Archived: Market Lavington Care Home

During the last inspection in March 2015, we found breaches to some of the legal requirements in the areas we looked at. Improvements were seen during this inspection which demonstrated the service had responded to our feedback and had implemented improvements in line with their action plan.

The inspection took place on 27, 28 and 30 September 2016 and was unannounced.

On the day of our inspection, there were 68 people living at the home within two separate units. The residential unit had people’s bedrooms on the ground and first floor. There were two lounges, a separate dining room, bathrooms and toilets and a passenger lift to give easier access to both floors. The nursing unit had similar facilities but also contained the main kitchen and laundry facility.

A registered manager was employed by the service. 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 registered manager has worked at the home for approximately fifteen years. The registered manager was present for the inspection and the area manager on days two and three.

The ordering, storage and disposal of medicines was managed effectively. We observed two medicines rounds during the inspection. The administration of medicines was done in accordance with current guidelines and regulations apart from one occasion when, during one of these medicines rounds, a staff member had not consistently witnessed people taking their medicines but had signed the medicine administration records to confirm they had done this. This increased the risk as the member of staff could not be confident these people took their medicines when administered and at the prescribed time.

People told us they felt safe when receiving care. Staff were able to tell us how to recognise signs of potential abuse and what action to take if they had any concerns. People’s risk assessments had been made and recorded in people’s care files. Staff told us there was a culture of balancing risk whilst also not being too restrictive which meant people’s freedom was considered in order to help them maintain their independence.

There were sufficient numbers of suitable staff to support people and safe recruitment practices had been followed before new staff members started working at the home. People who used the service and their relatives were positive about the care they received and said staff had sufficient knowledge to provide support and keep them safe.

Arrangements were in place for keeping the home clean and help reduce the risk and spread of infection. People’s rooms and sanitary ware in bath and shower rooms were kept clean.

People were encouraged to make decisions and staff gained people’s consent prior to carrying out any tasks. The service had a clear understanding on the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).

Staff received regular training in relation to their role and the people they supported and told us this training supported them to do their job effectively. Staff received regular supervisions and an appraisal where they could discuss personal development plans. This meant staff received the appropriate support to enable them to provide care to people who used the service.

The documentation to monitor diet and fluid intake of people who were at risk of malnutrition and/or dehydration were not consistently completed. Staff told us this information was recorded in people’s daily records but this was not consistently done. This meant people were at risk of dehydration and/or malnutrition.

People and their relatives told us they had access to health services and a GP performed weekly visits to the home with additional visits according to any changing healthcare requirements.

The registered manager and staff we spoke with were passionate about providing care which was tailored to people’s needs and choices. People told us they were happy with the care they received and the way staff treated them. Throughout our visit we saw most people were treated in a kind and caring way and staff were friendly, polite and respectful when providing care and support to people. However, we observed some staff who were task focussed and sometimes did not converse with people they supported with their meals.

Staff understood the needs of people they were providing care for. Care plans were individualised and contained information on people’s preferred routines, likes, dislikes and medical histories.

People, their relatives and staff were encouraged to share their views on the quality of the service people received and were informed of what improvements and changes had been implemented following their feedback.

People, their relatives and staff spoke highly of how the service was managed and as well as there being an open door policy, regular staff meetings took place to allow staff to voice their feedback and be updated on best practice.

There were systems in place to monitor and improve the quality and safety of the service provided. Where actions to improve the service had been identified, these had been acted upon.

We found a breach of the Health and Social care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.

We undertook this review to ensure the provider had taken action to address these shortfalls. We also had some information of concern about inadequate staffing levels and the care some people received in the evening. We looked at these outcome areas and the administration of medicines.

Within this review which took place between 8pm and 11.30pm, people told us they were happy with the care they received. There was no evidence to suggest people's needs were not being met.

Improvements had been made in relation to staff promoting people's rights to privacy and dignity.

People made decisions about their daily routines and were relaxed in their environment. People looked well cared for and received assistance from staff in a considerate manner.

Appropriate systems were in place to ensure people received their medicines in a safe manner.

Improvements had been made to the standard of cleanliness within the home. This particularly applied to all bathrooms and toilets.

Staffing levels were reported to be satisfactory to meet people's needs. The manager was considering a 'twilight shift' to further develop provision in a safe and effective way.

We saw staff responded quickly when requested and assisted people in a kind manner.

We saw evidence there was some tensions within the staff team in the residential unit and we were told this 'occasionally' impacted upon the care of people who used the service. The manager told us they would ensure any untimely personal care like assistance with toileting was appropriately recorded and investigated by the management team.

The manger told us they would look at ways to ensure they evidenced that people were checked on each hour. They said they intended to complete spot checks at night in the residential unit to see if people were being cared for safely by the staff team.

People told us they felt their privacy and dignity was respected. During our inspection observations we saw that although in general staff were respectful in their manner, there were a significant number of occasions where this was not the case.

There were shortfalls in the standard of cleanliness particularly in bathrooms and toilets. These issues had been identified within a recent home audit yet remained outstanding.

There were effective systems in place to support staff working in the home.

There were comprehensive systems in place to regularly assess the quality of the service people received.