Archived: Lymewood Court Nursing Home

Lymewood Court Nursing Home is a care home providing personal and nursing care for up to 46 people. Accommodation is provided across two units, both of which are situated on the ground floor of the building. across three units with one unit specialising in providing care to people living with dementia and one specialising in supporting people requiring rehabilitation following discharge from hospital. There were 21 people using the service at the time of the inspection.

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

The systems for checking on the quality and safety of the service had improved. However, we identified that further improvement was needed to in relation to monitoring and review of records to ensure that they contained clear up to date information about people’s needs.

Safe systems were in place for the management of people’s medicines. This was an improvement from the previous inspection.

Information and guidance was available to protect people from abuse. Family members told us that they felt their relatives were safe living at the service.

Risks to people were considered and planned for and clear plans were in place to keep people safe in the event of any emergency. Safe recruitment processes were followed to ensure staff were suitable to work with vulnerable adults. There was enough suitably skilled and experienced staff on duty to safely meet people's needs.

Accidents and incidents were recorded and where required actions were taken to prevent further occurrence. This included making changes to procedures and further staff training to mitigate any future risks. There were clear procedures to prevent and control the spread of infection. The service had managed the impact of the COVID-19 pandemic.

The service had an on-going improvement plan to continue to improve the service that people received. These plans involved improvement initiatives from the Clinical Commissioning Group.

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 Requires Improvement (report published 24 May 2019) and there was one breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out unannounced focussed inspection of this service on 24 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the systems to assess, monitor and improve the quality and safety of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Lymewood Court Nursing Home provides both nursing and personal care in one building for up to 46 people, some of whom live with dementia. When we inspected 34 people lived at the service.

People’s experience of using this service:

The providers processes for checking on the quality and safety of the service were not always effective in identifying and mitigating risk to people. The provider did not have sufficient oversight of the service to ensure consistent leadership and the delivery of safe care. There was a lack of partnership working with external agencies which delayed a safeguarding investigation.

The provider reflected on the concerns raised prior to the inspection and our findings. They advised us after our inspection that they had implemented a series of changes to their systems and approach to governance to bring about the required improvements.

We have made a recommendation about infection prevention and control. People were not fully protected from the risk of the spread of infection and risks to their health and safety. Clinical waste was not safely managed, and equipment used for people was not kept clean and hygienic. Action was taken at the time of the inspection to mitigate the risk of the spread of infection.

We have made a recommendation about the safe use of medicines. The management of medicines had improved in response to concerns raised by the Clinical Commissioning Group (CCG) and following our first day of inspection, however further improvements were required. Medication administration records (MARs) lacked information about prescribed creams and how they were to be used. There also needed to be a consistent approach to ensuring the safe management of medicines.

Safe recruitment processes were followed to ensure staff were suitable to work with vulnerable adults. There was enough suitably skilled and experienced staff on duty to safely meet people’s needs.

A full description of our findings can be found in the sections below.

Why we inspected: This inspection was prompted by information of concern which we received from partner agencies about people’s safety. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to the key questions we ask is the service safe and well-led. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lymewood Court Nursing Home on our website at www.cqc.org.uk.

Rating at last inspection: Good (Published 20 November 2018). The service has a revised rating of requires improvement.

Enforcement: The provider was in breach of regulation 17 because the governance of the service was not effective. You can see what action we told the provider to take at the back of the full version of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider, local authority and clinical commissioning group (CCG) to monitor progress. If any concerning information is received, we may inspect sooner.

What life is like for people using this service:

Improvements had been made since the last inspection to the way medication was managed. Medication was managed safely and people received their all their prescribed medication on time. People were protected from abuse and the risk of abuse because staff understood their role and responsibilities for keeping people safe from harm. People and their family members told us the service was safe. Risks people faced were identified and measures put in place to minimise the risk of harm occurring. People were protected from the risk of the spread of infection because staff followed good infection control practices. The premises and equipment were well maintained, kept clean and they underwent regular safety checks. People’s needs were met by the right amount of staff who were suitably skilled and experienced.

