Archived: Layden Court Care Home

Layden Court is a care home providing accommodation including nursing care for up to 89 older people. At the time of the inspection 85 people were using the service.

People’s experience of using this service

Although, some improvements had been made in the management of medicines, further improvements were needed. The provider monitored and analysed accidents and incidents and this helped prevent recurrences. However, there was room to improve the recording and monitoring of minor injuries, such as scratches and bruises of unknown origin. Overall, the provider ensured people were protected from abuse, and safeguarding concerns were reported appropriately to the local authority. There were enough staff available to meet people needs.

The provider had continued to make improvements to the environment and this was ongoing. The registered manager ensured shortfalls in cleanliness and infection control were addressed during the inspection. Some people's dining experience did not meet their needs on day one of the inspection. However, the registered manager addressed this and people’s experience was much improved on day two, although there remained some room for further improvement. Overall, people's needs and choices were assessed and care records showed people's needs were met. However, some people's care plans needed updating. Staff we spoke with felt very well supported by their managers, but not all staff had been provided with supervision sessions on a regular basis.

For the most part, staff treated people with respect and dignity. We saw that staff were kind and caring, recognised when people needed support and engaged appropriately with people. People and those close to them were involved in formulating their care plans, although there was room to improve the evidence of their involvement in the monthly reviews of their care.

People had opportunities to engage in activity and social interaction, although there was room to improve this for people who spent more time in their rooms, or those living with dementia. People's choices for their end of life care had been considered and were recorded and reviewed. People we spoke with knew how to raise a complaint and said they felt comfortable to do so. The registered manager dealt with people’s complaints in a fair and open way and used positively to improve the service.

Rating at last inspection and update

The last rating for this service was good ( published June 2017). You can read the report from previous inspection by selecting the ‘all reports’ link on our website at www.cqc.org.uk

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.

Layden Court is a care home providing accommodation including nursing care for up to 89 older people. It is situated in the area of Maltby, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and gardens at the rear. At the time of our inspection there were 78 people using the service.

There was a registered manager at the time of our inspection. 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 home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with were aware of procedures to follow and the importance of reporting any incidents. Assessments identified risks to people and management plans to reduce the risks were in place. People we spoke with told us they felt safe and relatives also said the home provided safe care.

Systems were in place to make sure people received their medications safely; however some minor improvement could still be implemented.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found the requirements of the act were being met.

There was an infection control policy and a procedure in place and the service was maintained to a good standard of cleanliness. However, staff told us they could do with domestic hours in the late afternoon or evenings.

At the time of the inspection there was sufficient staff on duty to meet people’s needs. Relatives we spoke with confirmed when they visited there were sufficient staff on duty. The provider had a system to ensure safe recruitment was carried out. However we identified some issues in two staff files which were followed up and resolved during our inspection. Staff told us they felt supported and communication was good. However, some staff had not received formal supervision in line with the provider’s policies.

Improvements to the environment had been made to provide areas that were dementia friendly. The registered manager was continuously looking at ways to further improve the environment for the people living with dementia who lived in the home.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. People told us they enjoyed the food provided at the home. However, some improvements could still be made at mealtimes to further improve the experience for people living with dementia.

We observed staff interacting with people who used the service and found they were kind, caring and respectful. People we spoke with spoke very highly of the staff and the care they received.

We looked at care plans and other written records and found that in most cases, they reflected people’s current needs. However, we saw in some files there was no end of life care plan to ensure people wishes and decisions were recorded.

The home employed two activity co-ordinators who was responsible for arranging activities and social events. We saw activities taking place and people enjoying these.

The provider had a complaints procedure in place. People felt they could speak with staff if they had a concern. People told us they were listened to and that the registered manager was very good, they were always willing to listen and resolved any issues no matter how minor.

Relatives were very happy with how the service was run, and told us the registered manager had made improvements.

There were systems in place to monitor and improve the quality of the service provided. Action plans were implemented for any improvements required and these were followed by staff. The quality monitoring had identified the issues we saw and the registered manager and regional manager had plans in place to ensure these were resolved.

This was the third rated inspection for this service which had previously been rated inadequate in November 2014. In May 2015 we carried out a further comprehensive inspection and found improvements had been made, but further improvements were required to be implemented and was rated as requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Layden Court’ on our website at www.cqc.org.uk’

Layden Court is a care home providing accommodation including nursing care for up to 89 older people. It is situated in the area of Maltby, approximately six miles from Rotherham town centre. It provides accommodation on both the ground and the first floor and has parking to the front of the building and gardens at the rear.

