them using my call bell.”

Our tour of the home demonstrated to us that the cleaning regime ensured that hygiene and infection prevention and control was completed to a good standard. We saw that the home followed Department of Health (DH) guidance for the safe and effective management and prevention of healthcare associated infections.

We found that the provider only employed staff after two suitable and acceptable references had been obtained. We saw that staff's previous employment history had been explored and a suitable explanation had been provided for any gaps that had been identified. People were assured that only staff who had been deemed fit and healthy and able to meet their care needs were employed at the service.

People we spoke with told us, "I know who to complain to if ever the need arose." The same people told us that they had never had cause to complain. Our review of the provider's complaint policy showed us that there were effective support systems in pace to support people if ever they needed to complain.

Inspection carried out on 3 December 2012

During a routine inspection

People told us that they were able to make choices about what they liked to be called, what time they wanted to get up and go to bed and where support was required. People were able to access health care professionals of their choice and at a time that they wanted and what support they may need to do this.

People's care plans were detailed and comprehensive and contained information that would allow any member of staff to care for that person in a way the person liked.

The provider had training, policies and procedures in place which ensured that vulnerable adults were protected from abuse. All of the staff who we spoke with were able to tell us where and how abuse should be reported.

We saw from the records that we reviewed that staff were supported to obtain further professional qualifications in health care. Staff also told us that the provider's training and induction processes were comprehensive.

The provider kept records for the appropriate amount of time, held them in a secure place and retained them as required by relevant legislation.

Inspection carried out on 29 February 2012

During a routine inspection

On the day of our visit on 29 February 2012 we were told that staff were very good at their job and that they knew how to help in a way the person wanted. At this visit staff were providing support with due consideration for dignity and choice and we were told that staff did not rush people.

People were happy with the care they received and said they liked the meals, one person told us they had more than enough to eat. We were told that people could always have a laugh with the staff group.

People confirmed that staff were available when needed and one person explained that a new member of staff had been unsure when assisting them but had taken notice when told what to do.