Lukestone Dementia Nursing Home

Lukestone Dementia Nursing Home is a residential home providing personal and nursing care for up to 43 people living with dementia. At the time of the inspection, there were 43 people living at the home. Lukestone Dementia Nursing Home is a large secure building, adapted over three floors, in a residential area of Maidstone.

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

There were not always risk assessments in place to give staff the guidance they need to keep people safe. Medicines were not always managed safely as there was a failure to ensure one person received their prescribed medicine for two weeks. Incidents were not always effectively reviewed to prevent a reoccurrence.

Staff told us there was not always enough staff to observe people and ensure their safety and meet their needs. Staff told us they did not have the training they needed to meet people’s needs around emotional distress and dementia.

Management checks and quality assurance systems had failed to identify the concerns we found at inspection and therefore necessary improvements had not been made. People and staff were not always engaged well with the service. Staff concerns were not known by the registered manager. People and their loved ones were not involved with their care planning.

People told us they felt safe and staff knew how to report incidents of avoidable harm. The prevention and control of infection was managed.

People living at Lukestone Dementia Nursing Home told us “it is a nice environment,” “staff are honest and open” and “they are good staff, nice people. I can always have a laugh.” Relative’s commented, “This place seems like a home,” “The staff are absolutely brilliant,” and “I am very happy with this care home.”

It was clear that most staff knew people well. Interactions were kind and supportive and people living at the service and their loved ones praised the care they received.

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 20th June 2018).

Why we inspected

We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the management of risk. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led section of this full report.

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.

At this inspection, we have identified breaches in safe in relation to management of risks and learning lessons from incidents and the safe management of medicines. We have identified breaches in well-led in the lack of effective management systems to ensure safe and quality of care and a lack of good record keeping.

Please see the action we have told the provider to take at the end of this report.

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.

We inspected the service on 15 and 16 May 2018. The inspection was unannounced. Lukestone Nursing Home is a ‘nursing home’. People in nursing homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lukestone Nursing Home is registered to provide accommodation, personal and nursing care for up to 44 people, and there were 37 people living at the service at the time of the inspection.

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.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service remains good.

People were protected from harm by staff who were trained to identify signs of abuse. Where risks to people of the environment were identified, staff took action to minimise them. There were enough staff to meet people’s needs, and staff were recruited safely. Medicines were stored, given to people as prescribed and disposed of safely. People were protected by the prevention and control of infection. Lessons were learned when things went wrong.

People’s needs were assessed before they moved into the service. These needs were met by staff who had the skills and knowledge to deliver effective support. People were supported to eat and drink enough to have a balanced diet, including those with complex health needs. People were supported to have healthier lives by having timely access to healthcare services. People lived in an environment which was suitable for people living with dementia. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People received a service which was caring. People were treated with dignity and respect by staff who were compassionate and caring. Staff treated people’s private information confidentially. People were able to make decisions about how their care was provided, and were involved in reviews of their care along with people who mattered to them.

People received care that was personalised to their individual preferences. Staff knew people’s needs and personal histories well. When people or their families had complaints or concerns they were encouraged to raise them. Management saw complaints to be an opportunity to improve the service. People were supported at the end of their life to have a dignified and comfortable death.

The registered provider’s vision and values were embedded into the service, staff and culture. Governance systems were effective in ensuring shortfalls in service delivery were identified and rectified. Management encouraged honesty and transparency in the service. . People and their families were encouraged to be involved and engaged with the service. The registered manager had developed links with the local community.

Further information is in the detailed findings below

Lukestone Dementia Nursing Home provides accommodation for up to 44 people who need nursing and personal care. Communal areas, such as the lounge and dining room are on the ground floor. Bedrooms are found over three floors accessed by stairs and a passenger lift. There is a garden to the rear of the building. At the time of our visit, there were 40 people who lived in the home. People had a variety of complex needs including dementia, physical health needs and mobility difficulties.

There was a registered manager at the home. 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.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to

manage these safely.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Staff knew each person well and had a good knowledge of the needs of people who lived at the home. Training records showed that staff had completed training in a range of areas that reflected their job role. Staff told us that they had received supervision and appraisals were on-going.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the home to be meeting the requirements of Deprivation of Liberty Safeguards.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The cook prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and that staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

At this visit we checked how the management of the home had addressed this and found improvements had been made.

People using the service had dementia. This meant they were not always able to tell us their experiences. We observed how people interacted with the staff and management of the home both during and after the lunch time meal. We spoke with five staff, the manager and looked at records.

We found that staff had a good understanding of the different people who lived in the home. Staff who we spoke with told us how they supported people and what people did and didn't like. One member of staff said, 'It is so important to talk to people, they need conversation and company'. Another member of staff explained how they were promoting, 'Meaningful interactions' with people and described the use of 'memory boxes' that contained items that were important to the person.

All the staff we spoke with knew how to support people when they displayed challenging behaviours.

We observed that staff were kind and patient with people. They listened to what people had to say and answered their questions with patience and understanding.

Staff had received updated training and guidance to support them in their roles.

Visitors we spoke with told us that they were happy with the care provided to their relatives. They told us, 'This is a very nice home and I am well pleased with the care and support given". 'Everyone is very respectful and they never get agitated with people". "Staff are very patient and kind'.

We found that people or their representatives had been involved in decision making and giving their consent for care and treatment.

People were provided with appropriate care and support, although some staff were unable to manage challenging situations and unsure of how to interact with someone who was aggressive.

People received the medication they needed at the time they needed it.

There were enough staff on duty to meet the needs of the people who lived in the home.

There was an effective system to regularly assess and monitor the quality of service that people received.

We have highlighted areas in the report which the provider may find it useful to note to make sure compliance is sustained.

People who lived at the home were experiencing dementia and were not always able to tell us about their experiences. We used a number of different methods to help us understand the experiences of people using the service. We observed how people interacted with staff and the management of the service. We saw the atmosphere in the home was calm and relaxed.

People we spoke with said, 'Care is genuine here, staff take time to sit and talk to people'. 'It is excellent care here, they always listen if I have any concerns and all the staff are very kind.' People told us they felt safe in the home. We saw that people enjoyed their meals and the activities on offer during our visit.