Archived: Livesey Lodge Care Home

Livesey Lodge is a residential care home providing accommodation and personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

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

The service was still not well-led, and lessons not learnt from previous shortfalls we identified. Serious ongoing concerns were identified in the day to day management and oversight at the service.

The registered managers attendance at Livesey Lodge was inconsistent and infrequent. They had only been present 9 of the previous 77 days to the inspection. No alternative arrangements had been put in place in their absence, instead care workers with no managerial experience were left to manage the service in their absence. This contributed to the widespread failings in the leadership and governance arrangements.

Staff did not receive adequate support and guidance from registered persons and were not listened to if they raised any issues.

Staff were assigned to multiple roles including cooking and cleaning due to a lack of consistent staff. Staffing levels meant people did not have opportunity to engage in regular meaningful activities.

A staff member was left to arrange the deployment of staff but had no authority to make changes to the levels of staff if they were needed.

The registered manager held no records staff were fully vaccinated for COVID-19 in line with government guidance. This increased the risk of a further outbreak of the virus. Protocols for visiting professionals did not include checks of their vaccination status.

Policies, such as infection control and safeguarding were not always reviewed, updated or contained the correct information.

Support, advice and guidance the service received from other agencies was not acted upon and opportunities missed to make improvements to service delivery and management.

Without exception people and relatives praised the safe care and treatment they received from care staff. Staff knew people well and held positive relationships with them. Observations during the inspection confirmed the feedback we received.

Risks to people health were safely managed. People were supported with their food and nutrition and their medicines managed safely.

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 last rating for this service was inadequate (published 27 April 2021) and there were two breaches of regulations and a recommendation made in relation to the provision of activities. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had still not been made and the provider remains in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Livesey Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to management and governance, infection control procedures, staffing and person-centred care at this inspection.

Due to the repeated breaches and failure to make improvements to exit special measures enforcement action was taken against the provider to remove their registration.

Livesey Lodge is a residential care home providing accommodation and personal care to 13 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

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

At the time of our inspection there was an outbreak of COVID-19 at the service. We found multiple failings in the provider’s infection prevention systems and processes which increased the risk of the transmission of COVID-19, and placed people at significant risk of harm.

The service was not well managed following the COVID-19 outbreak. The registered manager and deputy manager were both absent from the service but had not ensured appropriate cover had been arranged. It was not clear who had responsibility for managing the service.

Quality assurance systems and processes had lapsed despite our previous recommendations to embed them. This prevented the concerns we found during the inspection being identified.

People’s care plans and risk assessments had not been reviewed. The impact of people being required to self-isolate had not been fully considered.

Staff were working consistently long hours and whilst caring and respectful the time they could afford to support people was limited as they were assigned multiple roles in absence of regular staff.

People’s medicines were managed safely.

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 17 March 2020).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we received about the service. The inspection was prompted in part due to concerns received about infection prevention and control and staffing at the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with infection control and staffing arrangements therefore, we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Livesey Lodge Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection control, safe care and treatment and the governance arrangements at this inspection.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Livesey Lodge Care Home accommodates 24 people in a single level adapted building.

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

People were not always supported to have meaningful activities.

We made a recommendation about the provision of regular meaningful activities to people,

We also made recommendations about further improvements to infection control practices, the environment to meet the needs of people living with dementia and quality monitoring. .

The care and support people received was safe. Staff knew how to raise any concerns they may have about people’s welfare. Medicines were managed and stored safely. There were enough staff to meet people’s needs. The provider followed safe recruitment practices.

Staff were trained and experienced to fulfil the requirements of their role. Staff had a good understanding of the Mental Capacity Act. People were supported to eat and drink well. Staff supported them to stay well and access health care services when needed.

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.

Staff were kind and compassionate. They treated people with dignity and respect, and took steps to promote their rights. Staff supported people and their relatives to be involved in decisions about their care.

Staff made relevant adjustments to ensure communication was tailored to the needs of individuals. People knew how to raise complaints and the provider acted on their complaints. The provider had effective systems in place to care for people at the end of their life.

The registered manager was aware of their regulatory responsibilities. They had systems in place to monitor the quality of care provided at the service. They took steps to engage people and staff in service planning and making improvements at the service.

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 requires improvement (published13 May 2019).

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:

• The provider had taken steps to make improvements to the service. However, there was insufficient evidence to demonstrate that the improvements would be sustained.

• There was no clear culture of transparency and open communication within the service.