Improvements had been made to the environment since the last inspection. Adaptations had been made to the environment to better meet people’s needs. People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us they received the right care and support from staff who were well trained and competent at what they did. People were supported to maintain good nutrition and hydration and their healthcare needs were understood and met. People who were able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interest in line with the Mental Capacity Act.

Improvements had been made since the last inspection to how people were cared for. People were treated with kindness, compassion and respect. People told us that staff were kind and respectful of their privacy, dignity and independence. Staff used techniques to help relax people with positive outcomes. Family members and other visitors to the service were made to feel welcome at the service.

Improvements had been made since the last inspection to how people’s needs were responded to. People received personalised care and support which was in line with their care plan. People, family members and others knew how to make a complaint. They were confident about complaining should they need to and felt their complaint would be listened to and acted upon quickly.

Improvements had been made since the last inspection to the leadership of the service. There was a positive culture that was person centred and inclusive. People, family members and staff all described the management team as supportive and approachable. They told us many improvements had been made to the service since the last inspection and that they were fully engaged and involved in the running and development of the service. Effective systems were followed to check on the quality and safety of the service which lead to improvements being made.

More information is in Detailed Findings below

Rating at last inspection: Requires Improvement (report published on 08 December 2017)

About the service: Lymewood Court Nursing Home is a residential care home that provides personal and nursing care for up to 46 people, some of whom are living with dementia. At the time of the inspection 44 people lived in the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection and that the service has improved to good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Lymewood Court is a purpose built service, all bedrooms and communal areas are located on the ground floor. The service is registered to accommodate 46 people, there were 41 people living at the service at the time of this inspection.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in July 2017. 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 last inspection of the service was carried out in March 2017 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements in relation to people’s safety, dignity and respect, management of medicines and quality monitoring systems. We received an initial action plan and subsequent actions plans outlining actions completed to date and those that were ongoing. At this inspection we found that the provider had made improvements however we found further improvements were required to become fully compliant with the Fundamental Standards of Quality and Safety.

We have made a recommendation about the management of some medicines. Improvements had been made to the management of medication, however further improvements were required. Some prescribed medication not safely stored and administered in line with national guidance.

People received their prescribed medication on time and medication administration records (MARs) had been signed to indicate this. Where medication was not administered the circumstances for this was recorded. Medication such as eye drops were labelled on opening and used within the expiry date. Handwritten entries made on MARs were signed by two staff to ensure the accuracy of the information recorded.

Improvements had been made to the safety of the environment. People were protected against the risk of fire. Repairs had been carried out on fire doors and automatic closure devices were used for holding fire doors open. Pathways to external fire doors were clear from obstructions and regular checks were carried out to ensure this was maintained.

Improvements had been made to minimise the risk of the spread of infection. Cleaning schedules had been put in place and followed for the cleaning of equipment used by people to help with their comfort and mobility. Each person had their own hoist sling which was stored in their bedroom.

Improvements had been made to the recruitment of staff, however further improvements were required. The required checks on applicant’s criminal background had been carried out before they were allowed to started work at the service. However references obtained for some staff employed since the last inspection had not been obtained in line with the providers recruitment procedure.

Improvements had been made to the system for communicating people’s needs, however further improvements were required. Wound care provided to one person was not effectively communicated making it difficult to establish the actual care provided. Agency nurses were still heavily replied upon to ensure people were supported by the right amount of suitably skilled staff. However the same nurses who were familiar with people’s needs were blocked booked well in advance thus improving communication and consistency of care for people. In addition two permanent nurses had been recruited since the last inspection and further appointments were in the process of being made.

Improvements had been made to assessments, care plans and supplementary care records so that they reflected people’s needs. However further improvements were required. Care plans for some people had not been updated in a timely way to reflect changes which were identified during reassessment of their needs. Charts which were in place to monitor aspects of people’s care such as fluid intake, weight, positional changes and air flow mattress settings provided specific details of the care people required. Charts had been completed to reflect the care people received and the information was used to evaluate their care.

Improvements had been made to staff support and supervision. The majority of staff had received supervision since the last inspection. Timescales had been set to ensure all staff received the required level of supervision in line with the provider’s policy.

