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Archived: Lelant Nursing Home Outstanding

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Reports


Inspection carried out on 28 November 2016

During a routine inspection

This inspection took place on 28 November 2016 and was unannounced. Lelant Nursing Home is registered to provide nursing and personal care for forty older people. At the time of the inspection, there were 22 people living at the service.

There was a registered manager in post. 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.

This service is owned by a company that is in administration. The service is therefore under the ultimate management of the Administrators, who are licensed insolvency practitioners (IP) and were appointed by the company’s director. More information about this can be found on the Companies House website. The Administrators have utilised the services of specialist operators to assist in their management of the care home, and have regularly updated people, their relatives and the Care Quality Commission about this process.

Without exception, people and their relatives told us the service was very caring. One relative said; “They go above and beyond their duties all the time”. Staff were extremely caring and treated people with kindness, compassion and affection. The service was committed to delivering outstanding end of life care, in which people’s end of life wishes were respected and where people experienced a pain free, dignified death.

There was a strong focus on delivering innovative, personalised activities for people. The registered manager was committed to forging links with the local community and ensuring that people remained visible and were active inside and outside of the service. People had taken part in a highly creative and original piece of work which helped them to share their life histories with the wider community and to learn about other generations and their experiences. There was a focus on inclusivity and empowerment.

Relatives were made to feel important and were always warmly welcomed at the service. Staff and managers were considerate towards them and ensured that they felt looked after and valued. They were treated with kindness and respect and were enabled to spend quality time with their loved ones. Relatives were kept informed of any changes and were able to have an open and honest dialogue with staff and managers. Relatives felt able to approach the managers with any issues and their feedback was sought and was highly valued.

The service was extremely well led. The registered manager valued their staff, paid attention to detail and led by example. Lelant had recently been presented with “The dignity and respect care home of the year” award, in recognition of its commitment to providing an outstanding service. There was a clear focus on sharing best practice and the management team attended a number of forums in order to learn from others. The registered manager strived towards excellence and was committed to continuous improvement and development. All of the staff said they felt valued and supported by their colleagues and the managers. Other agencies were very positive about the leadership of the service and said the staff team listened to and embraced ideas.

Systems were in place to deal promptly and appropriately to any complaints or concerns. The registered manager promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. This reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment. Feedback on the service was sought in creative ways to ensure that everybody had their voices heard and that there was a focus on continuous learning.

The provider had a robust quality assurance system in place and gathered information about the quality of th

Inspection carried out on 13 August 2014

During a routine inspection

The inspection was carried out by an adult social care inspector. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well led?

As part of the inspection we spoke with seven people who lived at the home, a visiting relative, nine staff, the clinical lead and the registered manager. We also met the local Member of Parliament who visited the home on the day of the inspection.

We reviewed policies and records relating to the management of the home which included, eight care plans, daily care records and nine staff files. There were 28 people living at the home when we visited. Two people were in hospital.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were treated with respect and dignity by the staff. Everyone we spoke with commented on their safety at the home and told us they were reassured that they would be kept safe while living here.

There were systems, policies and procedures in place which ensured risks to people were reduced and that the service was safe. Risk assessments had been undertaken and helped ensure people received care safely. People were given choice and remained in control of decisions about their care and daily lives.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We noted that the home followed procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and took advice and guidance from medical professionals.

There was a stable staff team with the appropriate skills to support people who lived at the home.

Is the service effective?

People’s health and care needs were assessed in consultation with them prior to their arrival at the home. Everyone received a visit from a senior member of staff before they moved in and people were encouraged to be involved as much as they wished in all aspects of the home.

Care plans which identified people’s needs and how those needs should be met were developed alongside the person and/or their family member. We saw that staff were trained to support people’s health needs which ensured appropriate care and support was provided. Staff were encouraged to recognise changes in people’s health, mood, demeanour and levels of social interaction so that any concerns could be addressed promptly.

One person we spoke with said, “You would have to go a long way to find a better home. They look after us really well”

Is the service caring?

People living at the home appeared happy and relaxed. There was lots of laughter and interactions during a quiz game we observed which involved several people and staff on the day of the inspection.

People told us they were happy with the care they received. Two people said, “The care is lovely, and you can talk to anyone at any time if you have a problem” and “The staff are very caring and kind”.

Throughout the visit we saw that people were treated in a caring and compassionate manner, with dignity and respect.

We found that care and treatment provided was person centred and every consideration was taken to ensure people were involved in decisions about their care and daily lives. We saw staff were engaged in cheerful conversations with people and treated people as individuals, involving them in undertaking tasks in line with people’s wishes.

Is the service responsive?

There was an extensive activities programme in place which was developed in line with people’s social interests and backgrounds. We saw that staff had time to sit and chat with people in the communal areas and in their rooms.

Calls bells were installed throughout the home and were placed in easy reach so that at all times people's calls for assistance could be responded to promptly.

The service was particularly responsive to people’s social needs. We found that staff took time to get to know people’s individual preferences, needs and interests well. For example where a person wanted their cats to stay with them at the home, steps were taken to make arrangements for the person to be accommodated in a ground floor room with open access to a patio with a cat flap installed.

A relative we spoke with said, “This was the only place who said we could come and visit the home at any time we wanted. We didn’t have to make an appointment first”.

We found specific arrangements were made for people to retain, re-establish and maintain their contacts and relationships with friends and others people who lived in the local community.

Is the service well led?

There was a clear management structure in place and staff we spoke with were clear about their role and responsibilities. Staff told us they were well supported and if needed extra help it was “always readily available” from senior staff.

Feedback was encouraged from any one visiting the home and through more formal quality questionnaires.

Where unexpected circumstances or events occurred within the home, for example, a failure of the hot water system, the registered manager acted promptly to address and resolve the situation which ensured people’s comfort and safety.

