Archived: Lydfords Care Home

Accommodation was provided over two floors. There were communal areas, including two lounges, a family meeting room, dining room and an activities room. People had their own rooms. People had access to gardens at the rear of the home.

People’s experience of using this service:

We received mixed feedback about staffing levels from people, relatives and external health and social care professionals. Staff rotas showed that there were enough staff to meet people’s needs, but we recommend that the registered manager makes improvements to how staff are deployed.

At the last comprehensive inspection in October 2016 we recommended that the provider seeks guidance on how to safely assess, monitor and review call bell response times on a regular basis as call bells rang constantly. At this inspection, the registered manager and provider had installed a new system which gave them oversight of call bell response records. Despite this we did not see how the registered manager used the records to monitor responses to call bells to check that call bells are responded to promptly. We recommend that the registered manager continues to improve how they check that call bells are responded to promptly

In the last focussed inspection, we recommended that guidance for giving as and when needed medicines (PRN) and on steps to take before administering these as and when medicines was needed. At this inspection protocols for as and when (PRN) medicines continued to not comprehensively guide staff on steps to take before administering medicines. Despite this, people were not at risk of harm. Medicines were administered and stored safely.

Staff told us they had training and were supported to complete qualifications in health and social care. New staff completed an induction with mandatory training and the Care Certificate. Despite this, not all staff had received all training to meet people’s needs. We looked at training records and saw gaps. For example, two staff out of 35 had completed training in nutrition and hydration and only seven staff had completed training end of life care. Following the inspection, the registered manager provided us with further evidence to show that 12 staff had completed modules of the dementia care framework and dementia experience training since the inspection.

At the last comprehensive inspection, we recommended increasing and improving meaningful activities offered to people that are cared for in bed due to health needs or that chose to stay in their rooms. At this inspection, people cared for in bed continued to be at risk of social isolation. Activities staff had been supported to give dedicated time in people’s rooms, but this was only for 15 minutes per week per person. We gave this feedback on the inspection and immediately following the inspection the provider acted to recruit a full-time activities coordinator who was dedicated to spending time in people’s rooms. A structured activities programme was available to people and external entertainers visited once a month.

Systems of quality monitoring were in place but how the provider used the systems to learn from and improve the quality of care continued to be area of improvement. Mechanisms were accessible for relative’s, people and staff to give feedback about the service. Staff attended team meetings three times a year and relatives and resident meetings were held twice a year. People and relatives could give anonymous feedback at any time by using a tablet device displaying a feedback survey in the reception.

People told us they felt safe at Lydfords. Risks to people were minimised. People were protected as risks were assessed and managed. Staff knew how to keep people safe in an emergency such as a fire.

Records showed people have input from a range of health and social care professionals. The people living at Lydfords benefit from the being part of an enhanced GP care programme that links the service to a local GP.

The service met the characteristics of Requires Improvement in all areas. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection: Good. The last inspection report was published on 27 November 2017, this was a focussed inspection on the key questions of Safe and Well-led. The last comprehensive inspection received a rating of Good, that report was published on 14 October 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Enforcement: At this inspection we found three breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Follow up: We will review the service in line with our methodology for ‘Requires Improvement’ services. If any concerning information is received, we may inspect sooner.

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

The service had a registered manager in place. 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.

At the last comprehensive inspection on the 15 and 16 September 2016, the service was rated as 'Good' overall and Requires Improvement in the 'effective' domain. This focused inspection was prompted in part, by a notification of a serious injury involving a person who lived at the service. The incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident, indicated potential concerns about the management of risk in relation to fire safety and falls. This inspection examined those risks. We therefore looked at two key questions, is the service safe and well-led? This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lydfords Care Home on our website at www.cqc.org.uk

At this inspection the management of medicines was not consistently safe. Guidelines were not always in place for the use of ‘as required’ medicines. Documentation failed to reliably record the reason for administration for the use of ‘as required’ medicines. This meant the provider was unable to monitor whether the medicine was being administered for its intended usage. People received their medicines on time, however, the provider had not ensured that medicines were stored or managed safely at all times. Staff left the medicine trolley unattended during inspection. We have identified this as an area of practice that needs improvement.

Staffing levels were based on an assessment of people’s individual care needs. People and staff felt staffing levels were sufficient. However, observations throughout the inspection noted that the call bell system was constantly ringing. People raised concerns that they felt they had to wait for assistance. An audit of the call bell system found it failed to consistently record when people’s call bells were answered and when a number of people had pressed their call bells, the system did not record who pressed their call bell first. Steps were in the process of being taken to replace the call bell system. However, we have identified this as an area of practice that needs improvement.