Improvements had been made to people’s confidentiality, dignity and privacy, however further improvements were required. On occasions staff lacked respect for people when speaking about them and some records about people lacked compassion and referred to them in a negative way. Bedrooms which were overlooked from the car park at the front of the building had been fitted with vertical blinds. This enabled people to have more choice and control over their level of privacy. Personal records about people were kept secure when not in use and staff supervised records closely when completing them in communal areas.

Improvements had been made to assessing and monitoring the quality and safety of the service, however further improvements were required. More robust checks were required to ensure staff were recruited in line with the provider’s recruitment procedure, safe use and storage of some prescribed medication and the maintenance of care records.

People who lived at the service were safeguarded from abuse and potential abuse. People told us that they felt safe at the service and that they trusted staff. Safeguarding training was completed by staff and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. Staff knew what was meant by abuse and said they would not hesitate to report any kind of abuse which they were told about, suspected or witnessed.

People were cared for by staff who had received appropriate training. Staff completed a variety of training relevant to people’s needs and their role and responsibilities. Staff completed online training and classroom based training which took place in a dedicated training room at the service. Competency checks were carried out following each training session to make sure staff understood and benefited from the training undertaken.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Lymewood Court is a purpose built service, all bedrooms and communal areas are located on the ground floor. The service is registered to accommodate 46 people, there were 45 people living at the service at the time of this inspection.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in June 2016. 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 was absent from work at the time of our inspection. However in February 2017 an interim manager was appointed to manage the service in the absence of the registered manager.

The last inspection of the service was carried out in September 2016 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements in relation to people’s safety, dignity and respect, management of medicines and quality monitoring systems. We received an action plan which showed all actions would be completed by 31 December 2016. However at this inspection we found that the registered provider had not met these legal requirements and we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

CQC are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date.

The management of medication was unsafe. Some people did not receive their prescribed medication because stocks had run out and other people did not receive their medication on time. Medication administration records (MARs) for some people had been signed to indicate they had received prescribed medication which was not given. One person had been administered eye drops which had passed their use by date. Handwritten MARs had not been signed by two staff to ensure the accuracy of the information recorded. There was a lack of advice sought from healthcare professionals about the possible effects on people when they did not receive their prescribed medication. This put people’s health safety and wellbeing at risk.

Although some improvements had been made to the environment there were ongoing concerns which put people’s safety at risk. Some remedial work had been carried out on fire doors; however they did not provide people with full protection in the event of a fire. Some failed to close properly, others were damaged and a fire door to a bedroom which was occupied was held open with boxes. Trailing wires and equipment obstructed pathways to external fire doors. We alerted the Fire Safety Authority about our concerns following the inspection.

Equipment used to help people with their comfort and mobility was not clean which increased the risk of the spread of infection.

The recruitment of staff was not safe and thorough. The required checks had not been carried out on staff before they started work at the service. Staff were allowed to start work without some of the appropriate checks having been obtained on their character and suitability to work with vulnerable people.

There was a high use of agency nurses at the service. Agency nurses were called upon to ensure that people were supported by the right amount of suitably skilled staff. However the system for communicating people’s needs onto agency nurses was inadequate which lead to people receiving ineffective care and support.

Assessment’s carried out to plan people’s care were not always reflective of people’s needs. Charts which were in place to monitor aspects of people’s care such as fluid intake, weight, positional changes and air flow mattress settings did not provide specific details of the care people required. Some charts had not been completed to show that appropriate care was provided.

Staff did not receive an appropriate level of supervision for their roles and responsibilities. Some staff had attended group supervisions; however the last one took place over six months ago. There was no evidence to show that staff had been given opportunity to discuss on a personal level matters about their work such as their performance and personal development. Clinical supervision for nurses had not taken place.

People’s confidentiality, dignity and privacy were not respected. Some people’s bedrooms overlooked the car park at the front of the building and people in bed were on view. Although bedrooms were fitted with curtains there were no nets curtains or blinds which could be used to promote people’s privacy when they occupied their rooms with their curtains open. Personal records belonging to people were left unsupervised in communal areas which were accessed by visitors to the service.

