Leighton Court Nursing Home

Leighton Court is a care home providing residential and nursing care to up to 48 people. Some people live in the home and others stay for short periods of rehabilitation and assessment of their ongoing needs. At the time of the inspection, there were 41 people residing in the home.

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

Records did not always allow for clear oversight to be maintained in some areas of the service and required some work to ensure all records were robustly and clearly completed. A range of audits were in place to help the registered manager and provider monitor the quality and safety of the service. We saw that actions identified through the audits had been addressed to help drive improvements.

People told us they felt safe at Leighton Court. The home was well maintained, and staff were knowledgeable about safeguarding procedures and reporting any concerns they had. The home was clean and effective infection prevention and control procedures were in place, including those for COVID-19. Staff told us they felt safe going to work and they had access to all required personal protective equipment.

Individual risk assessments had been completed to identify risks to people and care files included information on how those risks should be mitigated. Regular reviews of accidents and incidents helped to monitor risks and reduce the chance of recurrence. Records showed that referrals were made to relevant professionals when required for specialist advice and support.

There was mixed feedback regarding staffing levels within the home, but most people and staff agreed that there were enough staff to meet people’s care needs. Feedback regarding the quality of service people received was positive and relatives told us they were kept updated about any changes regarding their family members health and wellbeing.

Medicines were managed safely and people told us they received their medicine when they needed them. Systems were in place to encourage independence with administration of medicines, especially for people receiving reablement support.

The registered manager and care manager were aware of their roles and responsibilities. CQC had been notified of incidents that providers are required to tell us about and the rating from the last inspection was displayed as required.

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 21 December 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The home is registered to provide personal care and nursing care for up to 48 people. The ground floor accommodated people who had chosen to live at the home and people receiving respite care. The first floor provided rehabilitation for people leaving hospital as part of a scheme known as ‘Transfer to Assess’.

The home is required to have a registered manager. 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 home had a registered manager who had been in post for several years.

At our last inspection of Leighton Court in July 2017, we found a breach of Regulation 18 of the Health and Social Care Act: staffing, because the provider had not ensured there were enough staff on duty at all times to meet people's needs in a timely manner. During this inspection we found that there were enough staff, but there was a heavy reliance on Agency staff which put pressure on the home’s staff.

Staff were recruited safely. Staff were supported in their role through an induction, supervisions and an annual appraisal. Training was provided to ensure staff had the knowledge and skills to work safely and effectively.

People told us they felt safe in the home and that they had no concerns regarding their care. They told us the staff were kind and caring and protected their dignity and privacy. The premises were clean and well maintained although ‘tired’ in places.

People’s medicines were managed safely.

Applications to deprive people of their liberty had been made appropriately. Records showed that consent was sought in line with the principles of the Mental Capacity Act 2005.

People were satisfied with their meals and with the choice of food available.

A range of social activities was provided to keep people stimulated and occupied.

The manager and the area director completed regular quality monitoring audits which identified any areas needing improvement. Action plans were agreed and implemented by the manager and the staff team.

We issued the provider with two warning notices. These related to breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was with regard to safe and appropriate care and good governance. A warning notice is an enforcement action used by the Care Quality Commission to direct a provider to improve their service to meet requirements of a specific regulation within a set time period. We gave the provider until the 30 April 2017 to meet their legal requirements in relation these regulations.

We requested an action plan from the provider for the other breaches found during our inspection and the provider submitted an action plan outlining the improvements they intended to make.

At this inspection, we found that improvements to the management of risk; the appraisal of staff; people’s right to privacy and dignity; the environment in which people lived and the way in which the service was managed had been made. These was a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to staffing levels and further improvements were required with regards to the assessment and planning of some people’s care needs and preferences.

Leighton Court Nursing Home is a purpose built building close to Liscard town centre in Wallasey. There are 48 single occupancy bedrooms. The home provides support for people with both nursing and personal care needs. The home also provides an intermediate care service. This means the home offers support to people discharged from hospital but who need a period of rehabilitation before they are ready to return home independently. There are 25 beds reserved for this purpose on the first floor (the IMC unit). At the time of our visit 44 people lived at the home.

There was both a home manager and a registered manager at the time of our inspection. 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 home manager had overall managerial control of the service with the registered manager acting as the deputy manager. At the time of our visit, the home manager and registered manager were not available so a manager from another of the provider’s homes assisted with the inspection.

