Background to this inspection
Updated
26 May 2017
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.
The inspection team on day one consisted of an adult social care inspector and an adult social care inspection manager. On day two of our inspection, the team consisted of two adult social care inspectors.
Prior to our unannounced inspection on 11 and 24 April 2017, we reviewed the information we held about Layton Lodge. This included notifications we had received from the provider. These related to incidents that affect the health, safety and welfare of people who lived at the home.
We walked around the home and spent time observing the interactions between people, visitors and staff. We spoke with a range of people about Layton Lodge. They included two people who lived at the home, two relatives, the registered manager and three staff members. We further discussed the service with a visiting healthcare professional. We did this to gain an overview of what people experienced whilst living at Layton Lodge.
We looked around the building to check environmental safety and cleanliness. Furthermore, we looked at a range of records. These included documents in relation to six people who lived at the home and two staff files. We reviewed records about staff training and support, as well as those related to the management and safety of Layton Lodge.
Updated
26 May 2017
The inspection visit at Layton Lodge was undertaken on 11 and 24 April 2017 and was unannounced.
Layton Lodge provides care and support for a maximum of 18 older people. At the time of our inspection there were 14 people living at the home. Layton Lodge is situated in a residential area of Blackpool close to local amenities. The accommodation consists of 16 single rooms and one twin room spread over two floors with a passenger lift for ease of access. Communal areas consist of two separate, comfortable lounges and a dining room.
At the last comprehensive inspection on 04 February 2015, we rated the service as requires improvement. This was because we found breaches of legal requirements. The registered manager did not have effective recruitment procedures to ensure staff were suitable to work with vulnerable adults. There were inconsistencies with how staff were recruited and their records did not always contain required checks. The registered manager failed to ensure all staff received induction to support them in their role. We followed this up on 09 September 2015 and noted the service was meeting the regulations they were in breach of. However, we could not improve the rating from requires improvement because to do so required consistent good practice over time.
During this inspection, people and relatives we spoke with said they felt safe whilst at the home. However, we found poor practice in risk assessment processes. For example, they did not outline the level of concern, actions to mitigate risk and follow-up review. There was no evidence to show the management team completed an analysis of accidents and incidents to reduce their recurrence.
People and relatives told us they felt fully involved in the review and update of their care planning. Staff demonstrated a good understanding of each person’s backgrounds and preferences. However, we found care planning contained missing information and lacked clarity to guide staff to be responsive to people’s requirements. The review of records set out by the management team was considerably overdue by several weeks to over a year.
We found staff had a good understanding of medication administration and practice, underpinned by recent training. However, medicines risk assessments were poor and not all of those who lived at Layton Lodge had one. We observed staff did not always administer medicines safely and related auditing lacked detail and depth to have full oversight of all procedures.
People stated they found their meals were of a good standard and alternatives were available. One relative told us, “The food is good, wholesome, home-cooked food.” However, care files did not contain nutritional risk assessments to protect people from the risk of malnutrition. Monitoring records were ineffective because we found gaps in records.
The provider failed to ensure quality assurance was up-to-date and fully assessed people’s experiences of living at Layton Lodge. Audits failed to pick up concerns we found and were not fit for purpose. For example, the last care planning audit demonstrated all records were in place, but we saw information was missing, not current and contained gaps.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Staff we talked with demonstrated they had a good awareness of how to protect people against potential harm or poor care. We saw there were appropriate staff numbers during the day and call bells and people’s needs were attended to with a timely approach. However, we found concerns with staffing levels at night, which were not sufficient to meet people’s changing requirements. The provider did not use a model to check they could continuously meet people’s needs.
You can see what action we told the provider to take at the back of the full version of the report.
In our discussions with staff, they were able to demonstrate a good awareness of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. However, we saw not all care files contained consent to care. Decisions-specific agreement was not documented where required, such as for bedrails.
You can see what action we told the provider to take at the back of the full version of the report.
The provider did not have oversight of the quality of cleanliness at Layton Lodge because they did not undertake regular audits. We found areas in the home required cleaning and lacked good standards in infection control.
We have made a recommendation the provider seeks guidance about safe practice and quality auditing of infection control.
Staff told us they had ample training and felt the registered manager was supportive in helping them to access further courses. Additionally, they had regular supervision to support them in their roles.
Staff demonstrated a caring and respectful approach to those they supported. A relative commented, “They have so much patience, respect and that caring touch.” They were respectful of people’s privacy and dignity during our inspection, such as knocking on doors before entering bedrooms. A staff member told us, “I try my best to look after the residents as I would want to be looked after.” We found people were encouraged to be involved in their care planning.
A programme of activities was available for people’s stimulation and interest. Those who lived at Layton Lodge and their relatives said they felt fully occupied.
People told us they had been informed about how to raise concerns if they had a complaint. The registered manager provided opportunities for them to feed back about the quality of their care and any suggestions they may have. Staff said they felt the management team was ‘hands on’ in their approach and listened to any issues they had.