The home 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.

During this inspection we found improvements to the service provided had continued to be made however we found these were not yet fully embedded into practice. We found and staff told us that the new Registered Manager was having a positive impact on the service. The main issues identified within this report related to management and staffing shortages that have now been addressed however the provider monitoring systems in place had failed to identify the impact of staffing shortages on the quality of the services provided to ensure risks could be managed or mitigated effectively.

We found that staff had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how support people who do not have the capacity to make specific decisions about their care.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms, so appropriate referrals to health professionals could be made. The home involved dieticians and tissue viability nurses to support people’s health and wellbeing. However, although staff knew people well and understood any risks associated with their care, we found these were not always documented in people’s plans of care and formal reviews had not been carried out.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. People we spoke with told us they enjoyed the food. However we found some meal times could be improved to meet the needs of people living with dementia.

We found staff approached people in a kind and caring way which encouraged people to express how and when they needed support. People we spoke with told us that they were able to make decisions about their care and how staff supported them to meet their needs.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, we found these were not always followed.

There were robust recruitment procedures in place; staff had received formal supervision and an annual appraisal. Staff received training to be able to fulfil their roles and responsibilities.

We found that generally, there were enough staff to keep people safe, although people told us there were times when staff were very busy. We also found there was a lack of stimulation and social activities for people who used the service.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. Staff praised the new registered manager and told us the home had improved with them in post and felt they were working well as a team to continue to improve.

People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it.

There were systems in place to monitor the quality of the service provided. We saw these were completed although they had not always identified areas which required improvement.

Our inspection identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

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

Is the service safe?

People were treated with respect and staff maintained people's dignity. People told us that the staff were very good and were always there to help them. One person said, 'The staff look after me, it is alright here.'

We found some quality monitoring systems were in place. This ensured the risks to people were identified and reduced, to be able to continually improve.

Appropriate arrangements for the recording, safe keeping and safe administration of medicines were in place.

Staff supervisions and appraisals had not been kept up to date since the manager had left. This included clinical supervision for qualified staff. The provider had appointed a new manager who had implemented a schedule to address this. The staff told us the new manager was very approachable and if they needed to discuss anything they would not hesitate to speak with him.

During our visit we observed there were not effective systems in place to reduce the risk and spread of infection. Many areas were not maintained to an appropriate standard of cleanliness.

Is the service effective?

Most people's health and care needs were reviewed, and if people were able they were involved in the reviews.

Audits and reviews had taken place, the audits were thorough and had identified shortfalls. For example the need to ensure staff supervisions were carried out. However the infection control audits and environmental audits had not been effective as the standards observed were not appropriate.

We observed activities on-going during our visit people were engaging in the activity and enjoying it. However it was a very small group of people engaging in the activity.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

We spent time in the dining room during lunch observing. We saw the experience was inclusive, calm, supportive and enjoyed by people who used the service. People were not rushed and their choices and preferences were respected. We observed staff giving appropriate sensitive support when required.

Is the service responsive?

The provider had redecorated a number of communal areas, however the redecoration programme had not continued and many areas were in need of improvement.

The new manager had already identified a number of improvements required and was in the process of implementing what was required to ensure the improvements were carried out.

Is the service well-led?

The provider had appointed a peripatetic manager to oversee the service until a new manager was appointed. At the time of our visit a new manager was in post, he had support from the peripatetic manager and the area manager.

The new manager told us he was in the process of submitting an application to CQC to become the registered manager.

We found people expressed their views and were involved in making decisions about their care and treatment. People were confident that their relatives would ensure they received appropriate care. One person we spoke with said, 'They know what to do for you and they do it.' Another person said, 'They look after you here, the staff are good and no matter what you want they will fix it up for you.'

We found staff had an excellent rapport with the people who used the service. One of the relatives said 'The nurses are absolutely excellent, and I have no concerns about my relatives care.' Another relative said 'Staff appears to be very caring with all of the residents which is important to me'.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff had a good knowledge of the needs of people who used the service.

People were cared for, or supported by, sufficient suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people received. Complaints were investigated and responded to in a timely manner.