Archived: Laughton Croft Care Home with Nursing

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

The environment people lived in did not always meet their needs and was not maintained in a timely way. There had been consistent problems with the central heating system for a number of months impacting on the provider’s ability to provide consistent hot water and maintain temperatures at the service in line with government guidelines. Leaks in the roof had caused a hole in the ceiling in one of the communal areas and some furniture in place was not fit for purpose.

The risks to people’s safety were not always managed safely. Staff did not always follow guidance in people’s care plans to provide care for people and some care plans lacked clarity on the care some people required. Medicines were not always managed safely and due to environmental concerns the risks related to infection prevention were not always well managed.

Although we saw there were quality monitoring processes in place being used effectively by the registered manager to improve standards of care. The processes had not been used effectively to highlight and address the issues we identified with the environment people lived in.

People were supported by adequate numbers of staff and safe recruitment processes were in place. There were systems and processes in place to manage safeguarding issues. People felt safe with the staff who supported them and the registered manager had processes in place to learn from events to improve the care for people at the service.

People were supported by staff who had received relevant training for their roles. People’s nutritional needs were managed well by the staff at the service who worked together to provide nutritious and were well presented meals for people. Nationally recognised assessment tools were used to assess their nutritional needs and people told us they enjoyed the food provided.

Staff worked together to effectively manage people’s health needs and there was evidence of how staff worked with health professionals to meet these needs.

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.

People were supported by staff who worked in a caring way and people told us they felt comfortable with staff. People’s views on their care were considered and where people required support from Advocates, the registered manager facilitated this support.

People were supported to enjoy social activities of their choice both as part of group and on an individual basis. When people wished to complain about any aspect of their care the registered manager was responsive and people felt their concerns or complaint were taken seriously and well managed.

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 4 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have identified breaches in relation to safe care and treatment and premises and equipment at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will 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:

Systems and processes were in place to safeguarded people from the risk of abuse, but these were not always effective. People did not always have their risk of harm assessed and reviewed. There were not always sufficient numbers of staff on duty to look after people, especially at weekends. People received their medicine from staff who were not always competent to do so. The service was not clean and some areas were in need of refurbishment and repair. Lessons were not learnt when things went wrong.

There was a lack of effective leadership. The clinical governance systems did not identify and address areas of the service that required improvement.

The service met the characteristics of Inadequate in both areas that we inspected. More information is in the full report.

Rating at last inspection: At our last inspection in October 2016 we rated the service as Good. The inspection report was published on 04 January 2017.

Why we inspected: The inspection was prompted by concerns we had received about the intermittent breakdown of the hot water and central heating boiler. Several areas in Ruby were without heating and hot water. Staff carried open containers of hot water from the kitchen to people’s bedrooms and people were provided with portable heaters. We were concerned about the management of risk of trips from trailing electrical appliance cables, contact from hot surfaces, scalds from carrying open containers of hot water in corridors and hypothermia from the lack of heating. In addition, we had received information of concern about a medicine error and about a person who had left the service unsupervised and was found by passers-by on a busy main road. We were concerned about the overall safety of people who lived at the service.

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

We undertook this follow-up comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Laughton Croft Care Home with Nursing on our website at www.cqc.org.uk. In addition we had received information of concern about the standards of care provided at Laughton Croft Care Home with Nursing.

This inspection took place on 27 October 2016 and was unannounced.

Laughton Croft Care Home with Nursing is registered to provide accommodation and nursing and personal care for up to 36 older people and people living with either dementia, a physical disability, sensory impairment or a mental health problem. There were 21people living at the service on the day of our inspection. The service has two units; Ruby and Emerald.

The recently appointed manager had commenced the process to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in February 2015 we asked the provider to take action to ensure that people were protected from the risk of infections, that people were protected from the unsafe management of medicines and that the provider operated effective systems and processes to make sure that they assessed and monitored their service. The provider sent us an action plan on 4 July 2016 and told us that these actions had been completed. On this inspection we found that the provider had made the required improvements and was no longer in breach of the legal requirements.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. One person at the time of our inspection had their freedom lawfully restricted under a DoLS authorisation and two people were waiting for a DoLS assessment.

People were protected from avoidable harm and abuse and had their risk of harm assessed. Staff were aware of the signs of abuse and knew how to escalate their concerns. There were sufficient staff on duty to keep people safe and meet their care needs. People received their medicine safely from staff that were competent to do so. People were cared for in clean and well decorated environment by staff who understood good infection control practices.

