This unannounced inspection was carried out on the 7 January 2015.
Laburnum Court provides nursing and personal care. The home has a dedicated unit for dementia care on the ground floor called The Priory. On the first floor there is a nursing and personal care unit called The Lowry. The home can accommodate a maximum of 68 people. At the time of our visit, there were 31 people being supported on the Priory Unit and 37 people on the Lowry Unit.
There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
At the last inspection carried out in July 2013, we did not identify concerns with the care provided to people who lived at the home.
During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
At 10.15am we went into the dining room on the Priory Unit where some of the residents were finishing their breakfast. We observed a considerable amount of debris on the floor which had not been cleaned up at this stage. When we returned to the dining room at 12.30pm, when lunch was being served, we observed the floor was still dirty and now included a liquid spillage which had not been cleaned up.
We spoke to a health care professional who was visiting the home during our inspection. They raised concerns about a strong unpleasant odour in one bedroom and stained and dirty carpets in another room.
We observed staff assisting during lunch time at the Priory Unit. We did not observe staff washing their hands or wearing gloves before commencing serving. We saw two members of staff who used their finger and a fork to place food on plates when serving meals. We also observed one staff member blow on a person’s food to cool it down. One visiting relative told us; “I have seen staff serve food with their fingers.”
This is a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, people were at risk to infection because the service did not maintain appropriate standards of cleanliness and hygiene. You can see what action we told the provider to take at the back of the full version of this report.
Relatives of people who used the service told us they believed their loved ones were safe at Laburnum Court Care Home. One visiting relative we spoke with told us; “My X is absolutely safe. I feel staff know my X very well and because I’m here often, I have witnessed very personalised attention to her needs.”
During our inspection we checked to see how the home protected people against abuse. We found suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. The notice board in the main reception area contained safeguarding information using illustrations as well as words, which made it clear to understand. It also described what action to take if people had any concerns.
On the whole, throughout the home, we felt there were adequate numbers of staff on duty during most of the day. However, we observed at peak periods during the day such as when medication rounds were undertaken on the Priory Unit and meal times throughout the home, that there were insufficient staffing levels to effectively meet people's needs.
We looked at how the service managed people’s medicines and found the arrangements were safe.
Staff explained they had undertaken a comprehensive induction before commencing their role, which included a period of shadowing more experienced staff and that their progress was regularly reviewed over a three month period.
The home was part of the Pearl Project, which was developed in January 2008 by the provider as a specialised approach to dementia services. The home had implemented an action plan over 12 months, which was on-going to address a number of areas affecting people with dementia that included; the environment, training and a person centred approach.
The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We saw there were procedures in place to guide staff on when a DoLS application should be made. The home maintained a record of all applications submitted and the current status.
We found meal times were very task orientated and not a pleasurable experience for people who used the service. In one dining room, we found people had to wait long periods of time before being served with their meal, several residents were fast asleep and snoring by the time their food was served.
There did not appear to be any clear strategy for dealing with the numbers of people waiting for their lunch. The deployment of staff appeared to be random and uncoordinated and not consistent with people having a pleasurable experience.
Visiting relatives told us they found staff to be very caring. One visiting relatives told us; “First and foremost, I cannot praise the carers enough.” People were able to approach staff and have a positive experience. The ease with which this occurred indicated staff that understood the needs of the people in their care.
The home was part of the North West End of Life Care Programme known as Six Steps to Success. Several members of staff had received training in this end of life care programme which enabled people to have a comfortable, dignified and pain free death.
We found no set activity programme in the home on the day of our inspection or very little in the way of mental or physical stimulation for people. On the day of our visit, a hairdresser was in attendance in the hairdressing salon. Loud jolly music was being played and people were clearly enjoying the experience. The room was a beehive of activity throughout the day. However, people not having their hair done were just left with the television switched on in the lounge with no other options of things to do.
We have made a recommendation about ensuring people had opportunities to take part in activities.
The registered manager was present throughout our inspection together with the regional manager. We discussed our concerns together where improvements were required, specifically relating to the absence of clear leadership on both units during our visits in relation to the deployment and coordination of staff. Staff deployment was random and uncoordinated, which had resulted in a lack of any coordinated activity by staff without a clear sense of priorities in relation to meal times and cleaning duties.
The service held regular relatives meetings to listen and learn from people’s experience with the service. We looked at minutes from these meetings which included topic such as food and dining. The manager held an open surgery every Thursday between 2pm and 4pm which was an opportunity for relatives to pop in and raise any issues or concerns. However, several visiting relatives we spoke to expressed frustration that requests and suggestions to improve the service were not always listened to.
Both people visiting the home and staff told us that the home maintained a positive culture which was open and inclusive. On visiting relative said “We have no worries here, If we saw anything we didn’t like we would soon tell them and the manager.” Another relative told us; “If I had any concerns or complaints, I would immediately speak to the Manager as I know the matter will be dealt with which gives you confidence.”