Archived: Ladymead Nursing & Residential Home with Dementia

During this inspection the Inspectors gathered evidence to help answer our five key questions, Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at care and welfare, management of medicines, infection control, recruitment, training, management and records.

This is a summary of what we found using evidence obtained by speaking with stakeholders, speaking with staff, speaking with people who used the service and observing care delivery and looking at records:

Is the service caring?

We undertook a short observational framework for inspection (SOFI) during lunch time SOFI is a tool used by inspectors to allow them to observe moods, interactions and activities for a sustained length of time.

We saw people were not offered a choice of food and there was little staff interaction and encouragement offered. We observed that staff assisted people who required help to eat and drink. Staff were sat down on people's level when assisting them with their meal. We noted the pureed diet was not presented in an appropriate and appealing way.

We were told, 'The food is alright'. Other comments included, 'I've got no complaints'. One person who had difficulties chewing complained about the meal provided, there were no choices offered to this person.

Throughout the day we did not see people who required assistance being taken to the toilet.

In the care records we looked at we saw personal preferences and choices for people were not recorded within the care records.

We found personal care for people required improvement with regard to oral hygiene, continence management and privacy and dignity when receiving medical treatment.

Is the service responsive?

People received an assessment prior to being admitted to the home. Care records did not contain detailed information about people's individual needs. Therefore people's preferences, choices rights were not respected.

Where one person's dietary preferences were documented we saw they were not always adhered to.

People's mental capacity was not taken into consideration and dealt with correctly with regard to decisions making and acting in a person's best interest.

Is the service safe?

The administration of medicines and recording of medicines was found to be unsafe. We saw medicines were not always given safely and records had not been completed as required to ensure the safety of people living at the home. This is the fifth time we have found medicines to be unsafe at the home.

We found two doors to be unlocked which led down steep stairs to the cellars. One of the doors was unlocked on several occasions throughout the day. This could have resulted in a serious accident if a person living at the home had attempted to go down these stairs.

We observed staff going in and out of the kitchen all day without the appropriate clothing. This could increase the risk of cross infection as they had been providing personal care to people living at the home.

Staff training in moving and handling had not been completed by some staff at the home and refresher training was overdue. This could be potentially dangerous to staff and people living at the home if staff were not using the correct techniques or equipment.

We saw fire safety procedures were not being adhered to with the unsafe storage of items under the fire escape and in the upstairs boiler room.

The manager and staff had little knowledge of Deprivation of Liberty Safeguards (DoLS), which are used when a person needs to be deprived of their liberty in their own best interests. This can be due to a lack of insight into their condition which result in restrictions being applied at the home which are to keep them safe but deprive a person of their liberty. The lack of knowledge and training could potentially lead to someone being deprived of their liberty unlawfully.

Is the service effective?

We observed there was little interaction between staff and people living at the home. When staff did have some spare time it was not spent with people living at the home.

We noted there were no activities provided. We saw people sat in the same chairs all day. We were told by one person who lived at the home, 'There's not much going on'. We saw no evidence of any planned activities either in the home or in the local community. There was no stimulation or variation to people's day.

We spoke with seven members of staff who told us that 'sometimes the care could be better' but felt this was 'sometimes out of their hands'.

Is the service well-led?

It was evident the manager of the home did not have overall responsibility for the day to day running of the home. When asked for information and records the manager frequently struggled to find the correct paperwork. The training matrix was difficult to understand and, when asked to explain it the manager was unable to do so. The training records were incomplete and the manager was unsure of what training was imminent.

Staff spoken with told us that management and decisions about the care were made by a senior person in the company operating the home and not by the manager. There should be clear guidelines of people's roles and responsibilities.

The quality assurance systems needed to be more effective to ensure any issues identified would be dealt with effectively and in a timely manner.

During our inspection we gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at care, staffing numbers, quality assurance, records and the environment.

Is the service safe?

We found the service was not safe because people were not protected against the risks associated with the unsafe use and management of medicines.

People were not always given their medicines as prescribed which placed their health at risk of harm. The records about the management of medicines did not show medicines were handled safely.

The premises were clean and safe. Improvements to the d'cor were ongoing.

Is the service effective?

