Ledbury Nursing Home

Ledbury Nursing Home is a residential care home providing personal and nursing care to 26 people at the time of the inspection. The service can support up to 36 people.

People’s experience of using this service and what we found

People were supported to stay as safe as possible by staff who understood what actions to take to reduce risks to their well-being. This included reducing risks to people's physical health and mental well-being. This was an area of improvement following our last inspection.

Staff used their skills and the equipment required to reduce the risk of people experiencing infections. Checks on the home environment were also undertaken and systems for identifying if there was any learning after safety incidents were in place.

Since our last inspection ongoing improvements had been made to the management and administration of people’s medicines. People were supported by staff to have the medicines they needed to remain well.

Staff recruitment procedures were in place and appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. There were enough staff to support people's care and safety needs. Staff induction and on-going training was provided to support staff in gaining the skills, knowledge and support they needed to undertake their roles.

The views of people, relatives, staff and health and social care professionals were considered when people’s needs were assessed, and their care plans developed and reviewed. People were supported to choose what they wanted to eat and to obtain care from health and social care professionals so they would remain well. The home environment was adapted in various ways to meet people’s diverse needs.

Wherever possible, people's consent was gained before any care was provided. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The manager had come into post since our last inspection and was keen to promote a culture of support for staff where learning was promoted and improvements continued to flourish. The manager and staff team worked in partnership with other professionals and the local community to achieve good outcomes for people.

Following the last inspection, the management team had worked together to bring about continual improvements to ensure their quality checking and monitoring practices were more effective. The provider and management team had established a range of quality checks which were regularly completed to make sure people received quality care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement published 20 January 2021.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ledbury Nursing Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Ledbury Nursing Home is a residential care home providing personal and nursing care to 31 people at the time of the inspection. The service can support up to 36 people.

Peoples experience of using this service and what we found

The service was not always well- led. The provider’s governance systems were not consistently effective to identify shortfalls, maintain continuous improvement and ensure compliance with regulations.

The provider was not able to evidence people were supported to have maximum choice and control of their lives in relation to their consent to receive a test for COVID-19.

Medicines were not always managed safely with people not always receiving their medicines as prescribed. There was evidence to demonstrate people’s medicines were not administered and stored safely.

Care plans were not always up to date and did not therefore always contain accurate information about people’s care and support needs. Records to evidence the care and support provided were not always in place or maintained to evidence how staff had support people to have their individual needs met. Terminology used within care records was not always in line with person centred care.

Staffing levels were assigned using a tool based upon people’s support needs. Staffing vacancies were met using agency staff. People enjoyed the food provided however some people’s dietary needs were not always met in a timely way.

People felt safe living at the home and staff were aware of their responsibility to keep people safe.

Staff were seen undertaking additional cleaning and using personal protective equipment to reduce the risk of cross infection. Staff received training to support their roles and provide them with skills and knowledge. Gaps in training were known to management for them to action and resolve.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 07 February 2020).

Why we inspected

We received concerns in relation to staffing levels, the deployment of agency staff and training. We had also received concerns about the management of medicines.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led relevant key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ledbury Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe in relation to their medicines, risks and care planning as well as the governances of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ledbury Nursing Home is a care home that provides nursing and personal care for up to 36 older people. It provides care to people requiring nursing care some of whom live with dementia and have physical disabilities. At the time of our inspection, 31 people were living at the home.

People’s experience of using this service and what we found

The provider’s risks assessment procedures in relation to risks associated with the home environment, were not as strong as they could be so people’s safety was consistently promoted. Some aspects of the administration and recording of people’s medicines were not as strong as they could be to evidence people’s health needs were monitored and met.

People were cared for by staff who knew how to keep them safe and protect them from abuse. Incidents and accidents were investigated, and actions taken to prevent recurrence. People felt there were enough staff when they needed assistance and staff responded promptly to their requests. The home environment was clean, and staff followed infection control and prevention procedures.

People's needs were assessed and care was planned and delivered to meet legislation and good practice guidance. Care was provided by staff who were trained and knowledgeable about people's care and support needs. People were provided with a nutritious and varied diet and they enjoyed the food provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Continual improvements were being made to the home environment to ensure people’s needs were met in the design and adaptation of this.

People were cared for by staff who were kind and showed understanding towards them. Staff were warm and considerate towards people they cared for. People's independence was respected, and their dignity maintained during care practices.

