Archived: Lorna House

Lorna House is a residential care home providing personal care to up to 24 people. At the time of our inspection there were 13 people using the service. Accommodation is over two floors of a large period property with bedrooms on the first floor serviced by a stair lift. Most bedrooms have ensuite facilities. There is a large communal lounge, a dining room, conservatory and pleasant, well-maintained gardens.

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

Following our last inspection, we imposed conditions on the provider’s registration which required them to complete a selection of audits and report their findings to CQC. The provider did not complete all of these audits within the required timescale. This meant it was a considerable length of time before the provider began to address some of the failings identified at our last inspection. For example, staff working without safe recruitment checks and people living with restrictions without the appropriate legal authority. The provider’s policies had not been reviewed and the audits they had completed did not always identify all areas for improvement. Some people’s relatives were unhappy about the lack of communication from the provider following the findings of the last inspection and did not feel they were open and honest about what had gone wrong, and what action they planned to take to address this.

People's risks were now being assessed and were well managed. People had appropriate equipment and accidents and incidents were regularly reviewed. People received their medicines safely and systems were in place to ensure people were protected from abuse. People, and their relatives, told us they felt safe. One person’s relative told us, “I am very confident [relative] is receiving safe care at Lorna House.” All restrictions relating to visiting had been lifted. One person’s relative said, “Visiting is much better, things have improved a lot.”

Not all staff had completed mandatory training or received a supervision, although the registered manager had begun to address this. Training was booked in and staff who had not completed training had been allocated courses to complete online.

People’s needs had been assessed and everybody living at Lorna House now had a care plan in place. Care plans reflected people’s individual needs and personal preferences and work was ongoing to expand the detail within people’s care plans. People and their relatives had been involved in creating the care plans and staff involved other health professionals where appropriate. People were supported to eat and drink a balanced diet and improvements had been made to the environment which was clean, tidy and odour free. Restrictions and routines that had previously been in place had been removed and staff told us people had more freedom. One staff member said, “The daily routines have changed. There’s no times to get up anymore.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We saw people being treated with dignity and respect and improvements had been made in the way staff communicated. People and their relatives gave positive feedback and felt the staff were kind and caring. A relative told us, “I find everyone kind and compassionate.” Another relative said, “I cannot speak highly enough of this care home where the various members of staff are all caring, helpful and friendly.” Staff had more time to spend with people and regular activities were taking place.

The registered manager had sourced and implemented a range of audit tools, and quality monitoring of the service had improved. Relatives acknowledged the registered manager, who took up their role during our last inspection, had worked hard to implement improvements and communication was improving. Staff gave positive feedback regarding the management of the service. One staff member said, “[Registered manager] has worked really hard to try and get things back on track.” The culture of the service was now person centred and staff, relatives and health professionals all commented on the improved atmosphere and standard of care. Staff worked in partnership with other health professionals who gave positive feedback about the registered manager and staff team.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 6 June 2022). The provider sent us monthly reports in line with conditions imposed on their registration.

At this inspection we found improvements had been made, however the provider remained in breach of some regulations.

At our last inspection we recommended that the provider ensure staff complete appropriate induction, supervision and training to ensure they have the knowledge and skills to meet people's individual health needs. At this inspection we found that not enough progress had been made.

At our last inspection we also recommended that the provider put systems in place to ensure the Accessible Information Standard is met and that the provider put systems in place to ensure complaints and concerns were recorded and responded to. At this inspection we found improvements had been made in relation to these recommendations.

This service has been in Special Measures since 6 June 2022. During this inspection the provider demonstrated improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led 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 Lorna House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to fit and proper persons employed, staffing and good governance at this inspection. Following our last inspection, we imposed conditions on the providers registration. These remain in place.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lorna House is a residential care home providing personal care to up to 24 people. At the time of our inspection there were 17 people using the service. Accommodation is over two floors of a large period property with bedrooms on the first floor serviced by a stair lift. Most bedrooms have en-suite facilities. There is a large communal lounge, a dining room, conservatory and pleasant, well-maintained gardens.

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

Risks to peoples’ safety were not assessed or monitored effectively and were not well managed. There had been a significant number of unwitnessed falls in the twelve months prior to our inspection. Accident records were not reviewed, and not enough action was taken to minimise the risk of falls. Other risks to peoples’ safety, such as choking, had either not been identified or were not well managed. One person, who was living with dementia, had a known risk of leaving the service alone when it was not considered safe to do so, no action had been taken to mitigate the risk. Staff did not always support people to access healthcare services in a timely way.

