The inspection took place on 9 and 10 March 2016. The inspection was unannounced. Lothian House is a residential care home based in Spennymoor, County Durham. The home provides personal care to older people and people with dementia. It is situated close to the Spennymoor high street, close to local amenities and transport links. On the day of our inspection there were 46 people using the service.
The home had a registered manager. 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 atmosphere was homely with a family feel that was warm and extremely welcoming.
Without exception we saw staff interacting with people in a person centred and extremely caring way. We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with upmost kindness. We saw staff being considerate and communicating with people exceptionally well.
We saw that people were encouraged to enhance their wellbeing on a daily basis to take part in activities that encouraged and maximised their independence and also contributed positively to the homely atmosphere, peoples wishes and the day to day running of the kitchen and around the home.
End of life care was care planned extremely carefully and in plenty of advance so that the person and their families were 100% involved in all decisions about their care, needs, wants and spiritual wishes. The service was working towards the GOLD framework (a national training and end of life accreditation programme) and the service also had an established and committed end of life champion within the staff team.
We spoke with a range of different team members; care, senior, kitchen staff, and maintenance staff who told us they all felt well supported and that the registered manager was supportive, and they were all polite, receptive, open and approachable.
Throughout the day we saw that people who used the service, relatives and staff were comfortable, relaxed and had an extremely positive rapport with the registered manager and also with each other.
From looking at people’s detailed care plans we saw they were written in plain English and in a person centred way and they also included a ‘one page profile’ that made excellent use of pictures, personal history and described individuals care, treatment and support needs. These were regularly reviewed by including family members and people. These plans were regularly updated by the care staff and the registered manager.
Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, continence advisor or chiropodist.
Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes in a person centred way.
When we looked at the staff training records. They showed us staff were supported and able to maintain and develop their skills through training and unique development opportunities were accessible at this service. The staff we spoke with confirmed they attended a range of valuable learning opportunities. They told us they had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. We also viewed records that showed us there were robust recruitment processes in place.
We observed how the service administered medicines and how they did this safely. We looked at how records were kept and spoke with the registered manager about how senior staff were trained to administer medicine and we found that the medicine administering process was safe.
People were consistently actively encouraged to participate in numerous activities that were well thought out, organised, personalised and meaningful to them including, outings and regular entertainers. We saw staff spending their time positively engaging with people as a group and on a one to one basis in fun and meaningful activities. We saw evidence that people were not only being supported to go out and be active in their local community, but on holidays and they were also valued members of the local community.
We saw people were encouraged to eat and drink more than sufficient amounts to meet their needs. We observed people being offered a varied selection of drinks and fresh homemade snacks. The daily menu that we saw was reflective of people’s likes and dislikes and offered varied choices and it was not an issue if people wanted something different.
We saw a complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. The compliments that we looked at were overwhelmingly complimentary to the care staff, management and the service as a whole and particularly around end of life care. People also had their rights respected and access to advocacy services if needed.
We found an effective quality assurance survey took place regularly and we looked at the results. The service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service and their representatives were regularly asked for their views about the care and service they received at meetings and via surveys.