Archived: Lancam Nursing Home

We carried out an unannounced comprehensive inspection of this service on 13 and 17 October 2014. Breaches of legal requirements were found. As a result, we undertook a focused inspection on 07 January 2015 to follow up on whether action had been taken to deal with the most significant breaches.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 13 and 17 October 2014:

This unannounced inspection took place on 13 and 17 October 2014. Lancam Nursing Home provides accommodation and nursing care for up to 16 people. Its services focus mainly on caring for adults of all ages including those with physical disabilities and people with dementia. There were 12 people living in the service at the time of our inspection.

This inspection took place in response to concerns raised by a range of health and social care professionals about the standard of care and treatment provided to people at the service. The local authority informed us during the inspection visits that they had made the decision to restrict further admissions of people into the service.

We also took into account the service’s inspection history, which included three inspections in the previous 12 months. We took enforcement action against the registered people as a result of the first of those inspections in November 2013. This took the form of three warning notices, in respect of concerns we found for the care and welfare of people, the management of medicines, and consent to care and treatment. These notices had been addressed at the subsequent inspection.

At this inspection, we found 11 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

There was a registered manager in post at the time of our visit. 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.

Six people told us they were happy with the overall services provided. Comments included, “I’m very happy, I like it here” and “It’s a home from home for me.” However, two people were not happy with the overall service, and a relative told us, “It’s a very ordinary care home.” Despite the positive comments received, we found significant failing in the quality of care and treatment being provided.

We found that arrangements to keep people safe from the risk of abuse were not effective. Some staff had not been trained on abuse awareness, and when someone using the service experienced excessive control or restraint, it was not recognised as abuse. Plans to minimise the risk of abuse were not followed through, and the provider did not respond appropriately to allegations of abuse in how they worked with the local authority after safeguarding alerts had been raised.

We also found safety concerns in respect of equipment maintenance, recruitment practices, and the management of some medicines. People’s individual risk assessments were not always kept up-to-date, and we were not assured that enough staff worked at the service at all times. We found that staff routines for providing medicines and breakfasts to people took priority over allowing people to sleep until they were ready to wake.

There had been no applications for Deprivation of Liberty Safeguards (DoLS) for people using the service at the time of our visits. This was despite the manager attending recent training, and our identification of people at the service who may be unlawfully deprived of their liberty.

The service had a care assessment and planning process that attempted to recognise people’s individual needs and preferences. However, we found that care plans did not always adequately guide staff so that they could meet people’s needs effectively. For example, two people’s plans did not include a section on pain management despite identified needs in this area. Care plans were not always kept under review so that they reflected people’s current needs.

We found that most people’s healthcare and nutritional needs were attended to. However, the service had not identified and taken action to address the significant weight loss experienced by one person.

There was variation in how respectfully people were treated, despite some positive and friendly staff interactions. Some aspects of the environment also indicated a lack of care towards people. We noted that some staff could not always communicate effectively with people due to their limited English language skills, which meant that people were not always understood and responded to.

The service had a complaints procedure that was accessed by people at the service. However, we were not assured of the effectiveness of the procedure at resolving people’s complaints to their satisfaction.

Whilst there were systems of providing staff with training and supervision, these were not adequate to equip them to meet people’s needs consistently.

Records were not always accurate and well-maintained. We found contradictions in the information recorded about people, and records were not always up-to-date. Records about the management of the service were not always available to us on request, which did not assure us that they were maintained. This did not protect people from the risk of unsafe or inappropriate care and treatment.

The provider’s system for assessing and monitoring the quality of services was not effective. This was because, despite a recent service audit, the provider’s system had not identified the concerns that we found, and records of risk management decisions were not always available.

Focused Inspection of 07 January 2015:

We undertook this unannounced focused inspection to check if the provider had addressed the action plans they sent us following the last inspection, that the points we made within our enforcement warning notices arising from the previous inspection had been addressed, and to confirm that legal requirements in respect of the breaches of direct impact on people had been met. We inspected the service against four of the five questions we ask about services: Is the service safe, effective, caring and well-led?