Records we saw were detailed, clearly written, were up to date and showed us that identified shortfalls were addressed promptly.

We found there was a strong commitment within the staff team to the continuous improvement of the service and to the well-being of people who lived at the home.

Inspection carried out on 9 November 2013

During a routine inspection

During our visit with met with thirteen people, spoke with five staff including the unregistered manager and reviewed four people's care records and eight people's care notes held in their rooms.

People told us “I like living here. The staff are nice”; "They are good workers (the staff)"; "I like the company and being looked after, they pop in and make sure you're alright"; "The staff are very kind, very good and usually explain what they're doing"; "It's very good here."

We found people were asked for their consent before treatment was given and where people were unable to give their verbal or written consent staff consulted with family and health professionals who knew people well. People had their needs assessed prior to coming to live at Lelant Nursing Home and the care given reflected people's needs. Care was individualised and people were able to access and become involved with activities in their local community if they wished.

People living at Lelant Nursing Home received a healthy, well balanced diet. Staff were aware of those who required additional support with their nutrition and hydration and provided help to people in an unhurried manner.

Staff working at Lelant told us they felt supported and valued and that they enjoyed their work. Regular one to one meetings occurred to support staff with their development and there were opportunities for professional development.

Inspection carried out on 12 November 2012

During an inspection to make sure that the improvements required had been made

We carried out an unannounced inspection on 12 November 2012 to follow up on the compliance actions set at our earlier inspection on 17 May 2012. We found that Lelant Nursing Home had made improvements.

On the day of our visit we were told there were 27 people living at Lelant Nursing Home. We spoke with 10 people who lived at the home, a relative, six staff members which included the new manager and administrator and looked at four people’s care files.

People we spoke with told us about how they were involved in their care and how staff respected their wishes. Comments included, “I am very happy here. I have no complaints. I feel I can ask staff to do things how I like them”, “Its very nice here, the staff are lovely, helpful. Today there was a staff shortage and the nurse came to help me, my needs were met appropriately” and “I am involved in decision making.”

People informed us that they felt safe and able to raise concerns if they needed to. Comments included, “If I had any concerns I would speak to staff, I do” and “I am safe here, comfortable.”

Inspection carried out on 25 July 2012

During an inspection to make sure that the improvements required had been made

We carried out this inspection on 25 July 2012 to follow-up on the warning notice issued following our earlier inspection on 17 May 2012, which required the provider to demonstrate compliance by 6 July 2012. The concerns were that we found care plans and assessments had not been routinely reviewed. This meant that people’s changing needs were not documented, with the required courses of action taken, such as seeking medical advice. Unsafe moving and handling practices and record keeping was poor. During our visit we saw that improvements had been made.

On the day of our visit there were 21 people living at Lelant Nursing Home. We spoke with six people who lived at the home, two relatives and three members of staff.

Inspection carried out on 17 May 2012

During an inspection in response to concerns

We carried out an inspection on 17 May 2012 in response to concerns raised by a relative of a person living at Lelant concerned about their care and welfare needs not being met; an alert from the local authority safeguarding team about poor nursing practice being witnessed and a notification about a person falling and sustaining a head injury. We also were following up on the issues raised at our earlier inspection in December 2011.

On the day of our visit we were told that there were 32 people living at the home, eight of whom required residential care, the remaining 24 needing nursing care.

We looked at ten care files. Although these had a level of detail about people’s health and social care needs, we did not find any evidence to suggest that people and their relatives were involved in planning this information. Care plans did not appear person centred, with them being prescriptive of the care needed to be provided. Care plans were standardised, meaning that everyone’s care plans were the same, but certain additions were added. We spoke to the manager, who recognised that the care plans were not person centred. They added that they had just started to implement a new style of care plan which needed to be handwritten by staff to ensure they reflected the needs of each individual. We saw that one person had the new style care plan, which had been rewritten on 9 May 2012.

We found evidence that care plans had not been routinely reviewed. This meant that people’s changing needs were not necessarily reflected, with the right courses of action taken, such as seeking medical advice.

Staff we spoke with expressed their concerns about not having sufficient time to do their jobs properly, such as meeting people’s care and welfare needs and completing paperwork. One staff member told us that personal care was just a quick ‘flick’ with a flannel because there was no time to do anything else. Another stated that at times they felt 'overwhelmed', adding “you tend to smile with your mouth, not your eyes.” Another staff member stated that staff tended to become so stressed and tired, with the only option to go off sick.

Inspection carried out on 24 October 2011

During an inspection to make sure that the improvements required had been made

People told us at the home that generally staff were kind and supportive.

We found that on the first day of the inspection due to staff shortages people were not having their needs fully met; staff were rushing and call bells were taking too long to be answered. However on the second day of our visit we found more staff on duty and most people were getting a better standard of care although some were still left without being washed until after lunch.

Three people that we were able to talk with all said that things had improved since our last visit and that there were more staff around.One person said " we could do with more staff but it is better than it was before".

Inspection carried out on 27 September 2011

During an inspection in response to concerns

People told us at the home that generally staff were kind and supportive. One person said" they work very hard to help me" and "the staff are very nice".

We found that during the morning much of the communication with residents was task based or based around staff giving information such as when it was coffee time. We observed staff rushing to attend to people and answer call bells which were constantly ringing.

Four people that we were able to talk with all said that there were not enough staff on duty to meet their needs. All four said that standards were not as good as they should be. One person said " I want to leave", another told us "I am lucky if I have a wash before lunchtime", another said " I always wait at least 10 minutes for someone to actually come and help me after I ring for help".

People said the home was usually clean and the food was good.

Reports under our old system of regulation (including those from before CQC was created)