Archived: Lea Green Court Care Home

We last inspected Lea Green Court in April 2015. At that inspection we found the service was in

breach of the legal requirements in force at the time with regard to Regulations 12, 9 and 15 of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. This was because people were at risk of unsafe care and treatment, records did not accurately reflect people's care and support needs and the premises were not well maintained.

The home provides nursing care and support for up to 45 older people, some of whom live with dementia or a dementia related condition.

A registered manager was 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.

We found significant improvements had been made to the service. People and staff told us they felt safe and there were enough staff on duty at all times to provide safe and individual care to people. There was more emphasis on providing person centred care to ensure people received care and support in the way they wanted and at times they chose. Staff had time to interact and spend time with people and not just when they carried out tasks.

Risk assessments were in place and they now identified current risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe and timely way.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

Records had been updated and they were regularly reviewed to reflect people's care and support requirements. Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions for themselves.

Staff received other opportunities for training to meet people's care needs and in a safe way. A system was in place for staff to receive supervision and appraisal.

Menus were more varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Some activities and entertainment were available for people. However, we have made a recommendation that more activities and stimulation should be made available for people including people who live with more severe dementia.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

Staff and people who used the service said the registered manager was supportive and approachable. Communication was more effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people’s care and support needs and the running of the service.

Changes had been made to the environment. It was cleaner and areas had been refurbished to improve infection control.

. Is the service safe?

. Is the service effective?

. Is the service caring?

. Is the service responsive?

. Is the service well-led?

This is the summary of what we found.

Is the service safe?

An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills and had received the training in order to meet the person's support requirements.

Risk assessments were in place. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to try to prevent admissions to hospital wherever possible.

We saw there were currently enough staff on duty at the time of inspection but we were told this is being kept under review and levels will increase as people's needs change and occupancy levels increase.

Is the service effective?

People we spoke with were positive about the service provided. People commented how helpful and friendly the workers were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. One person we spoke with commented how pleased they were with the care provided by staff at the home.

Staff we spoke with were knowledgeable about people's care needs. They had received training to help them understand the different care and support needs of people they worked with. They said there were good training opportunities and they spoke with enthusiasm about some recent training with regard to "resident experience."

Staff were observed to be patient and supportive as they worked with people.

The new manager had a wealth of experience about providing care to people with dementia. She had introduced several changes to improve the care and welfare of people living at the home. She was hoping the home achieved the Gold 'Pearl Award". This is awarded by the company when a home achieves certain criteria and shows an increased understanding about providing individual care, support and stimulation to people with dementia.

Is the service caring?

People and relatives spoken with talked well of the level of care provided by staff. We found people were encouraged to be involved in daily decision making. Staff were helpful and offered people information and support about their care. We saw there was good interaction between staff and people who used the service. We observed the interaction and noted the kind and caring way staff supported people, especially people with dementia. Staff allowed sufficient time for people to respond. It was evident that staff had developed a good understanding of people's communication needs and how best to communicate with them.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they moved into the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure the person's care and support needs had not changed. This helped ensure staff supplied the correct amount of care and support.

Referrals for specialist advice where made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in all decision making with regard to their care. They were kept informed and given information to help them understand the care and choices available to them.

Information collected by the service gave staff some insight into the interests and areas of importance to the person. It helped with the provision of social activities people may wish to be involved with.

Regular meetings took place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

There was a focus from management on the provision of individual care and support to people who use the service. Staff were knowledgeable about the support needs of people.

Staff received regular supervision and commented they felt supported by the management team and advice and support was available from the management team.

We saw people had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Records showed care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found at this inspection there were enough qualified, skilled and experienced staff to meet people's needs. The provider took the necessary action immediately to increase staff levels in order to help ensure people's needs were met in a safe and timely way.

We spoke to six people who lived at the home who told us staff were kind and helpful but they were kept very busy. They said they had to wait for staff as they were busy helping other people.

We observed staff were rushed as they tried to provide individual care to each person. Due to the low staff numbers on duty and the high dependency of many people care and support was not provided in a timely way as people had to wait for staff support. It was observed at times they were at risk. We also saw some people were not able to have choice when to get up in the morning or when they may have a bath.

We found the building was well maintained and suitably designed for the needs of people with dementia.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.

We saw the provider had taken action since the last inspection to improve the standard of record keeping. This meant people were protected from the risks of unsafe or inappropriate care and treatment.