An assessment of people's needs was carried out prior to them moving in to the home. However not all of the information on the assessment had been completed. We saw gaps there were about medications, medical history and personal preferences.

Care records contained basic information about personal details, allergies and risk assessments.

People with whom we spoke were happy with the care provided. One person said, 'The staff are kind and caring' another said, 'They work really hard'.

Is the service caring?

We observed staff met people's basic care needs; people were clean and well fed. However we noted peoples personal preferences were not recorded, which meant staff may not always act in line with peoples wishes.

Relatives comments included, 'Thanks for the wonderful care, it's a pleasure to visit and we having nothing but admiration for the staff'.

Is the responsive?

We observed there was little staff interaction with people throughout the day.

We spoke with people and asked them how they were to spend their day, one person replied, 'Why what's there to do'. There was no plan for social activities or recreation.

We could not find any mental capacity assessments in the care records to show that people's capacity had been assessed in accordance with legislation.

The Care Quality Commission had not received any complaint from people who used the service or their relatives.

Is the service well-led?

The manager is currently in the process of registering with the Care Quality Commission.

The manager needs to have clear guidelines of her roles and responsibilities to ensure the people who live at the home benefit from effective leadership.

We were told by staff the new manager was supportive and approachable.

We saw evidence of quality assurance and monitoring was ongoing. Improvements with audits checks had been made.

We did not speak to people about their medicines during this visit.

Overall we found that people were not fully protected against the risks associated with the unsafe management of medicines.

Overall, we found that medicines were not consistently managed in a safe way.

To ensure the safety of people who used the service we carried out a follow up inspection at Ladymead Nursing and Residential Home with Dementia on 6 August 2013. During our visit we found the areas of non-compliance for record keeping had been addressed.

The provider had sent copies of certificates to the Care Quality Commission (CQC) verifying that the necessary maintenance checks had been carried out and were valid.

We looked at some care records and found the information recorded had improved.

We spoke with the manager who told us they were in process of registering with the Care Quality Commission.

We spoke with the manager who is in the process of registering with the Care Quality Commission.

We were told by the staff things had improved since the provider had taken a more active role and people were happy to approach him.

We saw that significant improvements had been made to the environment.

People we spoke with were happy with the care and support provided. One said, 'Everything's fine, I am quite happy, the staff are very good'.

We asked one person if they were happy with their room. They told us they were and it was very comfortable.

We spoke with two visitors who confirmed their relative, who had not been at the home that long looked much better and so far they were happy with the care.

We looked a two care plans, records were incomplete or had been wrongly filled in. We were told that for some people being nursed in bed, positional turning charts were in use. We asked the manager and staff three times to see the charts for one person but they were not made available.

We spoke with people who used the service one told us,' I am happy here, we are well looked after'. Another person told us, 'The staff are marvellous'. We spoke with two people about the food. One person said, 'I am happy with the food and there is always plenty to eat'. Another person said, 'The food is lovely we get choices and lots of drinks'.

We spoke with two members of staff who told us the management of the home was not open and transparent and found it difficult to talk to manager. They said that there were no residents/relatives meetings anymore and that there was no meaningful activities and stimulation for the people living at the home. We were told that once a month a person came to the home to do 'zumba' and another person to offer pet therapy.

We spoke with the manager who told us that they were in the process of registering with the Care Quality Commission had begun; we received confirmation of this from the registrations team.

We observed one person who was still in bed; they had a duvet and three blankets on his bed. They told us that they were 'cold, especially when they get up'.

We spoke with staff. One person told us 'nothing has changed'. We were told the staff were expected to undertake cleaning laundry and cooking duties as well as caring for people who use the service.

When we arrived at the home at 07:00am we asked the staff if people had been offered a drink or a snack and were told they had not. At 7.30 am we observed a member of staff serve cold toast to two people and porridge to the other people. We asked when the toast had been made and were told at 6.45.am.

We asked the manager to tell us about audits that had been undertaken since our last inspection on 4 January 2013. We saw some evidence of water temperature checks in the home however there were discrepancies in the provider's checks and the findings during the inspection. The manager could not confirm whether the provider had undertaken any other quality audit or risk assessments.