Archived: Lansbury Court Nursing Home

This inspection took place on 15 June 2015 and was unannounced. This meant the provider did not know we would be visiting. A second day of inspection took place on 16 June 2015 and was announced.

Lansbury Court provides care for up to 56 people some of whom have nursing care needs. All bedrooms are on the ground floor. The service is in two wings Lansbury and Castle Dene House which is specifically for people who are living with dementia. At the time of the inspection there were 40 people using the service; 15 people had general nursing needs, eight received residential support; 17 people were living with dementia and six people were visiting for respite care.

The registered manager had recently left to take up alternate employment and had not yet cancelled their registration with the Care Quality Commission. There was a manager in post who had started employment three weeks prior to the inspection. They had not yet started there registration application.

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.

Medicine was administered to people in a safe way; however we saw that some bottled medicine did not have an opened date recorded on it. Medicine instruction sheets for the administration of warfarin had not been updated or reviewed to ensure they met people’s needs. For people who had been prescribed ‘as and when required’ medicines not everyone had a protocol in place for how or when these should be administered. We did not see any evidence of people having care plans and risk assessments in relation to the administration of their medicine.

Pre-admission mental capacity assessments were completed but the form did not specify the nature of the decision the person was being asked to make and therefore was not following the principles of the mental capacity act (2005).

One person had a DoLS authorisation in place for continuous monitoring however this had expired and we saw no evidence of a further application having been made.

Several people had been assessed as needing bed rails but we saw no evidence of best interest decisions or specific mental capacity assessments in relation to the use of bedrails. This could amount to a restriction under deprivation of liberty safeguards.

Staff training was not up to date and we saw no evidence that people had received an annual appraisal. The new manager had completed an introductory supervision session with staff since they had come into post but there was no evidence that supervisions had been completed prior to this point.

Care plans were person centred and had been reviewed and evaluated on a monthly basis however the care plan itself had not always been re-written following a change to a persons assessed need.

People and visitors felt their individual needs were being met by staff and that the staff were knowledgeable about people’s specific care needs but also knew people well.

Everyone we spoke with said they thought Lansbury Court was a safe place to live and that they were well cared for. Staff were conscious of maintaining people’s dignity and treated people with compassion and respect.

Safeguarding procedures were in place and staff were knowledgeable about safeguarding and how to report any concerns.

Specific risk assessments had been completed for moving and handling and falls whilst other risks and interventions were assessed using the care plan documentation. Any incidents were logged and an analysis of accidents and incidents were completed so staff could identify any triggers and manage them accordingly.

There were robust emergency procedures in place and staff were able to describe the fire evacuation procedure. Health and safety risk assessments had been completed. We saw one bathroom and the smoking room were being used for storage of wheelchairs and television sets which presented a risk to people and their visitors as they still had access to the rooms.

A computerised dependency tool was used to assess the number of staff needed. We saw there were plenty of staff working on the days of the inspection and we often saw staff spending quality time with people chatting and engaging in a relaxed and friendly way.

There were robust recruitment procedures in place which included checking people’s full employment history, the registration details of nurses, references and a DBS check.

A comprehensive induction was in place which included completion of the care certificate.

People told us the meals were enjoyable and we saw that they had been freshly prepared and presented well. There was a four week menu on the noticeboard but there was no indication of which week we were on nor were there any pictorial menus on show.

Two activities co-ordinators were employed and care staff saw it as part of their role to engage people with appropriate activities. Time was set aside for people who chose not to engage in group activities to ensure they received one to one time with staff members.

People and their visitors said they knew how to complain but had no reason to do so. Both past and present compliments letters and thank you cards were on display throughout the service.

Resident and relatives meetings were arranged regularly which gave people the opportunity to provide any feedback or share ideas. This was in addition to an annual survey which was sent to people, staff, relatives and professionals.

The new manager had an action plan in place. They had used feedback from several sources as well as their own observations and findings to develop the plan. They had an open door policy and we often saw people and their relatives popping into the office.

The manager was keen to include people, relatives and staff in suggesting and improvements to the quality of the service and they told us they were hoping to introduce a ‘relative and resident committee’ to be involved in quality assurance, recruitment and event planning.

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