Market Lavington Care Home

About the service

Market Lavington Care Home is a residential care home providing accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 87 people. The service provides support to people over and under 65 years, people with physical disabilities and people living with dementia. At the time of our inspection there were 52 people using the service.

Accommodation was provided across 2 buildings on the same site. People had their own rooms and there were communal rooms available in both buildings, such as lounges, dining rooms and bathrooms. There was outdoor space available for people to use accessed from ground floors.

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

Medicines were managed safely but improvement was needed to make sure all medicines records were transcribed accurately. We have made a recommendation about this. People who needed their medicines regularly on time did not always experience this. We saw no impact for people of medicines being late. However, times of administration required a review. The registered manager told us they would act without delay to address this shortfall.

Some people relied on staff for their food and fluid as they were not able to do this for themselves. Records for fluids did not always demonstrate staff had offered or helped people to drink enough during very warm weather. The registered manager provided assurance this was a recording issue and people were being offered regular drinks. During our inspection the provider cascaded out a new dehydration risk tool for staff to use. The provider told us this tool, where needed, would be used to assess dehydration risks and staff would be provided with training on how to use it.

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.

Risk management plans recorded measures in place for staff to follow. These were reviewed regularly and updated when needed. Health and safety checks were carried out and recorded. Staff and external contractors checked areas such as fire systems, moving and handling equipment and emergency lighting for safety.

The service was clean and smelt fresh. We observed staff using personal protective equipment safely. The provider had carried out a programme of refurbishment since our last inspection which had improved the environment. Communal areas had been redecorated and had new soft furnishings. Windows had been replaced and the outside space had been improved for people to enjoy sitting out in nice weather.

People could have visitors when they wished. People and relatives told us staff were caring and took time to understand and get to know people. People told us at times staff were busy and their call bells took time to be answered. We observed, during our inspection, there were enough staff available to meet people’s needs and call bells were answered promptly. Staff we spoke with told us there was enough staff and the registered manager was able to increase staff if needed. Call bell response times were monitored and analysed by management. Staff had been recruited safely.

People’s health needs were identified, and timely referrals made to local healthcare professionals. Feedback from healthcare professionals was positive and we were told improvements had been made to areas such as communication.

There was a registered manager in post who had notified Care Quality Commission (CQC) of events and injuries as required by law. There were systems to assess and monitor quality and safety. Staff carried out audits and any actions were added to the service improvement plan. The provider, central support staff and the registered manager took responsibility for making sure all identified actions were addressed.

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 (published 16 March 2021) and there was 1 breach of regulation 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of this regulation.

Why we inspected

We carried out an unannounced focused inspection of this service on 26 January 2021. A breach of legal requirements was found. The provider completed an action plan after that inspection to show what they would do and by when to improve regulation 17 (good governance).

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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 Market Lavington Care Home on our website at www.cqc.org.uk.

Recommendations

We have made 1 recommendation about handwritten recording of medicines.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Market Lavington Care Home provides personal and nursing care to 43 people aged 65 and over at the time of the inspection. The service can support up to 87 people. The home also has rooms used for short-term periods in agreement with the local authority. These were referred to as 'discharge to assess' rooms.

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

At the last targeted inspection on 17 August 2021 we found the home was not clean and some areas needed repair. We served a Warning Notice for a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We carried out this targeted inspection to check the provider had carried out the required improvement. We found they had made the necessary improvements.

The home was clean and smelt fresh. Domestic staff were observed carrying out their cleaning and recording their actions in cleaning schedules. The registered manager told us following the last inspection they had organised a deep clean of the home and now had staff to maintain the standard. People’s rooms were clean, and people told us they were happy with the standard of cleanliness.

Handrails had been painted which covered exposed wood and enabled them to be cleaned thoroughly. Damage to walls observed at the last inspection had been repaired. Many areas of the home had been re-decorated which made the environment brighter and more homely.

Two bathrooms had been refurbished which provided people with clean modern shower facilities. Repairs had been carried out to other bathrooms to make sure they were safe to use. A dining room we were concerned about had been repaired, cleaned and a new kitchenette installed. This gave staff a safe and hygienic area to prepare food and wash their hands.

