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Inspection Summary


Overall summary & rating

Inadequate

Updated 25 August 2018

Lound Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lound Hall is registered to provide nursing and personal care to a maximum of 43 older people, some of whom may be living with dementia. At the time of our visit there were 24 people using the service.

The inspection was unannounced and took place on 30 and 31 May and 5 June 2018.

At our previous inspection on 31 October and 1 November 2017, we identified shortfalls in the service which meant people did not always receive the care and support they required. We found that the service was in breach of regulations and needed to make improvements to staffing levels, the management of medicines, care planning, risk management, activities, the support people received to eat and drink, practices around the Mental Capacity Act 2005 (MCA) and the governance system in place. We rated the service Inadequate overall and asked them to provide us with an action plan stating how they would make improvements to the service.

At this inspection we identified continued failings which put people at risk of harm. The service continued to breach regulations and had not made all of the improvements they were required to make following the previous inspection.

The service had a registered manager in place. 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.

People were put at the risk of significant harm in the absence of clear records and assessments which reflected all current areas of risk and how these should be managed to protect the person from harm.

There were limited care plans available to guide staff on how to meet people's needs. Some people’s care plans had been updated to a newer format. However the care plans for some, including those with identified risks, had not been updated. Staff did not always know information that senior staff told us about people.

The support people needed to reduce the risk of malnutrition was not always care planned or updates to care planning had not been made where their needs changed significantly. Food charts did not evidence that people were supported as far as possible to boost their nutritional intake with extra foods outside of structured meal times.

Clear action was not always taken where people had unexplained bruising that required investigation.

Whilst the provider had identified and taken action to reduce some environmental risks, other risks in the environment such as uncovered radiators and unsecured substances which may be harmful if ingested had not been identified by the service.

Whilst some improvements had been made to the cleanliness of the service, improvements were required to ensure that the service was consistently clean and free of unpleasant odours.

People had access to other healthcare professionals. Whilst some records were kept of the contact people had with health professionals, where advice was given this was not always transferred into care planning which meant it was unclear how staff could consistently follow this advice.

Medicines were not managed and administered safely. There were discrepancies in Medicine Administration Records (MAR) where it was unclear if medicines had been administered and some tablets remained in blister packs.

People were not supported by staff to have maximum choice and control of their lives. Some people had not had an assessment of their capacity. Care plans demonstrated a poor knowledge of the formal process of making a best interest decision and care plans did not always reflect where people had a power of attorney who should be involved in all decision making. Staff did not always support people to make decisions independently.

Whilst activities provision had improved with the addition of two new activities staff, people did not consistently have access to activities that were meaningful and engaging in line with their individual needs. The activities provision in the service required further development and structure and the activities team required further training to develop their knowledge. People who were nursed in bed or preferred to stay in their bedrooms had inconsistent access to engagement and activity.

People’s care plans required further personalisation to ensure they were individualised. Care plans did not always reflect the views of the person or their relatives.

Whilst some areas of the service had benefitted from redecoration, improvements were required to the décor, adaption and design of the service to ensure it was suitably orientating for people living with dementia.

Improvements were required to the knowledge of the staff team. Staff we spoke with and observations of staff practice did not demonstrate a good knowledge of subjects they had received training in, such as nutrition, MCA and Medicines.

On 31 October and 1 November 2017 we rated the service inadequate following the identification of significant widespread shortfalls which meant people did not always receive the care they required to protect them from harm. The report resulting from the inspection made clear the areas of particular concern. Despite this, timely enough improvements had not been made in some areas identified at the previous inspection. For example, clear care plans had not been implemented for people at risk of choking.

There was a failure of the management team to ensure that systems in place to monitor the quality of the service were effective in identifying continuing shortfalls and areas for improvement. Improvements, particularly around risk management and care planning, had not been made in a timely way. The management team had not prioritised the updating of care plans for people who had been identified as at risk. This meant people had been placed at continual risk of receiving poor care.

Progress had been made in improving the culture in the service. We observed staff were caring and kind. However, they were still failing to identify the poor practice of themselves and others.

The registered manager and provider were honest, open and transparent with people and their relatives about improvements that needed to be made. People and their relatives told us they felt more listened to and were more positive that issues they raised would be taken seriously. Regular meetings had been organised where people had the opportunity to feedback their views.

The staffing level in the service had been much improved, with a new structure in place to ensure staff had set responsibilities. A review of call bell records demonstrated that response times were much more prompt. People and their relatives told us they were happy with the staffing level and that staff were prompt when support was requested.

The overall rating for this service is 'Inadequate' and the service therefore is in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

Inspection areas

Safe

Inadequate

Updated 25 August 2018

The service was not safe.

Improvements were still required to ensure appropriate risk management strategies were in place to minimise the risk of people coming to harm.

Medicines were still not consistently administered safely.

Improvements were required to ensure that the service was consistently clean and free from unpleasant odours.

There were enough staff to meet people’s needs.

Effective

Inadequate

Updated 25 August 2018

The service was not effective.

Improvements were required to ensure that people’s capacity to make decisions was appropriately assessed and that staff acted in accordance with the Mental Capacity Act 2005 (MCA)

The support people required with eating and drinking was not always clearly care planned. Records did not evidence that people always received appropriate support to reduce the risk of malnutrition or dehydration.

Improvements were required to develop the knowledge and skills of the staff team.

People had access to other healthcare professionals. However, improvements were required to ensure that clear records of contact were kept and that advice was transferred into care planning.

Caring

Requires improvement

Updated 25 August 2018

The service was not consistently caring.

We observed staff were intuitively caring and kind towards people. However, they were failing to identify the poor practice of themselves and others and take action to improve.

Staff did not always identify issues which may compromise the dignity and respect of people using the service.

Responsive

Requires improvement

Updated 25 August 2018

The service was not consistently responsive.

Care records did not always reflect the views of people and their relatives.

Care records required personalisation to ensure they reflected people’s preferences, hobbies, interests and personal history.

Improvements were required to ensure activities provided were engaging, individualised and meaningful.

Complaints were recorded and investigated. However, written outcomes were not always provided to complainants.

Well-led

Inadequate

Updated 25 August 2018

The service was not well-led.

Whilst some improvements had been made, those that required prioritising had not been completed in a timely manner.

The governance system in place did not always identify shortfalls that continued in the service.

Risk management oversight systems did not always contain accurate information about people’s needs and were not used to prioritise tasks.

Progress was being made in improving the culture in the service. Communication between the service, people and relatives was improved.

The registered manager and provider were transparent and open about the improvements that needed to be made.