People received effective care from skilled and knowledgeable staff who received training to meet people’s care needs. Staff had received appropriate training, and understood the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and were able people were asked for their consent to care. People received a balanced and nutritious diet and drinks and snacks were provided between meals. Staff ensured that when there were changes to a person’s health that they were referred to the most appropriate healthcare professional.

People were cared for with kindness and compassions by committed and caring staff. Staff involved people and their families in decisions about their care. People were cared for by staff who respected their privacy and dignity.

People received care that was personal to their individual needs. Some people were supported to take part in activities such as colouring or listening to music. However, the provision of purposeful and meaningful activity was limited to a few. People were confident that their concerns and complaints would be actioned and responded to in a timely manner.

The culture of the service had improved. The recently appointed manager was approachable and staff felt empowered. There have been improvements in the quality monitoring of the service through audit and feedback from people who lived in the service and staff.

We re-visited the service on 03 September 2014 to see what improvements they had made. We spoke with three members of staff and a visitor to the home. The focus of the inspection was to answer the key question; is the service safe?

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found the provider had improved the standard of cleanliness in several areas of the home. We saw that bedrooms and en-suite toilets were cleaner and there were no offensive odours.

We spoke with two housekeepers who told us their role had improved and they had systems in place to record the cleaning duties they had undertaken and access to better cleaning products. They told us they felt supported in their roles.

However, we also saw more improvements were needed to improve standards in some areas such as the sluice and laundry.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with people using the service and the staff supporting them. We spoke with five people and two relatives. We also looked at care files.

Is the service caring?

People were supported by kind and caring staff. We saw that care and nursing staff showed patience and gave encouragement when they supported people. For example, we saw one person being supported to eat their lunch. They were not hurried and the staff member offered encouragement throughout the meal.

Relatives told us if they made any suggestions about change to the manager that they were acknowledged and changes were made.

Sometimes people's needs were not respected. For example, the layout of some bedrooms meant that people could not access their call buzzer when they needed to call for assistance.

Is the service responsive?

The service was responsive to people's needs. We found risk assessments and care plans reflected individual needs and preferences.

Visiting relatives told us that if their relative became unwell staff contacted their GP and informed their family.

Is the service safe?

The service was not always safe. We have concerns about the standards of cleanliness in several areas of the service. We found infection control monitoring was weak and have identified several areas of concerns such as, ensuite toilets, the sluice and the laundry.

We found that people had access to areas where they may be at risk of harm. For example, the store room and boiler room were unlocked.

The system for reporting faults was not robust and repairs to broken equipment and furniture were not carried out in a timely manner.

We saw that people were at risk of harm in some areas of the gardens from uneven paths and lawns.

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA.

Is the service effective?

We saw staff were supported to carry out their role effectively. Staff had access to training that would lead to improvements in their knowledge and understanding of peoples care needs.

Relatives we spoke with were confident that care was effective. One relative told us, 'It's absolutely brilliant. They let her have time to herself and observe from a distance'

A person who lived in the service said, 'I would give it 4.9 out of five just to give them some room for improvement.'

Is the service well led?

Relatives and staff told us that the manager was approachable and would address any concerns.

We found that the quality monitoring systems were not robust. The manager did not identify and act upon the areas of concerns we identified during our inspection.

We spoke with four relatives about their views. We observed the support given by staff to people who used the service. We also looked at records, including care files for four people and carried out a tour of the building.

People's needs had been assessed and they received care, treatment and support which met their needs. We saw people being offered choices and opportunities which were respected and responded to.

One relative we spoke with said, "I can't say anything but good things about the home. They moved (name of relative) to a different room three times to give them a better view.'

People who used the service and relatives we spoke with were complimentary about the food and people were provided with a choice of suitable and nutritious food and drink. One person told us, 'The food is great and I have managed to put on weight since I came here.'

We found that effective systems were not in place to reduce the risk and spread of infection and we looked at records and found some files had information that was incomplete or missing which put people at risk of inappropriate care or treatment.

We spoke with two people who lived at the service, two relatives, four staff members, the registered manager and the homes administrator.

One person told us, 'I am feeling happy about being here. They look after me and I like the staff.' A visiting relative said, 'They (staff) look after people really well in our opinion. I feel our relative is safe and well cared for.'

We also used a method of inspection called a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to understand the needs of people who we were not able to speak directly with.

We observed staff communicated with people by speaking with them sensitively, and through the use of non verbal actions. We found staff were responsive to peoples needs and people were supported sensitively with their dignity maintained. We saw this helped ensure people were able to express their feelings freely and wherever possible make their own decisions about the care and support they received.

We also found that the provider and manager monitored the service regularly and created opportunities to gain the views on the service from relatives and from people who used the service.