Archived: Loran House

This unannounced inspection took place on 29 December 2016. At the last inspection of the service on 25 and 26 June 2015 the registered provider was non-compliant with regulations pertaining to deploying suitable numbers of staff [regulation 18 (1) staffing], providing effective levels of support to staff [regulation 18 (2)(a) staffing], and quality monitoring systems [regulation 17 good governance].

During this inspection we saw that the registered provider had taken action to ensure compliance had been achieved with the aforementioned regulations. People who used the service were supported by suitable numbers of staff who had received effective levels of one to one supervision and support. The registered provider had reviewed and developed their quality monitoring systems to ensure shortfalls in care and support were highlighted and rectified in a timely way.

The registered provider is required to have a registered manager in post at Loran House. We found the manager had been registered with the Care Quality Commission since 1 October 2010. 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.

Assessments of people’s care and support needs were undertaken regularly to ensure staff were deployed in suitable numbers to meet their needs. People who used the service were supported by staff who had been recruited safely following the completion of appropriate checks. Staff had completed training to ensure they knew how to protect people from abuse and avoidable harm. The registered provider had developed plans to deal with foreseeable emergencies which included guidance to enable staff to evacuate people safely in an emergency. Medicines were ordered, stored and administered safely and people received their medicines as prescribed.

Staff received effective levels of support and one to one supervision. Staff told us they felt supported by the service’s management team. People were supported by staff who had completed relevant training to enable them to meet the assessed needs of the people who used the service. Staff were encouraged to develop their knowledge and skills by undertaking nationally recognised qualifications. Staff understood how to gain consent from the people who used the service and the principles of the Mental Capacity Act 2005 were followed when people could not make specific decisions themselves. A range of healthcare professionals were involved in the care and treatment of the people who used the service. People were supported to eat a healthy balanced diet and appropriate action was taken when concerns with people’s dietary intake were identified.

People who used the service were supported by caring staff. People were treated with dignity and respect by staff who knew their needs and understood their preferences. Staff showed a genuine interest and affection for the people they cared for. We heard people laughing and sharing stories during their interactions with staff. People’s private information was stored securely and treated confidentially as required.

Staff recognised changes in people’s presentation or condition and responded appropriately. Reviews of people’s care took place on regularly and people or their appointed representative were involved in the initial and on-going planning of their care. Care plans had been created to ensure staff understood and could deliver the care and support people required consistently and safely. People took part in a range of activities and were encouraged to follow their interests. The registered provider had a complaints policy which was displayed within the service. We saw that when complaints were received they were responded to appropriately.

The registered provider’s quality assurance system included audits, checks, observations and service user feedback. The manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC as required. Meetings were held with staff and people who used the service to ensure their views were known and could be acted upon. Staff told us the management team were approachable, supportive and listened to their views regarding developing the service. People and visiting relatives knew the registered provider and were observed to comfortably engage with them during the inspection.

We have reviewed the records we held and the records held at the service. We found the registered manager had notified us appropriately and within the required timescales of any incidents or events that affected the health, safety and welfare of people who used the service.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

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

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

' Is the service caring?

People were supported by attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

Staff demonstrated a good understanding of the needs of the people who used the service and could describe how to maintain people's dignity and how to ensure people's choices were respected.

People who used the service, their relatives, friends and other professionals involved with the service, completed an annual satisfaction survey. Where suggestions or concerns had been raised the provider had listened and made changes to the service. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

' Is the service responsive?

Care records demonstrated there had been changes in people's needs. We found that other health care professionals, for example doctors and district nurses had been consulted and their advice sought.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated when required.

' Is the service safe?

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

The people who used the service told us they were happy and that they felt safe. We saw that people were treated with respect and dignity by staff.

Staff had completed training in how to safeguard vulnerable adults. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly so people who used the service were not put at unnecessary risk.

' Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care when possible. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

The majority of staff had received appropriate training and professional development. Specialised training had been completed to ensure the needs of the people who used the service could be met.

' Is the service well led?

The service had a quality assurance systems in place and records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

What people who used the service and those that matter to them said about the care and support they received.

People who used the service told us that they felt the home was clean and tidy. One person said, 'It's always lovely and clean, the girls do ever such a good job.'

People told us staff respected their privacy and dignity. Comments included, 'I like it here ' the staff are quite good and they do look after your health. I like to be independent and manage my own tablets; I prefer to stay in my room', 'The staff knock on bedroom doors before entering' and 'I'm happy here; the meals are ok.'

