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Inspection report

Date of Inspection: 21 May 2014
Date of Publication: 27 June 2014
Inspection Report published 27 June 2014 PDF

Overview

Inspection carried out on 21 May 2014

During an inspection looking at part of the service

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Lucerne House is comprised 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 on 24, 26 February and 03 March 2014 we identified significant concerns about the care and welfare of people, staffing levels and quality monitoring at Lucerne House. CQC took enforcement action by serving three warning notices on the provider, which required them to make urgent improvements in these areas within four weeks. We also identified concerns about five other standards, which were less serious.

This was a follow up inspection to check the most urgent improvements required had been made. We visited the home on 21 May 2014 and found the provider had complied with the warning notices served and had and made significant improvements in people�s care and welfare, staffing and in quality monitoring. We have since received an action plan from the provider about the remaining improvements underway at Lucerne House in relation to the other five areas of non-compliance. We will carry out a further inspection later this year to check further improvements have been made and to ensure existing improvements have been sustained.

At the time of our inspection there were 59 people living at Lucerne House nursing home. Following the previous inspection, the provider agreed not to admit people to the home until improvements in care had been made. We spoke with 23 people who lived there and with seven relatives to seek feedback about the care. We spoke with 24 staff who worked at the home which included the manager and other senior staff, nurses and care workers, agency and other support staff. We also spoke with five health care professionals who regularly visited the home to seek their feedback.

Is the service safe?

As a result of the concerns identified at the previous inspection, a multiagency safeguarding process was convened to oversee the improvements. A multi-disciplinary plan was drawn up by the provider and 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. Feedback we received from health and social care professionals confirmed our findings that care had improved across all areas of the home and risks had significantly reduced.

One person said, �I like it here and I feel 100% safe�. We found that people were well supported to have adequate nutrition and hydration and we found the health of people previously at risk of malnutrition and dehydration had improved and they had gained weight. Security in the home had also been improved to prevent visitors having unauthorised access to the home. Health and safety systems had been improved, all damaged crash mats and bed bumpers had been replaced and were being closely monitored. People on Shillingford unit who needed hoisting had individual hoist slings, which had increased their safety and reduced cross infection risks.

Is the service effective?

Since we last visited, staff on Ide unit had undertaken training on nutrition, hydration and on end of life care. Staff we spoke with demonstrated much more knowledge and confidence in caring for people�s needs. Nutritional care plans had been reviewed and updated to give staff much more information about how to support people�s nutrition and hydration needs. Health professionals also reported they received fewer phone calls for advice between their visits due to increased staff confidence in providing care. People and relatives also reported improvements. One said, �Absolutely fantastic, they are more organised� and another said, �I can see huge improvements�.

Is the service caring?

Throughout our visit, we saw that people were treated in a caring and compassionate manner and with dignity and respect. We saw that staff were engaged with in meaningful conversations with people and treated people as individuals. Comments included, �Mum is very well cared for� and �Overall my family and I are very happy with the care our mother receives�.

Is the service responsive?

Staffing levels at Lucerne House had significantly increased. A number of staff we spoke with told us how the increased staffing levels had improved people�s care. One said, �Staff are not so stressed, we can sit with people at lunch and engage with them�. One relative said, �X seems much calmer, staff can now spend more time with him, he is getting more to eat and drink regularly and I am pleased with that�.

We found that people were being regularly supported with personal care and that people who needed support to eat and drink regularly received that support. We also saw how care records had improved and provided better information for staff about how to respond to people�s individual needs. Staff were responsive when people called out and quickly went and reassured them and they also responded quickly to call bells. We observed that staff sat down next to people who needed support with their drinks and discreetly assisted them, where necessary. We saw that staff were patient and allowed people time to eat in a calm unrushed environment.

Is the service well led?

People and relatives we spoke with reported improvements in the leadership and management at the home. The manager has been in post for three months and is currently undergoing registration with the Care Quality Commission to become the registered manager at Lucerne House. One relative said, �The home feels more stable, the manager seems to be here more often, his door is always open which makes me feel happy to approach him if I felt I needed to�. Another relative said, I feel things are much better, we feel more confident in the home�.

We found the quality monitoring systems at the home had been improved and that prompt actions had been taken to reduce the risks we highlighted previously and to improve people�s health, welfare and safety.