Lowmoor Carehome

Lowmoor Nursing Home is a nursing home providing personal and nursing care for up to 42 people. There were 37 people living at the home at the time of our inspection. The service provides support to older people with a range of support needs including complex health conditions and dementia.

The service is a large adapted property and managed as three units each with its own lounge and dining facilities.

People’s experience of using this service and what we found

Risks associated with people’s care and support and the environment were monitored and managed. There was a new manager in post who had begun to make improvements to the way the service audited different areas within the home. Medicines were managed safely, and the manager had implemented effective auditing processes for different aspects of the service.

There were enough staff to meet people’s needs and safe recruitment practices were followed.

The home was clean throughout and domestic staff knew the importance of regular cleaning of touch points.

People were supported with their health needs and had access to healthcare services. People were supported by staff who had the training and support required to provide effective care.

People were supported well by staff who cared for them and treated them with dignity and respect. Family members spoke highly of the staff team and felt people were well looked after and kept safe.

The manager had started to make improvements to systems and processes. We discussed various aspects of improvement and the manager told us how they were going to work to make the improvements required.

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 (Published 13 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment and training, also management and monitoring of accidents and incidents. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is Good

Lowmoor Care Home can accommodate up to 42 people. At the time of our inspection there were 36 people living at the service. The home is sectioned into three separate areas.

Each part of the service had a dining room and a lounge area. The communal areas were clean and spacious and there were rooms for activities and a coffee shop for people to enjoy.

We found the following examples of good practice.

¿ Staff had received training in donning and doffing personal protective equipment (PPE) and we saw this was accessible throughout the home and staff used it in accordance with the most up to date guidance.

¿ Staff had received further training in Covid-19 and infection control.

¿ The service had three separate units which staff could access independently to avoid cross contamination.

¿ The infection control policy was up to date. We reviewed audits which reflected actions had been taken to maintain the standards within the home. There was a Coronavirus Policy which had been introduced in August 2020.

¿ There were no visitors allowed in the home apart from relatives when people were receiving end of life care. To enable people to keep in touch with relatives, they had found alternatives using technology with video calling. Only essential medical professionals had entered the home during the outbreak.

¿ In April 2020 everyone using the service had tested positive for Covid-19 and 20 of the staff. Most people had been asymptomatic, but the registered manager had taken appropriate action to prevent the spread of infection and isolate sections of the service. Careful management prevented the service having any further cases.

¿ Daily handovers had been adapted to ensure social distancing.

¿ Cleaning schedules had been increased and all rooms received regular deep cleans as well as regular cleaning of high contact surfaces.

Further information is in the detailed findings below.

Lowmoor Care Home is a care home providing personal and nursing care to 41 people at the time of the inspection.

The care home is purpose built and accommodates up to 42 people across three separate wings, each of which has separate adapted facilities. Two of the wings are single gender and specialise in supporting people who are living with dementia and have complex needs. The third wing is mixed gender and supports people who may require more intensive nursing care support.

People’s experience of using this service and what we found

People were safe at Lowmoor Care Home. The environment was safe, and people were protected from abuse, and serious harm, by the provider’s improved incident reporting procedures and staff training. Incidents were reviewed, and action taken, to reduce the likelihood of recurrence. Staff understood how to safeguard people from potential abuse. End of life care arrangements were appropriate, and staff knew how to access details of people’s end of life plans.

People were supported by staff who were appropriately trained. Enough staff were employed to meet the needs of the 41 people living at the care home at the time of the inspection. Risk assessments were carried out, and changes in people’s risks were communicated to all staff so people could continue to be supported safely. Prescribed medicines were managed appropriately, and good arrangements were in place to keep the care home clean and reduce the potential for infections spreading.

People’s care plans were comprehensive. Staff had enough information to support people effectively. Appropriate assessments were carried out so that people’s support needs were identified. The care home was equipped and furnished to meet people’s needs. This included dementia friendly decoration, and pictorial signage, to assist people who may sometimes become confused.

People were supported to eat and drink enough to maintain a balanced diet. Appropriate arrangements, and staff training, were in place to support people who required specialised diets. There was a variety of food available and people were able to choose what they ate.

People’s healthcare needs were supported by the care home staff, and people also accessed support from local healthcare services. The care staff ensured people had oral healthcare assessments in place and had access to a community dentist if required.

People were supported by staff who treated them with kindness and compassion. Equality and diversity support needs were identified in people’s care plans, and people were supported to be involved in planning their care; where they had the capacity to do so. Care staff treated people with dignity and respect when supporting with personal hygiene. Their privacy was maintained by care staff who understood people’s individual needs.

People were supported to maintain contact with their families, where that was appropriate. The care home provided a diverse range of regular leisure, and social, activities that people could choose to take part in.

People received person centred support from a staff team that was positive about ensuring people received good care. The registered manager ensured families were notified about any issues that affected their relative; and encouraged relatives to give feedback on the care home and ways in which it could continue to improve.

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.

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

Rating at last inspection and update

The care home was previous inspected on 22/25January 2019. The last rating for this service was inadequate (published 22 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service:

• There was limited oversight of incidents that had occurred at the service, this meant people may not have been protected from future harm.

• This was a recurrent issue from the last inspection and had resulted in unsafe care for people.

• Moving and handling was not managed safely and some staff training was expired in this area. Some trained staff had been dismissed due to poor moving and handling practice.