Staff were responsive to people's individual needs and wishes. People were offered choices on an ongoing basis. People had access to a range of recreational activities and entertainment and told us they could decide what they wished to do, and staff facilitated this. The staff member dedicated to planning and arranging recreational activities had a clear vision for driving through ongoing improvements. People's views and concerns were listened to and action was taken to improve the service as a result.

The provider and management team had methods designed to promote continuous learning. They were aware staff needed to effectively follow the systems implemented to improve the accuracy of recording and monitoring the administration of people’s topical medicines. The registered manager took a responsive approach to securing care documentation in one area of the home, so this was not accessible by unauthorised persons.

The registered manager and operational manager provided supportive leadership. They were well-known to people, their relatives and staff. The provider notified CQC and other organisations of issues as required. Complaints were managed in line with the provider's policy. The management team were committed to the continuous improvement of the service in the future.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any information of concern is received, we may inspect sooner.

Ledbury Nursing Home provides accommodation with nursing and personal care to a maximum of 36 older people. There were 28 people living at the home when we visited.

A registered manager was in post and present during 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.

At our last inspection on 3 and 4 May 2016, we found a breach of Regulation 9 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. We gave the service an overall rating of requires improvement. This breach related to the provider’s failure to ensure people received personalised care and treatment to meet their needs. The provider sent us an action plan setting out the improvements they intended to make.

At this inspection, we found the provider had made improvements to the service, and was now meeting the requirements of Regulation 9.

The information recorded on people’s repositioning charts about the support they required and received with this important aspect of their pressure care was not always accurate or complete.

Staff had received training in, and understood, how to recognise and report abuse. The risks associated with people’s individual care and support needs had been assessed, reviewed and plans put in place to manage these. The registered manager assessed and organised their staffing requirements, based upon current dependency levels. Prospective staff underwent pre-employment checks to confirm they were suitable to work with the people living at the home. Systems and procedures were in place to ensure people received their medicines safely and as prescribed.

Staff received effective induction, training and ongoing support to enable them to fulfil their duties and responsibilities. People’s rights under the Mental Capacity Act 2005 were understood and promoted. People had the supported they needed to eat and drink, and their nutritional needs were assessed and managed. People were supported to access healthcare services as required.

Staff adopted a caring approach towards their work, and showed concern for people’s comfort and wellbeing. People were encouraged and supported to share their views and be involved in decisions that affected them. Staff understood and promoted people’s rights to privacy and dignity. People could receive visitors at the home without unnecessary restrictions.

People’s care plans included information about their individual needs and preferences, and staff followed these. The involvement of people and their relatives in care planning was encouraged. People were supported to spend time doing things they found interesting and enjoyable. People and their relatives knew how to complain about the care and support provided.

The management team promoted an open and inclusive culture within the service. People’s relatives had confidence the management team would deal with any issues or concerns fairly. Staff felt well-supported by an approachable management team. The provider’s quality assurance activities had resulted in improvements to the service people received.

Ledbury Nursing Home provides accommodation for older people who need nursing or personal care. This service provides nursing and personal care for up to 36 people. On the day of our inspection there were 33 people living at the home.

There was manager at this home who was in the process of registering with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People did not always receive care that was personal to them and responsive to their needs. For example, people were not supported with enough specialist equipment to ensure they could get up in the morning as they wanted to. People we spoke with that needed this equipment told us they had to wait for their turn with the equipment. Also specialist equipment identified in their risk assessments was not always available for staff to provide the support they needed in the most comfortable way.

On many occasions staff were seen to be kind and caring, and thoughtful towards people. However: people we spoke with said their needs were not met in a consistent way. Relatives said that sometimes staff were excellent and were caring and promoted people’s independence, however at other times there was a lack of consistency in how people’s needs were met. Staff we spoke with said that there were changes depending on how the shift was lead. The manager recognised this and was taking steps to include staff in how they could improve care delivery. The manager told us they were actively recruiting new staff to improve continuity.

People told us they felt safe and there were enough staff available to support them. We saw the manager provided information to staff and agency staff to support people safely. People said call bells were answered quickly and there were sufficient staff on duty to meet people’s needs. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. Staff knew people well, and took people’s preferences into account and respected them. Staff had the knowledge and training to support people they provided care for. Staff ensured people agreed to the support they received. The manager explained they were in the process of reviewing people’s ability to make decisions and the support they needed to do this. People had access to health professionals as they needed them. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet.