• The management and administration of people’s medicines were safe. However, further improvements were required in the management and recording of support people received with prescribed creams.

• The provider had made improvements in the environment to make it safe for the people that used the service.

• The registered manager used a dependency tool to measure that there was sufficient numbers of staff to meet people’s needs.

• People were supported in accordance to relevant legislation. They were supported to maintain choice and control in their care planning.

• Staff supported people to meet their nutritional and health needs.

• Staff were kind and considerate to people.

• People were supported to engage in their interest and beliefs. They were supported to maintain relationships with people that were important to them.

• People had opportunities to raise any concerns they may have about the care they received.

Rating at last inspection: Inadequate; (published 14 December 2018).

Why we inspected: At our last comprehensive inspection on 15 May 2018 we found two breaches of the Health and Social Care Act 2008 (HSCA RA) (Regulated activities) Regulations 2014. These were breaches of Regulation 12 HSCA RA Regulations 2014; Safe care and treatment and Regulation 17 HSCA RA Regulations 2014; Good Governance. The service was rated as Requires Improvement. The Care Quality Commission (CQC) had also served the provider a warning notice for the breach of Regulation 17 HSCA RA Regulations 2014; Good governance.

On 25 October and 2 November 2018, we carried out a focused inspection to follow up concerns shared with the CQC. We inspected the service against two of the five questions we ask about services; 'Is the service Safe?' and 'Is the service Well Led?' This is because the service was not meeting some legal requirements in these areas and the information shared was relevant to these two key questions. At that inspection we found the provider had made some changes, but overall there was little improvement in the overall safety or governance of the service and the provider continued to be in breach of the regulations of the Health and Social Care Act 2008. The service was rated as Inadequate and went into special measures.

Following our inspection, the provider informed us what they would do to meet the regulations.

We carried out this comprehensive inspection to check their progress on improving the service and to check if they had now met the regulations. Our visit was unannounced. This meant the staff and the provider did not know we would be visiting. During this inspection we found the provider had implemented the necessary improvements, although some areas still needed further improvement. At this visit we found evidence to demonstrate and support the overall rating of Requires improvement. The service is no longer in special measures.

Follow up: ongoing monitoring; We will continue to monitor the home in line with our regulatory powers.

Livesey Lodge Care Home is a single storey, purpose built residential home which provides care to older people including some people who are living with dementia. The service is registered to provide care for up to 24 people. At the time of our inspection there were 20 people using the service.

Livesey Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Our last comprehensive inspection of this service was carried out on 15 May 2018. Two breaches of the legal requirements were found and we issued a warning notice. We found staff were not consistently following policies and procedures to ensure the safe management and administration of medicines, including those related to infection control. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe Care and Treatment. We also found the provider did not have effective quality assurance to monitor the quality of the care provided and ensure people received good care as a minimum standard. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance.

We rated the service as 'Requires Improvement'. The provider submitted information stating what they intended to do to address the shortfalls. You can read the report from our latest comprehensive inspection by selecting 'all reports' link for Livesey Lodge Care Home on our website at www.cqc.org.uk.

At this inspection we found the provider had made some changes, but overall there was little improvement in the overall safety or governance of the service and the provider continued to be in breach of the regulations of the Health and Social Care Act 2008.

The overall rating for this service is '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 no 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.

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.

There was a registered manager in post who was also the provider. 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.

People's safety was being compromised in a number of areas. Risks associated with the premises had not been effectively assessed or monitored. The provider had not taken action to protect people from the risk of burns or scalding from excessively hot surfaces and water temperatures. Maintenance was not provided in a consistent or timely manner to ensure the premises were safe and fit for their intended purpose.

The provider had not ensured sufficient numbers of suitably competent, skilled and knowledgeable staff were always available to keep people safe and meet their needs. The provider had adjusted staffing levels in response to concerns from external agencies, but had not used any recognised dependency tool or assessed people's dependency levels. They were unable to demonstrate staffing was sufficient to meet people's current needs. Staffing rotas were not an accurate reflection of staff deployment within the service.

Safe systems were not consistently in place to ensure people received their medicines as prescribed. Medicine errors were not identified or reported in a timely manner.

Risks associated with people's care and health conditions had been assessed but records did not always reflect people's current needs or demonstrate staff were following guidance in records. People were not always supported to move safely around the premises.