Staff were observed to be wearing personal protective equipment (PPE) safely. Staff told us they had plenty of stock available. Staff had been provided training on infection prevention and control good practice such as handwashing and how to put on and take off PPE safely.

People and staff were testing for COVID-19 as per government guidance. Any positive test was reported to the local public health teams and guidance followed. Prior to our inspection two positive COVID-19 results had been reported. The registered manager liaised with public health to make sure safe practices were implemented.

People could have visits from their relatives, which were booked in advance. This enabled the home to safely manage visits and follow government guidance. All visitors had to have a negative Lateral Flow Test prior to entry into the home. Visitors were also required to wear appropriate PPE.

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 (published 16 March 2021) and there was one breach of regulation. The provider completed an action plan after the inspection to show what they would do and by when to improve. We returned to carry out a targeted inspection on 17 August 2021 as we had received concerns about the cleanliness of the building. We found an additional breach of regulation and served a Warning Notice.

At this inspection we found the improvement required for cleanliness had been carried out, so the provider is no longer in breach of that regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

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

About the service

Market Lavington Care Home provides personal and nursing care for up to 87 people. Accommodation is provided in two separate buildings. One building is for residential care and one for nursing care. People have their own rooms and there are communal rooms such as dining rooms and lounges. The home also has rooms used for short-term periods in agreement with the local authority. These were referred to as ‘discharge to assess’ rooms. At the time of our inspection there were 52 people at the home.

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

This was a targeted inspection to look at concerns about cleanliness. CQC had received whistleblowing concerns about the cleanliness of the buildings.

The home was not clean and in need of maintenance. The planned refurbishment for May 2021 had not taken place. This meant there were some areas which were in need of repair and redecoration.

We observed communal bathrooms and shower rooms were not always clean. Shower trays in communal bathrooms were stained and one had black mould around the plug hole. The shower chair had rusty wheel fittings which could not be thoroughly cleaned. One dining room had a piece of skirting board missing which exposed brick and plaster work. The dining room had fluid spilled on the floor which had become sticky and we observed cobwebs around the windows and light fittings.

Handrails in corridors had chipped paint which exposed wood and plaster had come away from the wall in one corridor exposing the brick. These areas were porous and could not be cleaned thoroughly.

We observed one person’s room was in need of a hoover as there was debris on the floor and there was a dislodged radiator in the room which needed repair. We showed some of these areas and our concerns to the area director who was visiting at the time of our site visit. They told us they would address these shortfalls.

Cleaning schedules did not evidence the home was being cleaned regularly. There were gaps in recording for a number of weeks or staff had written that there were not any staff available to clean. The home had experienced a shortage of domestic staff. They informed us they had used agency domestic staff to fill gaps in the rotas. Whilst agency domestic staff had been used, it was only for a fraction of the gaps in staffing rotas. This meant there were times when there were no staff available to clean or one member of staff to clean the whole service.

People were able to have visits from their relatives. Systems were in place to make sure relatives had a Lateral Flow Test (LFT) prior to visiting which gave the provider a quick COVID-19 result. All visitors had to complete screening questions and visits were booked in advance.

People and staff were being tested as per the government guidance for COVID-19. Staff were observed to be wearing personal protective equipment (PPE) safely and there was plenty of stock available. Staff had been trained on how to use PPE safely and on infection prevention and control safe practices.

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 (published 16 March 2021). We found the service was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we did not review areas for the breach of regulation 17 so the service remains in breach of regulation. We have also identified a new breach of regulation at this inspection.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the cleanliness of the home. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of regulation in relation to poor cleanliness and maintenance in some areas. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Market Lavington Care Home was providing personal and nursing care to 48 older people at the time of the inspection, some of whom live with dementia. The service can support up to 87 people. Accommodation is provided in two separate buildings, one for residential care and one for people who need nursing care. The home also has rooms for people who had been discharged from hospital but not yet ready to move home. These rooms were used for short-term periods in agreement with the local authority and referred to as ‘discharge to assess’ rooms.

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

The home was not always clean as there was not enough domestic staff working to provide a safe cleaning service. In addition, there were areas of the home such as handrails that needed repair. The provider had planned a refurbishment at this home which had been paused, we have been told it will resume in May 2021. The lack of domestic staff had impacted on staff morale. Staff told us there were not enough staff and that they were concerned at the lack of action taken by the provider to address this.