Steps had been taken to ensure the building complied with fire regulation standards. A fire risk assessment dated May 2017 identified a number of shortfalls. Appropriate action had been taken to address the shortfalls. Training had been provided for staff to become fire wardens and fire drills were now taking place.

People were protected from harm and abuse. There were appropriate, skilled and experienced, permanent staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. Risk assessments ensured that risks were managed and people were able to maintain their independence.

Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

People, relatives and staff spoke highly of the registered manager. One staff member told us, “The manager is a fantastic boss and a fantastic nurse. We’ve got a staff meeting this week.” Quality assurance systems were in place to drive improvement and check the safety and quality of care delivered.

The service had a registered manager in place. 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 CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Applications to restrict people's freedom had been submitted to the appropriate DoLS office and checklists were in place to determine whether people’s rights were being restricted. Staff had received training; however, staff were not consistently aware who was subject to a DoLS and what that meant for that individual. Conditions attached to DoLS were not consistently being met. We have made a recommendation for improvement.

People's nutritional needs were met. They were provided with a wide range of food options and individual dietary requirements were catered for. People’s choking risk had been assessed and measures implemented to mitigate the risk of choking. However, improvements are required to enhance people’s dining experience. Further work was required to ensure food and fluid charts were completed correctly. We have made a recommendation for improvement.

Appropriate recruitment checks took place before staff started work. Staffing levels were based on the individual needs of people and staff and people felt staffing levels were sufficient. Observations throughout the inspection found that the call bell constantly rang. An audit of call bell response times found that people had occasionally had to wait in excess of twenty minutes for staff to respond. The management team were responsive to this feedback and took action immediately. We have made a recommendation for improvement.

People's privacy respected and their right to confidentiality was maintained. People were involved in their care and decisions that related to this. Care plan reviews, as well as residents' meetings, enabled people to make their thoughts and suggestions known. People's right to make a complaint or comment was welcomed and acknowledged and action had been taken in response to people's concerns.

People, staff and relatives were complimentary about the leadership and management of the home and of the approachable nature of the management team. One relative told us, “The manager is very bright and fair but will not let anything go. She is also a good nurse, if there is a gap she wears her nurse’s uniform and works the shift.” There were quality assurance processes in place to ensure that the systems and processes were effective and people's needs were being met.

Positive relationships had been developed between people as well as between people and staff. There was a friendly, caring, warm and relaxed atmosphere within the home and people were encouraged to maintain relationships with family and friends. People and their relatives were complimentary about the caring nature of staff, one relative told us, “The most important thing is they are very nice to her, they treat her like a human being and do not talk down to her.”

People's safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people's safety. Risk assessments ensured that risks were managed and people were able to maintain their independence. There were safe systems in place for the storage, administration and disposal of medicines. People told us that they received their medicines on time and records and our observations confirmed this.

Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people's needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people's needs. The provider had a training plan in place and staff had received regular supervision. People were supported to maintain relationships that were important to them.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us "Yes they certainly know how to look after people here and I'm very happy thank you'.

Staff we spoke with said that they had undertaken safeguarding vulnerable adults training and people living at the home told us that they felt safe and knew who to talk to if they had any concerns.

At a previous inspection it had been identified that staffing levels had not been appropriate to meet the needs of people at the home. In response to this we reviewed the current staffing levels and found that the provider had taken steps that ensured sufficient staff were employed with the right skills to meet the needs of people who were using the service.

Staff were told us that they felt valued and supported and that their training needs had been met. However, we found that during the absence of the manager on maternity leave only a few members of staff had participated in regular supervision. There was no evidence to support that any staff had received an annual appraisal.

The provider had assurance systems in place to continually manage risk and monitor the quality of the service provided.

We found that people's needs were assessed and their care plans included their individual preferences. Risks to people's health and wellbeing were identified and managed. We found that care plans were regularly updated and reviewed. A visiting doctor told us "staff provide good care, and the manager has a good knowledge of people's needs".

People's medicines were handled safely and appropriately. Medicines were administered by qualified nursing staff who were assessed as competent to do so.

We found that the staffing levels were not based on a risk assessment and analysis of people's needs and this meant that people were not always supported by enough staff. We have asked the provider to ensure that there are always sufficient number of staff to ensure the health, safety and welfare of people who used the service.

The provider had an effective system in place to respond to the complaints and comments made by people or those acting on their behalf. We found that improvements were made to the service where concerns had been raised.