The provider had not adequately monitored the service to ensure it was safe. The provider had begun to undertake audits on areas of the service relating to hygiene, cleanliness and decor. Audits and checks had not identified the areas of concern we found during our inspection. The provider had not made adequate arrangements to ensure the effective leadership and governance of the service.

The provider had not made the significant improvements required since our last inspection to meet the requirements of the regulations and to keep people safe from harm. The provider demonstrated that lessons were not learned and our findings showed improvements were not made to provide a safe and well led service.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At the last comprehensive inspection in April 2017 the service was rated, 'Requires Improvement.' We found the service had made some improvements since our previous inspection in January 2017. However, further improvements were needed to ensure there was sufficient staffing to meet people's needs, risk assessments included the detail and guidance staff needed to keep people safe and meals were sufficiently varied and provided in a way in which people's needs were met.

At this inspection, we found the provider had made some improvements to meals and staffing. However, further improvements were needed to the management and administration of medicines, the safe deployment of staff and quality assurance to ensure people received consistently good care. The provider had failed to make sufficient, sustainable improvements to the quality of the service. The overall rating for this service remained 'Requires Improvement'. The service has been rated as 'Requires Improvement' for over three consecutive inspections.

Livesey Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Livesey Lodge Care Home accommodates up to 24 older people in one purpose built building. At the time of our inspection there were 18 people using the service, many of whom were living with dementia.

The service had a registered manager in post. 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.

Improvements were needed in the management and administration of medicines to ensure people received these safely. Staff demonstrated they did not consistently follow policies and procedures in managing medicines, including those related to infection control.

There were sufficient numbers of staff to meet people's needs but staff were not always deployed effectively to ensure people received the supervision they needed.

Staff demonstrated a good understanding of actions they needed to take to keep people safe. Records showed potential risks to people had been assessed, but did not always include the detail and guidance regarding the measures and interventions staff needed to take to reduce risks.

The provider had systems in place to monitor the quality of the care people received. These were not used consistently or effectively in ensuring staff followed systems and processes and people received good care as a minimum.

There were arrangements in place for staff to make sure that action was taken and lessons learned when accidents or incidents occurred. Reviews and analysis of records was not always undertaken in a timely manner to identify trends and patterns.

People were offered a limited range of activities. Further improvements were needed to ensure people were supported to engage in meaningful activities and were provided with sufficient stimulation to meet their needs and wishes.

Staff had completed training to enable them to recognise signs and symptoms of abuse and felt confident in how to report concerns.

Staff were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures.

Staff received on-going development training and supervision of their role. The registered manager reviewed and evaluated training to ensure it was effective. This supported staff to gain the skills and knowledge they needed to provide effective care.

People were provided with sufficient to eat and drink. Improvements had been made to the variety and provision of meals in the service. We found further improvements would help to enhance the 'dining experience' for people.

Care plans supported staff to provide personalised care. However, records were not always updated in a timely manner and did not demonstrate if or how people had been involved in the review of their care.

People's needs were assessed before they began to use the service. People were supported to make decisions and choices about their care. Staff understood the principles of the Mental Capacity Act 2005 (MCA), sought consent before providing care and respected people's right to decline care and support. 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.

People were supported to access a range of health professionals to maintain their health and well-being. Staff sought advice and worked in partnership with other agencies to support people to get the healthcare and treatment they needed.

People were treated with kindness, respect and compassion and they were given emotional support when needed. Staff demonstrated they understood the importance of upholding people's right to privacy and dignity.

Staff supported people to express their views and be involved in making decisions about their care as far as possible. This included consulting with relatives and access to independent advocates if necessary.

People and relatives told us they felt comfortable in raising concerns and complaints if they needed to and had confidence in the registered manager to take action to resolve them.

People, those important to them and staff were able to share their views about the service and the quality of care they received. These were used to review the service and bring about improvements to develop the care provided.

You can see what action we told the provider to take at the back of the full report.

Livesey Lodge provides residential care for older people. It is registered to accommodate up to 24 people, there were 21 people using the service on the day of our inspection.

The service had a registered manager. 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.

People and their relatives told us that they felt safe. Staff were aware of their responsibility to keep people safe. Safe recruitment practices were followed. People told us that there were not enough staff to meet their needs.

Risk associated with activities of people’s care had been assessed. Guidance was provided to staff to keep people safe from the risk of harm. The environment and equipment was checked and maintained in order to keep people safe. However, risks associated with hot radiators had not been assessed.

