You are here

Archived: Lymewood Nursing Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 14 October 2015

We previously carried out an unannounced comprehensive inspection of this service on 29 Jul, 6, 10 and 26 August 2015. At this inspection we took enforcement action in relation to four breaches of regulations by serving four warning notices and made requirements for four other breaches.

At the time of this inspection on 8 September 2015, the timescales for the provider to meet the timescales set in the warning notices had not passed, nor had the period of time for the provider to respond to the warning notices or the draft inspection report of 29 July, 6, 10 and 26 August 2015.

This inspection was carried out because we were concerned about the staffing situation at the home. In addition, we had received information of concern that people who were at risk of choking were not receiving safe care to prevent this known risk. The team inspected the service against one of the five questions we ask about services: is the service safe?

This report only covers our findings in relation to this. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Lymewood Nursing Home) on our website at www.cqc.org.uk

Lymewood Nursing Home is registered to provide accommodation for up to 37 adults who require nursing or personal care. The home offers its service to people who have dementia or mental health needs. At the time of this inspection there were 30 people living at the home.

The service does not have a registered manager in post. The current manager had been in post for six weeks but has resigned and is due to leave in October 2015. 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.

As a result of the previous inspection, and the number of concerns about the service, a whole home safeguarding process continues. This is through multidisciplinary safeguarding strategy meetings which include representatives from Dorset and Devon health and social care agencies. The service is being monitored daily through a combination of visits by social services staff, the safeguarding nurses, the community nursing and local mental health team. Reviews of the people’s care are being carried out to check if the home is able to meet their needs. Placements to the service remain suspended by health and social care commissioners. The provider voluntarily agreed not to admit anyone new to the home.

Concerns remain regarding the staffing arrangements at the home. This was because some staff had left and because of the high reliance on agency staff. There were still some gaps in the rota where staff had not yet been found to cover upcoming shifts. We asked the provider to provide further assurances that the staff rota was completed and up to date. Staff on duty were kind, caring and considerate to people they were providing care but some staff had a more in depth knowledge and understanding of people’s needs than others.

There remains a risk of people not getting their care in a timely way because of the numbers of staff on duty at times. On the day we visited three people had received their breakfast late and two people had to ask for lunch on two occasions before it was provided. Because of the lack of continuity of a stable permanent staff group, there remains the risk that people’s current needs were not always known or identified in a proactive way.

We followed up concerns raised with us about ten people with possible swallowing/choking risks. This was to check whether the food and drink offered to those people was of the appropriate consistency. Also, to check whether staff had the knowledge they needed to safely care for those people.

Of the ten people we looked at, four people had known swallowing/choking risks. Each of those four people had a swallowing assessment completed by a speech and language therapist (SALT). Their care plans included instructions for staff about any dietary modifications needed and about positioning the person safely for eating and drinking. We observed three people having lunch in their rooms; each person was assisted to eat/drink by care staff. All three people were given food of the appropriate consistency as recommended by their SALT assessment. Each person was appropriately in an upright position and staff gave the person time to swallow each mouthful of food/drink before offering more food. Two people’s drinks were thickened to an appropriate consistency in accordance with their care plan.

An experienced care worker was supervising an agency care staff to assist one person with their lunch whilst they assisted a second person. However, an agency staff assisting a third person with a choking/swallowing risk was unaware of this risk. The staff handover sheet in use included information about people’s dietary modifications but it did not include any information about choking risks. A fourth person with a choking risk was refusing to accept the dietary modification recommended by the SALT and remained at risk. However, the person’s mental capacity assessment showed they had capacity to weigh up the risks and benefits of this decision.

Kitchen staff had the appropriate information about people with choking risks being on pureed diets and knew how to prepare foods of the appropriate consistency. Three people had recently been identified as having possible swallowing/choking risks and urgent SALT assessments had been arranged. However, those people did not currently have any dietary modifications. We encouraged the provider and manager to seek further advice about managing those people safely whilst awaiting a SALT assessment.

The remaining three people we looked at did not have choking risks but were on modified diets due to other reasons, such as not being able to chew. However, communication between staff about which people had swallowing difficulties/choking risks was not always effective, which meant some staff did not receive the information they needed to safely care for each person.

We looked at fluid and food charts of four people. These were being completed most of the time, but there were some gaps in the records. This meant we were not sure whether these were recording omissions or whether those people had not received some meals/drinks. This could put people at increased risk of malnutrition or dehydration.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Since this inspection the provider voluntarily decided to close the home and the remaining people moved out on the 25 September 2015.

Inspection areas

Safe

Inadequate

Updated 14 October 2015

The service was not safe.

We could not improve the rating for safe from inadequate because there were still concerns regarding staffing at the home.

Staffing numbers and continuity continued to put people at risk.

People with choking risks were being offered food and drink in accordance with their care plan. However, some staff were not always aware of which people had choking risks.

Some people with suspected swallowing difficulties/choking risks were awaiting assessment but did not have modified diets. We asked the provider to seek advice about this.

People’s food and fluid charts were not always completed. This could be recording omissions or mean people had not received some meals/drinks. This put people were at increased risk of malnutrition or dehydration.

Effective

Requires improvement

Updated 25 September 2015

The service was not effective.

Staff did not always have the skills or knowledge to support people effectively.

Where people did not have capacity to consent to specific decisions, the service did not act in accordance with the Mental Capacity Act 2005. As such, it could not be demonstrated that decisions made were always in people’s best interests.

People’s dietary preferences and needs were not always met.

Caring

Inadequate

Updated 25 September 2015

The service was not always caring.

Although some people gave positive comments about staff and how they were cared for, this was not consistent.

A lack of positive interaction and communication from staff towards people when providing support was observed. We saw instances where people’s privacy and dignity was not maintained.

Responsive

Requires improvement

Updated 25 September 2015

The service was not responsive.

Although some staff were friendly and supportive towards people, care was sometimes task based as opposed to meeting the personalised needs of people. This did not support people’s choices or dignity.

People’s care plans did not consistently reflect a comprehensive, complete or person centred approach to assessing and meeting their individual care needs.

There was a lack of stimulation and interaction available for people. Some people displayed behaviours which indicated boredom and withdrawal.

Well-led

Inadequate

Updated 25 September 2015

The service was not well led.

In the absence of a registered manager, the provider was not managing the service effectively.

Audits and quality monitoring did not effectively identify areas for improvement. We identified a number of breaches of regulation which should have been identified and rectified through a robust system of quality assurance.

Incidents and accidents were collated and analysed but the findings had not been fully explored to identify trends and to protect people from risk.

The service had not always informed the Commission about notifiable incidents in line with the Health and Social Care Act 2008.