The Care Quality Commission (CQC) has rated Lorna House, Torquay, inadequate overall, following an inspection in April.
Lorna House is a care home providing personal care for up to 24 people, run by Crocus Care Ltd. At the time of the inspection there were 17 people living there.
The service was previously rated good overall, and good for being safe, effective, caring, responsive to people’s needs and well-led.
It was inspected as part of a random selection of services that were previously rated good or outstanding, to check those ratings still applied.
Following the recent inspection, the home’s overall rating and its ratings for being safe and well-led have dropped to inadequate. Its ratings for being effective, caring and responsive have dropped to requires improvement.
CQC notified the local authority to mitigate any immediate risks to people and told the provider to take action to address the concerns identified. The service is now in special measures. This means it will be kept under review and re-inspected to check sufficient improvements have been made. The provider is now working with the local authority improvement team to raise the standards of care.
Amanda Stride, CQC’s head of inspection for adult social care, said:
“When we inspected Lorna House, we were concerned to find the provider of the service had no oversight of the home, and risks to people’s safety, such as falls or choking risks, were not being well managed.
“In the twelve months leading up to our inspection, there had been a significant number of falls in the home, the provider hadn’t looked into the circumstances or taken action to minimise the risk of further falls.
“On the second morning of our inspection, one person, who had dementia, was found on the driveway of the home attempting to go to the shops alone. Staff told us this had happened before, including at night, but nothing had been done to keep them safe.
“We saw another person struggling to swallow food. Staff hadn’t recognised this person could be at risk of choking and had not asked for professional advice.
“In the previous 12 months, four safeguarding alerts had been made to the authorities by health professionals, but no notifications had been made by the service itself, even though most staff had completed safeguarding training.
“We found that people were not always supported to be independent. During the inspection, we saw people trying to stand up and move but they were repeatedly asked to sit back down, rather than supported to go where they wanted. When staff asked one person where they wanted to go, they replied, ‘anywhere’.
“Staff told us they didn’t feel supported, and morale was ‘very low’. Despite this, they were doing their best to provide care.
“People and their relatives told us the staff were kind and caring, and we saw warm relationships between staff and the people living at the home.
“When we inspected, although there was a registered manager in post, they had been absent from the home for some weeks. The provider of the service responded quickly and put an acting manager in place who took immediate action to mitigate the risks we identified and ensure the most urgent concerns were addressed.
“However, further improvements need to be made. People living in care homes deserve to receive safe care, and we will continue to work with system partners to monitor the service and ensure the provider makes the necessary improvements to enable them to deliver a quality service.”
Inspectors found the following during this inspection:
- The provider did not have any quality oversight systems in place to audit medicines, incidents, accidents, care plans or complaints, or to identify themes and trends and learn from these. Notifications were not always made in line with legal requirements.
- Risks to people’s safety were not assessed or monitored effectively, or well managed. Accident records were not reviewed, and not enough action was taken to minimise the risk of people falling.
- Systems were not always used effectively to ensure staff were recruited safely. New staff members did not have a formal induction and staff said they did not receive regular supervision.
- The service had not identified that staff required training around individual health needs and conditions, such as dysphagia (difficulty swallowing), diabetes or the management of Parkinson’s disease.
- Not everyone had a care plan. Care plans that were in place were very brief, basic, task-orientated and had not been regularly reviewed or updated to reflect people’s changing needs. Care plans also did not contain any information to guide staff as to how to support people to manage specific medical conditions safely.
- People’s medicines were not managed safely. There were no stock control systems in place and the amount of medicines received were not recorded. No medicines audits were being completed. There were no protocols in place to guide staff when it was appropriate to use 'when required' medicines.
- People’s privacy and dignity was not always respected, and language staff used was not always respectful.
- There was limited support for people to avoid social isolation, follow interests or take part in activities. People were not supported to have maximum choice and control of their lives, and staff did not support them in the least-restrictive way possible or in their best interests. The policies and systems in the service did not support good practice.
- People and their families were not involved in their care planning and there were no systems in place to seek feedback from people using the service.
- Staff did not always support people to access healthcare services in a timely way. For example, one person relied on hearing aids, but they were broken at the time of admission and nothing was done to replace them.
- The risk of the spread of infection was not well managed.
- There were no systems in place to ensure continuous learning, and there was no service improvement plan. The registered manager worked in isolation from the other homes in the group, and they had not taken advice from the local authority to improve care planning and record keeping when it was offered.