Care plans did not contain any information to guide staff as to how to support people to manage specific medical conditions, such as diabetes and Parkinson’s Disease, safely. Fire safety records were not kept up to date.

Peoples’ medicines were not managed safely. There were no systems in place to monitor stock control and the amount of medicines received were not recorded. No medicines audits were being completed. Systems were not always operated effectively to ensure staff were recruited safely and the risk of the spread of infection was not well managed. No notifications of abuse or neglect had been made by the service since our last inspection, however, four safeguarding alerts had been made by health professionals in the past twelve months.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good practice.

People’s care was not always delivered or continually assessed in line with their desired outcomes. People's family members told us they were not involved in reviews of people's care.

Most staff had completed training in the areas the service identified as mandatory, such as safeguarding and moving and handling. However, the service had not identified that staff required training around individual health needs and conditions, such as dysphagia, diabetes or the management of Parkinson’s Disease.

People’s privacy and dignity was not always respected. People were not always supported to be independent and we saw people trying to stand up and move being repeatedly asked to sit back down rather than supported to mobilise where they wanted to be. Three people did not have any care plans in place. Care plans that were in place were very brief, basic and task orientated, and had not been regularly reviewed or updated to reflect people’s changing needs. Staff told us there were some routines in place that appeared to suit the staff, rather than people. There was limited support for people to avoid social isolation, follow interests and take part in activities.

There were no systems or processes in place to ensure the service was well led. The service had failed to identify and act on risk and had failed to provide a service that met people’s individual needs and preferences. There were no systems in place to audit medicines, incidents, accidents, care plans or complaints to identify themes and trends. The provider did not have any quality oversight systems in place. Notifications were not always made in line with legal requirements.

People and their families were not involved in their care planning and there were no systems in place to seek feedback from people using the service. Staff told us they did not feel supported, and felt morale was “very low”. One staff member told us, “I love working here, but you dread coming to work because you don’t know what it’s going to be like.”

People told us they enjoyed the food and were offered choices. We observed people enjoying a meal on the first day of our inspection. One person told us it was, “Very nice.”

People were well dressed. One person’s family member said their loved one, “Always looks well, clean, tidy and shaven.” We saw warm relationships between staff and people, and people and their families told us they felt the staff were caring. One person told us the staff were “wonderful” and another said, “They’re very kind, and jolly, I’m happy here.” Comments from people’s families included, “Staff are caring”, “Immensely kind” and, “The girls are really nice.” Some staff had worked at the service for many years and knew people well.

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 24 January 2018).

At our last inspection we found there were no protocols in place to guide staff when it was appropriate to use 'when required' medicines, which is good practice. We discussed this with the registered manager who said they would discuss implementing them with the pharmacist. At this inspection we found that this had not been done and there were still no protocols in place.

At our last inspection we recommended the service consider how information could be made available to people to support assisted communication where they may benefit from this. At this inspection we found no progress had been made.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding. 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 see what action we have asked the provider to take at the end of this full report.

The registered manager was not available at the time of our inspection. The provider responded immediately and put an acting manager in place in the registered managers absence. The acting manager took immediate action to mitigate the risks identified and worked openly with CQC and the Local Authority to ensure the most urgent concerns were addressed. This included modifying two peoples’ diets, providing clear information for staff, removing some equipment, putting other equipment in place and asking the district nursing team to administer one person’s insulin.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person-centred care, need for consent, fit and proper persons employed, notification of incidents and good governance 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection of this service in May 2015, we awarded an overall rating of Good.

At this inspection we found the service remained good.

Lorna House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lorna House is an elegant two storey Victorian residence set in a residential area in Torquay. The service is a residential care home service providing accommodation for up to 24 people, some of whom are living with dementia. There were 22 people living at the home at the time of our inspection.

The home had a registered manager. 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.

Why the service is rated Good:

People told us they felt safe at the home and with the staff who supported them, one person said “Yes I feel safe here, they’re very good and very caring.” There were systems in place to keep people safe. Staff were aware of safeguarding processes and how to raise concerns if they felt people were at risk of abuse or poor practice.

Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed. We discussed the storage of medicines which were prescribed for people at the end of their life to keep them comfortable. The Registered manager took action to ensure these were stored safely.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and had received training and developed skills and knowledge to meet people’s needs.

There were adequate staffing levels to meet people’s needs. The registered manager had recognised people’s dependency needs had increased and had raised the staff level to meet their needs.

People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. They were familiar with people’s history and backgrounds and supported them fairly and without bias.

People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes. Staff relationships with people were caring and supportive. They delivered care that was kind and compassionate. People said staff treated them with dignity and respect at all times in a caring and compassionate way.

The registered manager was putting in place a new care plan format. They were in the process of rewriting everybody’s care plans. The new care plans were personalised and guided staff how to meet people’s needs. We have made a recommendation about people being given access to information in a format that was accessible to them.

People were referred promptly to health care services when required and received on-going healthcare support. The healthcare professional was positive about the quality of care provided at the home and the commitment of the whole team to provide a good service.

People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them. People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the registered manager. There had been no complaints received at the service since our last inspection. The registered manager attended all handovers while at the service so they were aware of any concerns.

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 support this practice. Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. They had made appropriate applications for people they had assessed that required to be deprived of their liberty to the local authority DoLS team.

People were supported to follow their interests and take part in social activities. A program of activities was available for people to attend as they chose.

People were supported to eat and drink enough and maintain a balanced diet. People and relatives gave us mixed feedback about the food at the service. The registered manager said they had a new cook and were working with them to revise the menu.

The provider had a range of quality monitoring systems in place which were used to continually review and improve the service.

The premises were well managed to keep people safe. The home was clean and homely with a welcoming atmosphere. Arrangements were in place to ensure the environment was kept clean and safe with audits being completed on all aspects of the building and equipment. There were emergency plans in place to protect people in the event of a fire or emergency.

The laundry room at the service was very small. We discussed how soiled laundry was kept away for clean laundry to stop cross contamination. The registered manager said they would review the laundry process with staff. The provider said they would also review the system with the registered manager.

Further information is in the detailed findings below.

People who lived the home and their relatives were positive about the care delivered at Lorna House. One relative told us 'I looked at 30 homes and this was the best of those 30.' People's needs had been assessed and were delivered in line with their care plan.

There was a wide choice of healthy and nutritious food and drink for people. The home had an experienced cook. One person said 'There's always good food here and I can eat where I like.'

People were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse. Care workers understood their responsibilities and knew how to identify and raise concerns. People told us they felt safe at Lorna House.

We saw evidence to show that background checks had been made which ensured that staff were suitable to work with vulnerable people.

We looked at the quality assurance systems in place to monitor the quality of care delivered. We saw that the provider monitored the service and sought regular feedback. One person had commented 'Well maintained, constant standard of care and cleanliness with a welcoming and happy atmosphere.'

Following that inspection the home sent us an action plan identifying what actions they intended to take to improve.

On this inspection we looked at those actions. We found that the home had obtained information to help staff understand the principles and legal principles of consent and capacity. The staff member we spoke with was clear about the day to day issues with regard to ensuring people's views about their care were listened to.

We found the home had implemented new systems to ensure people were involved in making decisions about their care. Where they were not able to do so, forms had been provided to help staff identify when additional support would be involved from professionals supporting the service. This might include for example community psychiatric nurses.

We found that people were being involved in giving their wishes with regard to day to day as well as end of life care. Healthcare professionals such as general practitioners were supporting the home with regard to providing treatment escalation plans where indicated.

The files that we saw showed us that people's care needs had been assessed and the care plans were based upon people's needs. The plans had been reviewed regularly and following discussions with staff we found they were a reflection of the care being delivered. Staff told us about the ways in which people liked their care to be delivered and the plans we saw contained some information about the person's life before coming into the home. This helped staff to care for them and understand their behaviour in the context of the life they had lived. However where people lacked capacity, decision making was not recorded well.

People we spoke with told us the home was well run. They also told us the manager was a warm person and that they trusted her abilities. One told us the manager "is lovely, and the staff are really good too. I don't think I could be anywhere better".

We saw that care had been taken to make Lorna House a homely place for people to live in . As an example there were flowers on the dining tables and folded napkins. Fresh fruit was set out in the lounge for people to help themselves.

We saw there were activities every day, including craft, exercises, dancing, memory games and music.

The staff group had not changed for a long time and the staff we spoke with understood people's needs well.