Incidents and accidents had been recorded, but not all incidents had been reported to the local authority where required. The provider told us they would take action to address this shortfall.

People told us they felt safe living at the service and that the staff were helpful and kind. Feedback from people and relatives about staffing numbers was mixed and we have shared this with the provider.

People’s risks had been identified and assessed by staff and management plans were in place. Where people needed additional support to manage risks the records did not always evidence the support had taken place or that monitoring was happening. The provider had identified some of the recording gaps through their quality monitoring processes and were taking action in some areas.

Staff had been trained in infection prevention and control and provided with personal protective equipment (PPE). Staff told us they had access to ample supplies of PPE, and we observed they used it safely. Staff told us the provider had made support available for them to help with their wellbeing if they needed it. There were mental health champions identified amongst the staff group and numbers for staff to ring for help, support or guidance.

Visiting indoors had paused during our inspection except for compassionate reasons. People were supported to keep in touch with relatives using a variety of means. Any new people moving into the service were isolated in their rooms and tested for COVID-19. Everyone at the service was being tested for COVID-19 as per the government guidance. We observed there were information posters up around the service giving guidance on washing hands and staying safe during the pandemic.

Since the last inspection there had been instability with the management of the service which had been unsettling for people, relatives and staff. There was a new manager in post who was in the process of registering with CQC. Feedback received about them was very positive.

Quality monitoring visits were taking place which supported the new manager and the staff team. Some areas for improvement and development had been identified and the provider was monitoring outcomes.

Communication had been a cause for concern at the service for professionals and relatives, but the new manager was taking steps to make improvements. There had been one relatives’ meeting via the internet which had been well received. The manager was planning to hold more to help with communication.

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 19 May 2018).

Why we inspected

We received concerns in relation to unsafe medicines management. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe 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 Market Lavington Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one breach of Regulation in relation to the providers failure to have systems in place to assess, monitor and mitigate risks and the quality and safety of the service.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Market Lavington accommodates up to 87 people across two separate buildings, each of which have separate adapted facilities. The residential building is known as Vicarage Gardens and was named by the people who live there. At the time of our inspection 67 people were living in Market Lavington Care Home.

The inspection took place on 22, 23 and 26 March 2018 and was unannounced on the first day.

At the last inspection there was a breach of the legal requirements in the area of risk. During this inspection we found that improvements had been made.

A registered manager was in post. 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 has worked at the home for many years and was present on day two of the inspection. The deputy manager and the unit manager were available on days one, two and three.

The ordering storage and disposal of medicines was managed safely. We observed the lunchtime medicines round and saw that medicines were given in a safe and caring way. Medicine administration records (MARs) were completed correctly. There were appropriate systems and records in place for ordering and disposing of medicines. However, we found some out of date medicines and missing protocols for ‘as required’ medicines from the records. We have made a recommendation about the management of some medicines.

Staff sought people’s consent before carrying out any support and they had knowledge of the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS). However there were many locked doors in the residential part of the home which restricted access to some areas. We have made a recommendation about best practice for people living with dementia.

People told us they felt safe. Staff knew and understood their responsibilities for safeguarding people against potential risk or harm, and were able to tell us how and when they would report any concerns. Staffing levels were appropriate to meet people’s needs and staff recruitment practices were conducted correctly.

People were supported by staff who had access to training to equip them with the skills and knowledge they needed. Staff benefited from regular one to one supervision sessions to discuss their needs and development.

People and their relatives told us the staff were caring. We observed and heard many kind and compassionate interactions between staff and the people they were supporting. However, some interactions and information lacked dignity. We have made a recommendation about the practise of person centred care methods.

Care and support plans were individualised and contained information on people’s likes, dislikes and preferred routines. People were supported to have maximum choice and control of their lives and staff supported people to make decisions.

There were systems in place to monitor and improve the quality and safety of the service provided. People, their relatives and staff were encouraged to share their views on the quality of the service people received. Where actions to improve had been identified these had been acted upon.

The home had a new provider and the registered manager was effectively supporting people, their relatives and the whole staff team with the changes.