Although there was a comprehensive system in place for checking on the quality and safety of the service, it was ineffectively used. Many checks which were required had not been carried out when required, and senior managers who were aware of this failed to act upon it. Action plans which were set to address improvements which were identified at the service were not followed. The plans were not monitored by senior managers or the registered provider to ensure appropriate action was taken to mitigate risks to people.

People who lived at the service were safeguarded from abuse and potential abuse. Staff had completed safeguarding training and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. They recognised the different types and indicators of abuse and were confident about reporting any concerns they had.

Staff received the training they needed. Training relevant to people’s needs was provided to staff on an ongoing basis and their competency was checked to make sure they understood and benefited from the training undertaken.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

Lymewood Court is a purpose built service, all bedrooms and communal areas are located on the ground floor. There is a car park to the front of the building and gardens to the rear. There were 45 people using the service at the time of this inspection.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in 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 last inspection of the service was carried out in May 2014 and we found that the service was meeting all the regulations that were assessed. However this was the first inspection under the current provider who was registered in June 2016.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s health and safety was put at risk because parts of the environment were unsafe. Pathways were uneven and had pot holes and a build-up of moss which posed a slip trip and fall hazard. Items of equipment which were stored in communal areas obstructed fire exits and people’s access to areas of the service. Staff removed the equipment after we raised our concerns with them. Some fire doors to people’s bedrooms failed to close properly putting people‘s safety at risk in the event of a fire. The fire doors had been repaired by the second day of our inspection.

The management of medication was not always safe. An open medication trolley was left unattended on a corridor and people who use the service and visitors could have accessed the content of the trolley. Medication administration records (MARs) were not always signed at the right times. Medication for one person was pre dispensed and placed in a pot half an hour before they were due to be administered to the person. Handwritten entries made on some people’s MARs had not been countersigned to check the accuracy of the record made.

Food items were not always safely stored and foods which had exceeded their use by date were kept. Pureed foods were put in the freezer without a label displaying what the content was and without dates to show when it was stored and a use by date. The system for labelling pre prepared foods which were put in the fridge was unreliable because staff were unclear about the information provided. Sauces in the dining room and other food items which were kept in the food stores had passed the use by date. All unlabelled food items and out of date food had been disposed of by the second day of our inspection.

People’s confidentiality, dignity and privacy were not always respected. Some people’s bedrooms could be viewed from the car park at the front of the building. Although bedrooms were fitted with curtains there were no nets curtains or blinds which could be used to promote people’s privacy when they occupied their rooms with their curtains open. People in bed could be seen from the car park outside. The doors to offices where care plans and other personal records belonging to people were stored were left open. In addition staff communication books and monitoring records detailing personal information about people were stored in communal areas.

Although there were systems in place for checking on the quality of the service they did not always identify areas for improvement. When areas of improvement were identified the registered provider failed to act upon them to ensure the health and safety of people who used the service and others. Action plans developed in conjunction with the registered manager and operations manager highlighted ongoing concerns with regards to the outside of the premises, however no action was taken to rectify the concerns and they remained outstanding since the service was newly registered in June 2016. It was only after we raised the concerns as part of this inspection that action was taken to address the concerns.

We have made a recommendation about records. Monitoring records were completed for some people who required aspects of their care monitoring, however some of the records did not provide important information about people’s needs. Fluid charts did not show the amount of fluid a person needed to consume each day and daily checks carried out on the pressure settings of air flow mattresses was not kept.

People who used the service were safeguarded from abuse and potential abuse because the registered provider had taken steps to minimise the risk of abuse. Staff had completed safeguarding training and they had access to information about how to prevent abuse and how to respond to an allegation of abuse. They recognised the different types and indicators of abuse and were confident about reporting any concerns they had.

Staff received the training and support they needed. Training relevant to people’s needs was provided to staff on an ongoing basis and their competency was checked to make sure they understood and benefited from the training undertaken. Staff were provided with opportunities to explore their training needs and discuss any additional support they needed.

People and family members had been provided with information about how to complain and they were confident that any complaints they raised would be listened to and dealt with.