Whilst we found evidence to demonstrate that a few aspects of the provider’s action plans had been followed, we also found that a number of aspects of the action plans had not been addressed. We found that a number of breaches of legal requirements continued to occur, including breaches in relation to our warning notices. This put people using the service at significant risk of receiving inappropriate or unsafe care and treatment.

The provider’s system for assessing and monitoring the quality of services remained ineffective. There had been no further documented service audits despite the concerns arising at our previous inspection. There continued to be no documented system of checking that people’s call-bells worked. We found that in one person’s room, there was no call bell for them to use despite it previously being available and that they could not otherwise easily summon staff support due to the use of bed-rails on their bed. Despite there being records of occasional incidents of behaviours by people that challenged the service, there continued to be no record of auditing incidents so that learning could take place with the aim of minimising the risk of harm to people using the service and staff.

There had been an audit of staff recruitment checks, however, documented action taken to address shortfalls could not be given to us on request. This meant that recruitment checks were still not effective at demonstrating that all current staff members were of good character.

Overall, we found that the majority of our concerns highlighted in the warning notice we served after the last inspection, in respect of assessing and monitoring the quality of services, had not been addressed. This continued inability to address the shortfalls identified and breaches of the regulations meant that the provider failed to protect people using the service and staff against the risks of inappropriate or unsafe care and treatment.

We found that the provider’s arrangements to keep people safe from the risk of abuse had improved but these arrangements were not comprehensive. We found no instances of anyone using the service experiencing excessive control or restraint during personal care, and staff showed some awareness of listening to people’s choices. However, we found that some staff still had no documented training on abuse awareness. We found that on some night shifts, none of the staff working had had this training, which put people using the service at unnecessary risk of abuse as it could be unrecognised.

We remained concerned that the service did not have enough staff working at all times. For example, none of three staff rostered to work the morning shift on the day of our visit arrived at the start of their shift. The two night staff continued working until cover had been arranged, two hours later. We found that cover arrangements could have been made sooner, and there was a consequent delay in supporting people to get up and have breakfast. We additionally found occasions in December 2014 when the provider’s planned staffing levels were not met, and occasions when the levels were only met because staff who lacked sufficient skills and experience were used. This failed to safeguard the health, safety and welfare of people using the service.

We found that the care provided to four people was not always meeting their needs and ensuring their health, safety and welfare. For example, one person was supported to eat lunch in a way that did not follow healthcare professional guidance for them as the support failed to ensure the person’s dignity, safety and welfare and put them at risk of choking. Another person had a health issue which we found the service was not treating appropriately.

We still saw some ways in which people were not treated respectfully. Doors were not always knocked on before gaining permission for entry, and one aspect of the environment, the broken blinds in one person’s bedroom, continued to indicate a lack of care towards them.

Where applicable, people’s individual mental capacity assessments for specific care and treatment decisions, such as for the use of bed-rails, had still not been reviewed to act in accordance with the Mental Capacity Act 2005.

Staff had received some training and supervision since our last inspection. However, the system of providing staff with supervision was still not adequate to equip them to meet people’s needs consistently. For example, there had been only one documented supervision of any nursing staff since our last inspection.

We also identified a new breach of regulations, for the safety and suitability of the premises. This was because one person’s room had a strong smell of sewage but no action had been taken to permanently rectify this or move the person to a vacant room.

We found that some improvements had been made. Medicines cupboards were kept locked and there were records of audit of medicines to help minimise the risk of unsafe administration. There had now been applications for Deprivation of Liberty Safeguards (DoLS) for people using the service where appropriate, although none had been authorised at the time of our visit.

The registered manager continued to be in post at the time of our visit. Whilst we had been sent plans on changes to the management arrangements at the service, we found that current management arrangements were inadequate at consistently protecting people using the service against the risks of inappropriate or unsafe care and treatment.

We found overall that people using the service were at significant risk of receiving inappropriate or unsafe care and treatment. We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 amongst those regulations that we checked on. As a result of this inspection, we served notices proposing to cancel the registration of the provider and manager. You can see what action we told the provider to take at the back of the full version of this report.