During our visit, we asked people if they thought there was enough staff on duty. Their opinions were mixed. Our observations of care were similar to our last inspection when we found that there was not always sufficient staff on duty to meet people’s calls for assistance in a timely manner. We looked at staff rotas and saw that the number staff on duty did not always correspond with the number of staff determined as safe by the provider. This was mainly at night. Some staff had also worked excessive hours without a break. Overall, we found that little improvement to the staffing levels at the home had been made since our last visit.

We looked at the care files of five people and saw a marked difference in the quality of information available to staff in the delivery of care to people who lived on the residential unit as opposed to those people who lived on the IMC unit. People receiving residential care had assessments, care plans and risk management plans that were clear, easy to follow and up to date. People on the IMC unit had limited assessment information and poor care plans. This meant staff had minimal guidance on people’s needs, care and preferences. People we spoke with on the residential unit said staff knew them well whereas most of the people on the IMC unit we spoke with felt that staff did not know them very well. This showed that the lack of clear information in people’s IMC care plans about their needs and preferences directly impacted on their experience of care.

The majority of people said they felt safe at the home and that staff treated them well. Safeguarding records showed that incidents of a safeguarding nature were listened to and adequately responded to. We found that one of the safeguarding concerns reported to the registered manager had not been reported to the Local Authority or CQC in accordance with legal requirements.

People told us that staff were kind, caring and respectful. They said the majority of staff treated them well and ensured their needs were met. Our observations of care confirmed this. Staff we spoke with had an understanding of the support people needed but recognised that sometimes it took them a little longer to respond to people’s needs when there were fewer staff than there should be on duty.

We checked staff files and saw that staff were recruited safely and had been trained to do their job Staff had received regular supervision and were now in receipt of an appraisal. This was an improvement since our last inspection. People we spoke with felt staff members had the skills and abilities to care for them effectively.

People had access to adequate food and drink and everyone told us they had a choice. We found that improvements were still required to the way staff recorded and monitored people’s dietary intake.

People’s records showed that they received support with personal care and had access to a range of health and social care professionals in support of their needs. Adequate and up to date personal emergency evacuation plans were in place for people who lived at the home which meant that emergency personnel had access to important information about people’s needs in an emergency situation.

The home was clean and well maintained. Equipment in use was certified as safe and regular health and safety checks on the premises and the equipment were undertaken. A new communal lounge had been organised on the IMC unit which meant people had a suitable communal space to socialise with others or simply relax outside of their bedrooms. A nurses’ office had been installed downstairs where people’s personal information was stored securely.

People’s access to activities had improved and people’s feedback at this visit was positive. We saw that opportunities for people to feedback their opinions and suggestions on the running of the service had improved. Regular resident/relatives meetings took place, a recent satisfaction survey had been undertaken with positive results and people had access to an online survey if they wished to provide feedback in an alternative manner.

We checked people’s medications and saw that they were administered safely. The quantity of medication in stock was correct and matched what had been administered. This indicated that people had received the medications they needed, as prescribed.

During our visit, it was clear the home manager and registered manager had taken on board the concerns we identified at the last inspection. Overall sufficient improvements to the management of the service had been made but further improvements were still required in some areas. For example, IMC care planning and the deployment of a sufficient staff to meet people’s needs. For this reason, we were unable to give the domain of well-led a rating of good.

We undertook this comprehensive inspection on the 12, 13 and 17 January 2017. During this visit we followed up the breaches identified during the December 2015 inspection. We found that sufficient improvements to the way medicines were managed and how people’s consent was sought, had been made. We found however that although staff now received regular supervision, they did not always have an annual appraisal of their skills and we found that no appropriate action to ensure that the service was effectively managed had been taken. This was a continued breach of Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We also identified new breaches of the Health and Social Care Act 2008 with regards to Regulations 9,10 and12, These breaches related to the management of risk, the delivery of person centred care and poor staffing levels. You can see what action we told the provider to take at the back of the full version of this report.

Leighton Court Nursing Home is a purpose built building close to Liscard town centre in Wallasey. There are 48 single occupancy bedrooms. The home provides support for people with both nursing and personal care needs. The home also provides an intermediary care service. This means the home offers support to people discharged from hospital but who need a period of rehabilitation before they are ready to return home independently. There are 25 beds reserved for this purpose on the first floor. At the time of our visit, there were 45 people who lived at the home.