People said they were able to maintain important relationships with family and friends. They were included in meetings to ensure they had a say in the choices available to them. We saw staff treated people with dignity and respect whilst supporting their needs. We saw people’s personal records we not always kept securely. We spoke with the manager and they said they would take action straight away.

People and their relatives knew how to raise complaints. There was a new management team with the manager and the deputy new to the service. People and their relatives said they were approachable and they would raise concerns if they needed to. We saw there was a process in place to ensure complaints were investigated and action taken to resolve them.

People and their relatives were encouraged to be involved in regular meetings to share their views. The management team were reviewing how they sought feedback to improve the service provided and encourage relatives to be involved in their meetings.

We found the provider had not ensured improvements to the quality of the service were actioned despite regular visits to monitor the service provided. The new management team had identified areas for improvement and had a plan in place to ensure these actions were completed. Improvements to the quality of the service needed to be completed and established to ensure people received consistent quality care.

You can see what action we told the provider to take at the back of the report.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

Is the service safe?

People told us that they felt safe. Risk assessments were well completed and actions to minimise the risks identified were reflected in care plans. Risk assessments balanced risk with the rights of people to choice and independence. Service wide risk assessments together with the actions to reduce those risks were reviewed regularly.

The provider had appropriate systems and processes in place with regard implementing the Mental Capacity Act 2005. Staff had received training in relation to this and were clear about their role and responsibilities.

People told us that the home was always clean and tidy. We saw that people were being cared for in clean, hygienic premises. Staff had received infection prevention and control training and were clear about their role and responsibilities. There were effective systems in place to reduce the risk and spread of infection.

There were registered nurses on duty at all times. All staff had received training on dealing with emergencies and sudden illness.

Is the service effective?

People had their needs assessed at the service. Care plans reflected both the needs and preferences of people. Staff had a good knowledge of people's care needs.

Staff had access to a range of relevant training to meet the needs of the people they cared for. Policies and procedures were appropriate, up to date, and reflected current research and guidance. Registered nurses had undertaken training and had been assessed in a range of clinical skills including medication, skin care and catheterisation.

Is the service caring?

People told us that the staff were kind and compassionate. We observed staff treating people in a friendly and caring way. One person told us, 'They (the staff) are all very kind.' Another person told us, 'All the staff look after me very well.' We saw staff talking to people in a friendly and respectful way. People who were unable to communicate fully had communication care plans. We saw staff responding to non-verbal communication effectively.

Is the service responsive?

People's needs were assessed and care plans developed. People told us that they had been involved in developing their care plan. Care plans reflected both the needs and wishes of people. One person told us, "The staff are very responsive to what I ask for.'

The provider had systems in place to ensure the views of people who received the service were sought and acted upon. People were invited to resident and relative meetings where they were encouraged to make suggestions about improvements to the home.

People had access to a wide range of activities. A member of staff was employed to coordinate activities for residents.

Is the service well-led?

Staff we spoke with told us they felt well supported by the registered manager and senior staff. Staff said they were able to raise issues with their manager at any time and were confident they would be acted upon. Staff had opportunities to raise and discuss issues at staff meetings and at supervision sessions.

The provider had a well-established quality monitoring system which consisted of regular audits and quality reviews.

People who used the service and staff were clear about the complaints process. People told us they were confident that any issue raised, or complaint made, would be thoroughly investigated and acted upon. Complaints that had been received by the provider had been investigated and responded to appropriately. Lessons learnt from incidents, feedback, and complaints and any subsequent actions were discussed at regular staff meetings and supervision sessions.

We found people who lived at the home were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs. One person told us: 'Care is quite fantastic day and night.' Another person said that the staff: 'Go out of their way to be helpful' and 'Are very nice.'

We saw positive interactions between staff and people during the day, with staff helping people to make simple everyday decisions. There were arrangements in place where required, to help people with bigger decisions so that their best interests were upheld.

We saw that people who lived at the home had their medicines as prescribed at the right time and in the right way. This made sure people's health needs were effectively met.

There were enough staff to meet people's needs. People who lived at the home told us that care was provided by staff who knew them well and their needs.

We found that the service was well led. The manager had responsive systems in place to monitor and review people's experiences and complaints. This meant that positive outcomes for people were continually developed, reviewed and improved upon when needed.

We found that the management of medicines by the service needed to improve in order to ensure that people using the service received their medicines safely.