Background to this inspection
Updated
9 April 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This unannounced inspection took place on 19 February 2015 and was in response to concerns raised by the local authority and Shropshire Clinical Commissioning Group. The inspection team comprised of one inspector, one specialist advisor and an expert by experience who had expertise in dementia care. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection, we reviewed the information we held about the home and looked at the notifications they had sent us. A notification is information about important events which the provider is required to send us by law.
During the inspection, we spoke with six people who lived at the home and five relatives. We spoke with seven staff, the registered manager and the provider.
We looked at four records about people’s care, complaint files, falls and incidents reports, fire inspection report, food hygiene inspection and electrical checks.
Updated
9 April 2015
The inspection was unannounced and took place on 19 February 2015.
The Legrand Nursing Home is registered to provide accommodation and personal care for adults who require nursing care and who may have a dementia related illness for a maximum of 38 people. There were 35 people living at home on the day 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 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 that they felt safe and free from the potential risk of abuse. Staff told us about how they kept people safe. During our inspection we observed that staff were available to provide advice or guidance that reduced people’s risks.
People received their medicines as prescribed and at the correct time. However, we found systems and processes needed to be improved. Staff had not monitored the amount of medicines used where people required medicines ‘as needed’. The provider would then be able to identify where a person required a review of their medicines.
People and relatives told us there were enough staff to support people at the home. Staff at the home felt there were enough staff to meet the needs of people living at the home. However, the provider agreed that reviewing people’s health and care needs would make better use of their current staffing group.
People told us they liked the staff and felt they knew how to look after them. Staff were provided with training which they felt reflected the needs of people who lived at the home. Nursing staff were limited in their clinical supervision and support, but a nurse had been recruited to support them.
Assessments of people’s capacity to consent and records of decisions had not been completed in their best interests. The provider could not show how people gave their consent to care and treatment or how they made decisions in the person’s best interests. Therefore, people had decisions made on their behalf without the relevant people being consulted.
People were supported to eat and drink enough to keep them healthy. We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.
People told us and we saw that their privacy and dignity were respected and staff were kind to them. However, on occasions we saw that people had not always received supported to have their choices and decisions respected.
People had not always been involved in the planning of their care due to their capacity to make decisions. However, some relatives felt they were involved in their family members care and were asked for their opinions and input.
People had not always been supported to maintain their hobbies and interests or live in an environment that supported their needs. Relatives we spoke with told us they were not aware of the provider’s complaints policy, but were confident to approach the manager if they were not happy with their care. The provider had not reviewed or responded to all concerns raised. They had not used the information to learn and improve the service.
The provider and registered manager had not made regular checks to monitor the quality of the care that people received and look at where improvements may be needed. The management team had not kept their knowledge current. The management team were approachable and visible within the home which people and relatives liked.
You can see what action we told the provider to take at the back of the full version of this report.