A relative we spoke with said, 'My Mum has passed away now, she received end of life care here and I couldn't have asked the home to do more.' Another relative told us, 'I can't fault the care; they look after her so well' and 'I can go away and if I'm needed I will be called. It means a lot to know she is in good hands.'

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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

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

Is the service safe?

We saw people who used the service were treated with respect and dignity by the staff who supported them.

Systems were not in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

The service was generally well maintained. However, the provider did not follow best practice guidance in relation to infection, prevention and control. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control.

There were not sufficient numbers of staff on duty to support people's individual needs and promote their independence. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing.

Is the service effective?

People's health and care needs were not assessed on a regular basis. People who used the service and their relatives had not always been involved in writing plans of care. Care plans were not reviewed and updated appropriately. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care and welfare of people who used the service.

The majority of staff had not received appropriate training or professional development. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff.

Is the service caring?

People living at the home were supported by staff to maintain their independence; staff gave encouragement and showed patience when supporting people. All of the interactions between staff and people who used the service we witnessed were positive.

Is the service responsive?

Care records did not demonstrate there had been changes in people's needs. We found that other health care professionals, for example doctors and district nurses had been consulted and their advice sought.

People had limited access to social activities. During our visit we saw people going out into the community supported by staff or participating in activities at the service.

Satisfaction surveys had been used to enable people to share their views on the service provided.

The manager told us there had been no complaints since our last inspection.

Is the service well-led?

There was no quality assurance system in place to assess if the home was operating correctly. We saw no action plans were in place to address any shortfalls and monitor that progress was made to address them.

Staff had no access to policies and procedures to inform and guide them. Staff training and development needs had not been assessed to enable the provider to arrange future training sessions.

What people who used the service and those that matter to them said about the care and support they received.

We asked some people who used the service about the activities they participated in. They told us, 'What activities, there is no programme. We used to have a person that came in to do chair based exercises but I think that has stopped now. It's a pity because lots of people enjoyed those sessions', 'No activities and no singers now. I pass time looking after people; when I'm in the lounge I call the staff if people need help' and 'They had entertainment when I first moved in. I like to mooch around during the day and watch a bit of TV.'

People told us that the staff were, 'A good bunch', 'Very nice bunch of staff, they do anything for you' and 'One or two are really good. Some staff just seem to forget what you've asked them but some of the others are excellent.'

We were also told, '75% of the staff are efficient generally; some staff are good and some not so good. For the other 25% it's just a job' and 'I came here when it first opened but as numbers have increased the standards have slipped. Sometimes people don't get the support they need, they have to wait for help.'

A visiting relative said, 'Some of the care staff don't handle people with memory problems well. I've seen when residents have been escorted to the toilet and 10 minutes later they want to go again. Some staff can distract people and with others it's confrontational.'

Staff were able to explain the direct care and support they provided for people who used the service and who they were a 'key worker' to. A member of staff we spoke with told us, 'The care plans tell us what people's needs are and if these needs change we would document this in their care plan.'

We saw that people's care records included a visit from other health care professionals and were recorded on a 'professional visits sheet'. For example, a doctor or an emergency care practitioner.

Staff we spoke with were knowledgeable about hand washing procedures and good practice. Staff confirmed that uniforms provided by the service were not allowed to be worn outside the workplace. Staff also confirmed uniforms were washed at their own home on the highest temperatures, which ensured the risk of cross infection was reduced.

We saw that rooms were personalised by the people that used the service. This showed the service promoted people's independence and supported their daily living activities.

We found that people were provided with a varied and nutritional diet. People told us the food was excellent and they had plenty of choice. Comments included, 'The food is excellent you can't fault it', 'I really enjoy the food, I'm always full after my meals' and 'There is always plenty of choice.'

We found that people's medication was administered and stored safely and staff had received medication training.

We found that staff had received training about meeting the needs of older people and how to keep people safe from harm. Comments included 'The girls are very professional and always make sure I'm safe and well looked after.'

We found that people could make complaints and these were acted on and resolved were possible to the person's satisfaction. People told us they would approach the manager or the owner if they had any concerns. Comments included 'I would talk to the manager or the owner if I wasn't satisfied', 'They are all very approachable' and 'I have spoken with the owner and he always listens and puts things right.'