There was both a home manager and a registered manager in place at the home at the time of our inspection. 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 home manager had overall managerial control of the service with the registered manager acting as the deputy manager at the time of our visit.

We spoke with eight people and two relatives during our visit. All of the people felt safe at the home and said staff treated them well. A relative however felt that the care of their loved one required improvement.

We looked at the care records of eight people. We found that people’s care plans did not cover all of their needs and lacked clear information about the management of some risks. We found that some of the risk management actions had not been acted upon consistently, to protect people from harm. Where people had challenging behaviours, appropriate risk assessments had not been completed to ensure people were appropriately supported. Dementia care and aspects of some people’s person centred care was poor with care plans lacking adequate information on people’s emotional and social needs.

We found the provider’s emergency procedures needed improvement to ensure people were safely evacuated in the event of an emergency. This was because the personal emergency evacuation plans in place for each person who lived at the home, were sometimes inaccurate and out of date.

Staff had been recruited safely but some staff member’s criminal conviction check had not been renewed since they first commenced in employment. For one member of staff this was six years ago. This meant there was a risk it could be out of date.

We looked at the support and training arrangements in place for staff and found gaps in the appraisal of some staff members. This meant that some staff had not had their skills and competencies reviewed for some time. We checked staffing levels and found that at times they did not sure staff were able to provide safe and prompt support to people who needed it. There was no adequate system in place to ensure the number of staff on duty was sufficient.

People had access to adequate food and drink but people’s feedback on the quality of the food and the choice of meals was mixed. Activities were provided but they were limited and the provider did not have adequate communal space to enable people to socialise appropriately. This placed them at risk of social isolation.

People’s confidential information was not always kept secure and some of their information was displayed on their bedroom door for other people to see. This did not promote their right to privacy. Some people had difficulties communicating verbally but there was no evidence that any appropriate action had been taken to facilitate alternative means of communication so that they were able to communicate their needs and wishes to staff. This did not demonstrate that the service was caring.

Staff we spoke with had a general understanding of people’s care but some staff were unaware of elements of people’s needs. Staff had an understanding of signs of potential abuse and what to do should they suspect abuse had occurred.

When people became distressed, staff were seen to be caring, compassionate and patient and we heard people asking for people’s consent before any support was given. We saw that where people’s capacity to consent to decisions about their care may have been impaired, the Mental capacity act 2005 and the deprivation of liberty safeguard legislation had been followed to ensure legal consent to any decisions made, was obtained.

We saw that staff treated people kindly and spoke to them with respect. It was obvious that people felt comfortable and relaxed in the company of staff but some people said they would like to spend more time with staff but staff were always so busy.

The home was clean, safe and well maintained. Equipment in use had been certified as safe and regular health and safety checks on the premises and the equipment were undertaken.

Medications were administered safely and in a kind way. We checked the stock of medication against people’s records of what had been administered and found they were correct. This indicated that people had received the medicines they needed and people we spoke with confirmed this. We found that there was an excess stock of nutritional supplements and fortified drinks and we spoke with the nurse on duty about this, as this indicated that the ordering of these items required review.

We checked safeguarding and complaint records and saw that any safeguarding incidents and complaints received had been investigated and properly responded to.

The provider had a range of audits in place to check the quality of the service. The systems in place however were ineffective as they failed to pick up the areas of concerns that we identified during our visit. There were also limited opportunities for people to be given information about the running of the service and to share their views on the care provided. This meant there were no suitable mechanisms in place to enable the provider to come to an informed view of the quality and safety of the service provided. This indicated that the management and leadership of the service required improvement.

A full initial assessment was undertaken before people began to use the service and a person centred care plan was developed over a number of weeks. We spoke with six people who used the service and comments included; "The girls are great", "I feel respected and safe", "This is a brilliant place" and "I get what I need". Staff we spoke with were familiar with the needs of the people they were supporting and understood what was required to meet them.

The home co-operated with other providers and people were supported by health and social care professionals from other hospital and community services.

A new electronic medication system had been introduced to manage people's medications effectively and safely. We observed the medication round and were shown how the system highlighted errors to avoid them before they occurred.

We found that staff were recruited appropriately, induction was received and training was provided so that they could support the people using the service.

There was a suitable complaints policy and people knew how to access staff and speak with the manager if they had any concerns.