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Inspection report

Date of Inspection: 24, 26 February and 3 March 2014
Date of Publication: 20 May 2014
Inspection Report published 20 May 2014 PDF

Overview

Inspection carried out on 24, 26 February and 3 March 2014

During an inspection looking at part of the service

At the time of our inspection there were 68 people living at Lucerne House nursing home and the home employed over 100 staff. The service consisted of three units known as Shillingford unit, which provides care for people with dementia; Ide unit, which provides care for older people, and Alphinbrook unit, which provides care for younger people with physical disabilities.

At our previous inspection in August 2013, we identified five areas of non-compliance with the Care Quality Commission�s Essential Standards of Quality and Safety. These were related to people�s care and welfare, equipment, premises, staffing and managing complaints. The provider sent us an action plan outlining improvements being made to become compliant. This inspection was undertaken to check the required improvements had been made.

We visited the home over three days and spent a day on each unit. We spoke with 27 people and relatives to gain their feedback about the service. We also received feedback directly from five relatives via our website. We looked at 14 people�s care records. We spoke with 31 staff who worked at the home which included the registered manager, other senior staff, nurses and care workers, kitchen, housekeeping and maintenance staff.

Some people and relatives we spoke with were happy with the care and support they received. One person said, �When I want them, they are there.� A relative said, �The care is excellent, they look after her really well�. However, a number of people and relatives raised concerns with us about shortages of staff and about the lack of skills and experience of some staff. One person said, �The main issue here is not enough staff, they are understaffed quite a lot of the time�. A relative said, �Staff are mostly friendly and hard -working but some appear very inexperienced�. A second relative said, �They are going through a difficult time of being short staffed, particularly in the evening�. A third relative we spoke with was really concerned the person wasn�t getting enough to eat and drink.

Most of the staff we spoke with told us the home was short staffed on a regular basis. The registered manager confirmed they had reviewed staffing levels in relation to people�s needs since the last inspection and had increased staffing levels. However, we saw that frequently, the recommended staffing levels required to meet people�s needs were not being maintained due to staff absence. This meant people did not always receive the support and help they needed to maintain their health, safety and welfare.

We spoke with nine health care professionals who regularly visited the home to seek their feedback. Health professionals told us that the home contacted them appropriately for advice and support about people�s care. However, several health professionals we spoke with raised concerns with us about the lack of knowledge and experience of some staff who worked at the home and about low staffing levels. One health professional said, �It depends on which staff are on duty, some are very experienced, others less so�, another health professional said, �Some staff are struggling�.

During our inspection, we found staffing levels were not sufficient to meet people's needs. On Ide unit, we found staff were not able to meet some people�s basic care needs in a timely manner such as providing support for people who needed assistance with eating and drinking. People on Ide unit were not adequately supported to have regular meals, drinks and snacks. Also, eight care records we looked at about people�s eating and drinking were so poorly documented that we could not tell whether those people were given enough to eat and drink. We found nutrition care plans in relation had not been followed and three people had lost weight. This meant the care needs of people who were at risk of malnutrition and dehydration were not being met, which put their health, welfare and safety at risk.

We immediately raised our concerns with the provider about the lack of support for people with eating and drinking on Ide unit and gave clear feedback about the areas for improvement. The examples of poor management of care and poor practice we found on Ide unit were promptly shared under a safeguarding process. A multi-disciplinary plan was drawn up by health and social care professionals to protect people�s safety and well-being. This resulted in health professionals visiting the home as part of a safeguarding investigation and in a protection role.

We followed up equipment concerns raised at our previous inspection about damaged and soiled bed rail bumpers and crash mat equipment. We found a number of people�s bed rails bumpers and crash mats were soiled and torn. These were unsightly and undignified for those people and represented an infection control risk. We also identified ongoing security risks related to the main entrance of the home. This was because the reception desk was often unmanned during the day and because the main entrance was left open early in morning and between five and eight o� clock at night. This meant visitors and others had unrestricted access to the home, which put vulnerable people at risk.

The home had a number of quality monitoring systems in place, but some of these were not effective. This was because they were not identifying the risks we highlighted during the inspection such as about adequate nutrition and hydration for people, concerns about low staffing levels, soiled and damaged equipment and t security risks. This meant prompt actions were not being taken to reduce those risks which put the health, welfare and safety of service users and others at increased risk.

We found the home had not made the required improvements and was not compliant with any of the eight standards we inspected.