Staff had received training and supervision to meet the needs of the people who used the service. Staff told us that they felt supported.

People received their medicines as required. Medicines were administered safely by staff who were appropriately trained and competent to do so. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People were supported in line with the requirements of the Mental Capacity Act (MCA). People’s capacity to consent to their care had been assessed when there was a reasonable belief that they may not be able to make a specific decision.

People were supported to have enough to eat and drink.

People were supported by staff who understood that they should be treated with dignity and respect. People’s independence was promoted and encouraged. People’s relatives were welcomed to visit them without undue restriction.

People were supported to engage in activities that they enjoyed. People’s relatives had been asked for feedback about the service. People themselves had not yet been offered opportunity to feedback about the service.

People received support that was centred on them as individuals. Records reflected that people’s care needs had been met.

People’s relatives felt that the service was well-led. They knew how to complain should they have needed to.

Staff felt supported and that communication between them and the registered manager was good. They were clear on their role, the expectations of them and the aims and objectives of the service.

The registered manager had taken action to address concerns raised at our previous inspection. Systems were in place to monitor the quality of the service being provided.

The registered manger was aware of their responsibility to report to CQC and external agencies events that occurred within the service.

At the last inspection on 9 April 2015 we asked the provider to take action to make improvements. We asked them to improve practice relating to ensuring that people’s care was centred on their wishes and assessed needs and with regard to the way that the service was run. At this inspection we found that the provider had not made the necessary improvements. We identified that the provider was in breach of four of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see at the end of this report the action we have asked them to take.

The service provides accommodation for up to 24 older people and people with dementia and physical disabilities. On the day of our inspection there were 22 people using the service. Some of the people that used the service had advanced levels of dementia.

There was a registered manager. 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.

People did not feel safe at Livesey lodge. Staff had received training to keep people safe and understood how to raise concerns. The registered manager was not aware of their duty to report and respond to safeguarding concerns.

Some people displayed behaviour that could have caused harm to themselves and others. Staff were not clear about how best to support people whose behaviour posed a risk. Staff did not always have the knowledge and skills to meet the needs of people who were living with dementia.

Safe recruitment checks had not taken place prior to staff employment. There were not always enough staff to meet people’s needs.

People were not protected from risks relating to their support needs for example when they needed support to maintain a balanced diet.

People could be assured that they received their regular medicines as prescribed by their doctor. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was not routinely asked.

Where people were at risk of dehydration this was not monitored appropriately. People were not consistently offered choices about their meals.

Staff treated people with dignity and respect but people’s bedrooms were not respected as private. People were not offered the opportunity to contribute to the planning of their care. People were not consistently supported to engage in activities that they enjoyed

Records were not always detailed and did not always reflect the support that people had received particularly around people’s anxieties. People were at risk of being over medicated when experiencing behaviours that could cause harm or distress to themselves or others.

People’s care plans did not include enough information to guide staff on the activities and level of support people required for each task in their daily routine. There was a risk that people would not receive the care that they needed. People’s changing needs were not formally assessed.

Feedback about the service had not been sought and complaints were not dealt with in line with the provider’s policy. People could not be confident that the registered manager would act on their concerns even when these were expressed to staff. There were no systems in place to challenge poor staff practice and take action where concerns had been raised.

Systems were in place to monitor the quality of the service being provided however, these were not always effective. Not all of the concerns raised at our last inspection had been addressed.

People's needs and the support they required were recorded within care plans. People were supported by a range of health care professionals in the monitoring of their health and wellbeing. Staff we spoke with had a good understanding of the needs of people who used the service.

We found people's nutritional needs were assessed through the services assessment process. We observed the lunchtime dining experience for people, which was positive. People we spoke with gave mixed views about the meals provided. One person told us: 'The food isn't that good, I'd like a bit more meat and roast potatoes instead of mashed.' Whilst two other people told us: -'The food is alright.' And 'the food is reasonable, however there's no choice, but if you didn't like something they'd cook you something else.' The Chef, who was new to the service, told us they had begun consultations with people about their meal preferences and were hoping in conjunction with the provider to revise the menu and the meals provided.

Records we viewed confirmed staff had undergone an effective recruitment and selection process and had accessed the appropriate training. We viewed records which showed the service had effective systems for the maintenance of the property.

" They clean my room well and I have a new mattress on my bed."

" There is plenty of food to eat, it is very nice here."

" Nothing concerns me here."

" Two staff always use the hoist when they assist me."