Archived: Layton Lodge Residential Care Home for the Elderly

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.

Following the inspection we met with the provider to discuss our concerns. We requested and received an action plan. This detailed procedures put in place to address the concerns raised. We used this inspection to see what actions had been taken.

We spoke with a range of people about the home. They included the registered manager, staff members, relatives and people who lived at the home. We also asked for the views of external agencies in order to gain a balanced overview of the service provided by Layton Lodge.

We spent much of the time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support. Staff treated people with respect and ensured their dignity when supporting them. They provided support or attention as people requested it.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "The staff are fantastic. I am really treated well."

We found new procedures and paperwork had been introduced. This was to ensure there was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We spoke with a range of people about the home. They included the registered manager, staff members, relatives and people who lived at the home. We also asked for the views of external agencies in order to gain a balanced overview of the service provided by Layton Lodge.

We spent time in areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. We spoke with people about the care and support they received. They said they were happy living at the home and said staff were polite and kind.

During the inspection we looked at care planning records. We found further examples where proper steps had not been taken to assess people's care needs and plan the support required by each individual. We also looked at audits and systems in place to monitor the quality of the service being provided. We found that quality audits of care planning and delivery were not undertaken. Therefore monitoring processes continued to be insufficient to manage the risks to the health, safety and welfare of people who lived at the home.

Comments from those living at the home included:

"They (the staff) are very nice. They look after us well."

"We just sit and watch the television. There is not much going on really. A singer comes occasionally."

"The staff are lovely and very helpful. They are always there for me day and night if I need anything. Hilda (the manager) is very nice. She will listen to any problems I have. I have no complaints. I don't think anyone does. You won't get a better home than this."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at the cleanliness of the environment and how the control of infection was monitored. Standards relating to the management of medications, staff support and monitoring the quality of service provision were also inspected. We found several areas of none compliance, which are identified within this report. We have asked the provider to submit a detailed action plan showing how the areas of concern are going to be appropriately addressed.

People we spoke with told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved relatives, where possible to ensure people received the right care and support. This was confirmed when we spoke to two visiting relatives. One told us, "I am always kept informed about my relative's care.'

We were able to speak with people during the day of the inspection about their care and support. We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

When we arrived some people were still taking breakfast. We observed people were being supported in a relaxed and unhurried manner. Individual breakfast preferences were noted with residents taking this meal in various rooms in the home.

We spoke with people about the care and support they received. One person told us, 'I couldn't wish for any more comforts.' 'I am happy here.'