• Improvements were needed around Mental Capacity assessments and people’s meal time experience

• Since the last inspection, we have seen considerable improvements to the service. This included, safe recruitment processes, regular staff supervision, safe medicine management, the use of effective communication aids, a robust complaints procedure, and better engagement with people using the service. These improvements had positively impacted on people at the service. People told us that they felt the service had improved.

• There was a new registered manager in place and people spoke positively about them. In the absence of the registered manager, the provider had failed to improve other aspects of the service. This continued failure had resulted in repeated breaches of the law. It had impacted on peoples’ safety.

• While improvements have been made, this service requires further work to ensure safe practice is embedded. Some significant concerns over people’s safety had not been adequately addressed. More information is in the full report.

Rating at last inspection: At the last inspection, the service was rated ‘requires improvement’ (Published 14 September 2018).

Why we inspected: At our last inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included regulations 13, 17, 18 and 19. We inspected this service to see if improvements had been made as required.

Enforcement: At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included regulations 12, 13 and 17. We also found an ongoing breach of the Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the level of risk at the service until the next inspection visit.

The overall rating for this service is now ‘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 months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Accommodation for up to 42 people is provided over two floors in three separate units. There were 41 people using the service at the time of our inspection. Lowmoor Carehome is designed to meet the needs of older people living with or without dementia.

This is the first time the service has been rated Requires Improvement.

The service did not have a registered manager at the time of our inspection visit. Lowmoor Carehome had not had a registered manager since 31 March 2017. 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. The provider had appointed a manager in December 2017, but the provider confirmed the manager had now left the service.

People were not consistently kept safe from the risk of abuse. The systems in place to identify and deal with concerns had not worked to safeguard people from abuse. The provider had not consistently ensured staff were of good character and were fit to carry out their work. Risks associated with the service environment had not always been assessed and mitigated. There was no comprehensive system to enable the provider to review accidents and incidents. People’s medicines were not always managed safely.

People were at risk from receiving care from staff whose skills and knowledge was not assessed or monitored. The provider had not consistently ensured that staff had undertaken training to enable them to meet people’s needs effectively. People and relatives were not consistently supported to participate in planning or reviewing their care. People who needed support to communicate were not always able to meaningfully participate in making decisions about their care.

Staff we spoke with were knowledgeable about people’s individual preferences and lifestyle choices, but this information was not consistently available to all staff. There was a risk people's views and information about their lives were not available to support staff in providing care. People and relatives knew how to raise concerns or make a complaint. However, concerns and complaints were not clearly resolved, and the provider did not have clear information about areas where improvements were needed. People experienced varying levels of support to maintain interests and hobbies.

The service was not well-led. There was a lack of consistent management at the service, which had affected people’s quality of care. The provider had not always notified CQC of significant events as they are legally required to do.

People and relatives spoke positively about the skills and knowledge of staff. There were enough staff to provide the care and support people needed. Risks associated with people’s health conditions were assessed and mitigated. Risks associated with infections were minimised, and the premises were clean. People were supported and encouraged to have a varied diet that gave them sufficient to eat and drink. People were supported by staff to access healthcare services when required. The provider had taken steps to ensure the environment was suitable for people's needs.

People were 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 supported this practice. The provider was working in accordance with the Mental Capacity Act 2005 (MCA), and people had their rights respected in this regard. People and relatives spoke positively about the caring approach from staff, and throughout our inspection visit, we saw people were treated in a dignified way. People's right to private and family lives were respected. People and relatives were supported to discuss their end of life care, and staff knew how to support people and their relatives in the way they wanted.

We found four 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.

Accommodation for up to 42 people is provided in the service over two floors in three separate units. The service is designed to meet the needs of older people living with or without dementia. There were 42 people using the service at the time of our inspection.

A registered manager was in post and she was available during the 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.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Risks were generally well managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Medicines were generally safely managed.

People’s rights were not fully protected under the Mental Capacity Act 2005. Not all staff had received sufficient training to support people with behaviours that might challenge.

Staff received appropriate induction, training and supervision. People received sufficient to eat and drink.

External professionals were involved in people’s care as appropriate. The environment had been adapted to support people living with dementia.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though care plans could be further improved.

A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken.

The provider and registered manager were generally meeting their regulatory responsibilities, however, they had not sent statutory notifications when DoLS had been authorised. There were effective systems in place to monitor and improve the quality of the service provided.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with three people who used the service and a relative and asked them for their views. We also spoke with four care staff, two nurses, the registered manager and the provider. We also looked at some of the records held in the service including the care files for six people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found where people were able to they gave consent to their care and treatment and people received care and support that met their needs. A person told us, 'I am treated reasonably well. I can make my own decisions, I am an independent person.' Another person told us, 'I have the help I need to manage my mental health.

We found people who used the service were protected from abuse. A person told us, 'They keep me safe here. They keep an eye on you. I see them watching to make sure others are safe.'

We found the staff team were supported through training. A person told us, 'I think they are fairly well trained, I see them having meetings and training all the time.'

We found the provider had systems in place to deal with comments and complaints. A person told us, 'If I have got any complaints I tell the manager. They then deal with it. I am happy how they deal with things. I am not made to feel bad for saying something.'

One relative told us her father's behaviour had improved since arriving in the home. Another relative told us that his mother's dementia meant she could get quite agitated but that since arriving he thought she had settled down.

Care staff told us how much they enjoyed working there. Staff who had been there for several years told us that the assessment process had improved and as a consequence they were able to provide more personalised care and reduce challenging behaviour.

People told us they were happy living in the home and had no complaints.

A healthcare professional present on the day of inspection told us that she felt the home provided a supportive, professional environment. She said she had no concerns about the standards of care provided.