Loran House

Loran House is a residential care home providing personal care to up to 46 people in 1 adapted building. The service provides support to younger and older people, some of whom are living with dementia. At the time of our inspection there were 35 people using the service.

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

Information about risks and safety was not always comprehensive or up to date. Full information about risks to people's safety was not always communicated to the staff.

Medicine practices were not always in line with best practice guidelines.

A system was in place to monitor the quality and safety of the service, however, this was not always effective in identifying and addressing issues.

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 did not always this practice.

People were supported by staff who had been recruited safely. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. The service had enough staff to keep people safe. We observed staff respecting people's privacy and dignity when providing care and support.

We found the registered manager to be open and responsive to feedback. Visiting healthcare professionals told us that the management team and staff worked well with them.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 May 2021).

Why we inspected

The inspection was prompted in part due to concerns received about governance, medicine management, staffing and risk management. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements.

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 Loran House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicine management, risk management and good governance at this inspection. We have also made a recommendation in relation to mental capacity records.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow test result, proof of vaccination against COVID-19, the requirement to show a COVID-19 pass, hand sanitisation and wearing personal protective equipment (PPE).

People were supported to have visitors in line with national guidance and alternative arrangements were available to support people to maintain contact with their family and friends in the event of an outbreak. Processes were in place to ensure safe visiting practices were followed.

Regular infection control audits took place and actions had been followed up when required.

Risks in relation to COVID-19 were assessed for people.

The local infection control team had recently visited the service and made some recommendations. We found the provider had taken prompt action to remedy shortfalls. This included additional waste receptacles and deep cleans to some bedrooms.

The provider took prompt action to address some gaps we found in the cleaning schedules.

Loran House is a residential care home providing personal care to 31 people at the time of the inspection. The service can support up to 46 people. The care home accommodates people across three floors.

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

Since the last inspection, improvements had been made in the management of medicines, cleanliness in the service, records and general management.

People received their medicines as prescribed. Staff knew how to keep people safe from the risk of harm and abuse. Environmental and individual risk was assessed so measures could be put in place to minimise incidents. Staff were recruited safely and there were enough staff on duty to support people. More frequent checks were undertaken to ensure cleaning schedules were completed. There were good systems in place to help staff prepare for and manage Covid-19 outbreaks.

Staff had access to induction, training, supervision and support. People and their relatives were complimentary about the staff team. People liked the meals and choices available and said staff supported them to access health professionals when required. 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.

The overall management of the service including communication with staff and relatives had improved. Staff felt supported, could raise issues and told us they worked well together as a team. The culture of the service was open and inclusive; people were asked their views and felt these mattered.

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 22 October 2020) and there were breaches of regulation. 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 regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 8 and 9 September 2020 due to concerns raised with us. 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, Effective and Well-led which contain those requirements.

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.

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.

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

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.

Loran House is a residential care home providing personal care to 45 people at the time of the inspection. The service can support up to 46 people, some of whom may be living with dementia. The care home has three floors; ensuite bedrooms are situated on each floor and three communal rooms are on the ground floor.

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

People had not always received their medicines as prescribed due to various reasons, which could place people at risk of harm. There were areas of the service, and specific items of furniture, which required cleaning. In addition, infection prevention and control practices required review and addressing with staff. There were some areas of significant shortfall with regards to records. The quality monitoring system had not identified this range of issues.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported good practice but were not followed. We have made a recommendation about the manager using the code of practice related to mental capacity legislation.

On the first day of inspection, staff were not attentive to people’s individual needs and didn’t notice when someone needed more support. There was also very limited social stimulation. Improvements were noted on the second day and measures taken to discuss concerns with the staff team and improve practice.

There were systems in place to safeguard people from the risk of harm and abuse, and the manager notified CQC and the local safeguarding team when required. Recruitment of staff was safe.

People told us they liked the food, and menus provided choices and alternatives. Any concerns regarding nutrition or other health needs were referred to health care professionals.

Staff had access to training, supervision and support. There were enough staff planned for each shift but short notice absences and specific staff practices such as seniors completing long medication rounds, left some care staff feeling they needed more support. The manager told us they would monitor this and discuss with staff. There were plans to have team building to aid communication between staff and management.

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 (report published 2 August 2019).

Why we inspected

We received concerns in relation to the timeliness of people’s health care support and staff skills/approach. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 improvements. Please see the safe, effective and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Loran 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 monitor the service.

We have identified breaches in relation to managing medicines, infection prevention and control, records and overseeing quality monitoring.

Please see the action we have told the provider to take at the end of this report.

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.

Loran House is a residential care home providing personal care to 42 people at the time of our inspection. Most people were older and may have had a physical disability or were living with dementia. The service can support up to 46 people. The care home accommodates people in one purpose built building with wide corridors over three floors accessed by stairs and a lift.

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

Some people had missed medicines and advice had not been sought. This was addressed following the inspection. Systems were in place to maintain people's safety and protect them from abuse. Risks were identified, appropriate control measures were implemented, and the safety and cleanliness of the environment was maintained. Systems were in place to recruit staff safely.

People were supported with good nutrition and could access appropriate healthcare services. Staff were equipped with relevant skills.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff who were kind and caring and were aware of how to promote people's privacy and dignity.

Staff were responsive to people's needs and provided support in line with their preferences. People had care plans in place which provided information to staff about their needs. Staff supported people to engage in their social and leisure interests. People were able to raise any concerns and felt these would be addressed.

People and staff felt listened to and their feedback was sought. They told us the registered manager was accessible and approachable. There was a positive culture; staff and the registered manager shared the values of providing high quality care. Systems were in place to drive improvement within the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This was the services first inspection since the provider changed to Prime Life Limited.

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.