Laverstock Care Centre

Laverstock Care Centre is a nursing home in Salisbury. Accommodation is provided over three floors for up to 80 people some of whom live with dementia. Each floor had two separate units with their own lounges and dining areas. All rooms have their own en-suite facilities. At the time of our inspection there were 63 people living at the home.

People’s experience of using this service and what we found

People’s care was delivered by sufficient numbers of staff on duty. Staff had been recruited following safe systems to carry out the required pre-employment checks. Staffing numbers were kept under review by the registered manager and increased if needed. People benefited from safe systems of medicine management and their medicines were administered as prescribed. People told us their medicines were given to them on time. Risks to people and the environment had been assessed and there were management plans in place. Staff kept these all under review and changed them if needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were cared for by a staff team who were trained and regularly coached by designated staff. New staff were given a thorough induction and then able to have training updates in a range of areas. Healthcare referrals were timely and appropriate, and the service worked in partnership with many local healthcare professionals.

People enjoyed the food and had a choice of meal. If they did not like the options, the chef made sure alternatives were available. Meals were relaxed and unhurried and there was enough staff to support people where needed. People told us staff were kind and caring and respected their dignity at all times. People were involved in their care and where they wished relatives were also involved. People had a choice of activities to enjoy if they wished. Activity staff were employed and planned events that people enjoyed. If people did not want to join in group activities staff made sure they had a one to one session to do an activity that was more personalised.

Individual care plans contained the guidance needed for staff to meet their needs. Care plans were reviewed monthly or sooner if needed. Some people needed additional monitoring which was carried out by staff responsively. For example, some people had food and fluid monitoring charts in place and some had re-positioning charts in place. All were completed in full and checked by nursing staff.

People told us the home was well-managed. There was quality monitoring carried out and regular checks for safety. The provider had employed a new home manager who was having an induction period to enable them to get to know people, relatives and staff. The registered manager was overseeing operational day to day management so the new manager could take uninterrupted time to settle in.

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

Rating at last inspection - The last rating for this service was requires improvement (published 11 December 2018).

Why we inspected - This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the service. We also asked them to provide us with a weekly action plan to keep us updated with the action they were taking. At this inspection we found significant improvements had been made. This service is no longer in ‘Special measures’, however, the rating reflects that further improvement is required.

Laverstock Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Accommodation is provided over three floors for up to 80 people. Each floor had two separated units. Each unit had a separate lounge and dining room which included a small kitchenette. All rooms had en-suite facilities and there were communal bathrooms and toilets. At the time of our inspection 54 people were living at the home.

Following our previous inspection, the registered manager left the service. The provider appointed another manager who also left the service. A new manager was in post and in the process of registering with us. 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.

Risks had been identified but not all safety measures in place were robust. The provider had taken steps to reduce the risks we found at the last inspection. The environment was clean and cleaning schedules were being followed to maintain cleanliness.

People received their medicines as prescribed. Nursing staff administered medicines and had their competence assessed. Improvement were needed to how some medicines were stored.

Staff had been recruited safely as the provider had completed all necessary recruitment checks. Staff could identify the different types of abuse and knew how to report any concerns. There had been an improvement to the culture at the service so staff now felt more confident about reporting concerns.

Accidents and incidents were recorded and analysed by the clinical staff. Lessons had been learned and measures put into place to reduce the risks of reoccurrence.

People were being supported by staff who were trained. New staff received an induction and were allocated a mentor to support them with their learning. The provider had put key senior, experienced staff at the service to mentor and coach existing staff. This had improved staff confidence, skills and knowledge.

Where appropriate referrals to healthcare professionals had been made. Records demonstrated that people could access healthcare advice and support when needed. People received sufficient food and drink. Where people required additional monitoring of fluid this had been completed thoroughly.

People were being cared for by staff who were kind and caring. Overall people’s dignity was promoted and privacy respected. We observed interactions between people and staff that were caring and demonstrated that staff knew people and their needs well.

Incidents of distress were supported by staff who demonstrated an understanding of people’s needs. They followed identified strategies and recorded their actions. Behaviour support plans were in place which were person centred and positively written.

People had their own care plan which was personalised. Improvement had been made to how staff recorded daily information. Nurses reviewed care plans monthly or sooner if needs changed.

There was a range of activity available for people to engage with. The service had identified activity workers who co-ordinated activity provision and planned events for the whole home. People were able to have visitors without restriction.

Complaints were recorded and responded to within the providers timescales. Quality monitoring was realistic and transparent about how the service was provided. The new leadership at the service was appreciated by people, relatives, professionals and staff.

Laverstock Care Centre is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Laverstock Care Centre accommodates 80 people in one purpose built building. On the first day of the inspection, there were 69 people living at the home. People’s bedrooms were located over three floors. Each floor had two separated units. One unit supported people with nursing needs whilst the other supported those living with dementia. Each unit had a separate lounge and an adjacent dining room and kitchenette. Bedrooms had en-suite facilities and there were communal bathrooms and toilets. All units were supported by a central kitchen and laundry.

There was a registered manager in post. 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 registered manager was available during the inspection on all but the second day.

At this inspection, serious concerns were identified regarding people’s care. There were not enough staff to support people effectively and in a dignified way. There were periods during the early morning between 06.00 and 08.00 when units were not staffed. This was because the allocated member of staff was helping another member of the team, in a different unit. Insufficient staffing at this time meant two people did not receive assistance with their personal care. One person asked staff to help them to the toilet. Staff told the person to use their incontinence aid, as staff did not have time to assist them.

Potential risks to people’s safety had not been identified or properly addressed. In one person’s bedroom, there was a crash mat against the wall. This should have been on the floor to minimise injury, if the person fell from their bed. Re-positioning regimes to minimise people’s risk of pressure ulceration were not being accurately followed. People’s medicines were not safely managed and staff did not always follow safe moving and handling procedures.

People were not treated with dignity and respect and care was not person centred. The majority of interactions were task orientated and did not take into account people’s preferences. In one unit, people were assisted to bed without consultation. All except two people were in bed by 19.45. In the morning, there was an expectation a number of people would be “up and dressed” before the day staff came on duty at 08.00. Some people were “top dressed”. This was a practice where people were assisted to wash and dress the top half of their body. They were then able to return to sleep. One member of staff told us they started assisting people to get washed and dressed from 05.00 onwards. This showed routines were task orientated and for the benefit of staff, rather than people’s preferences.

We were not assured that people had enough to drink. Staff had identified those people at risk of dehydration. However, records showed some people had consistently not reached their recommended daily fluid intake. Whilst this had been identified, there was limited evidence to show additional fluids had been promoted.

Not all staff had an understanding of people’s needs. One person became clearly distressed whilst receiving assistance with their personal care. Staff did not use any de-escalation techniques to minimise the person’s agitation or distress. At 06.45, another person was in bed, fully dressed in the clothing they had worn the previous day. At 11.25, they still had the same clothing on but their trousers were wet, with a strong odour of urine. Some people had repeatedly declined support with their oral care. Strategies to address this had not been appropriately considered or monitored.

People’s calls for help were not always responded to appropriately. This included one person sitting at a dining room table, calling for help. The person sounded distressed and repeated their request for assistance. A member of staff sat next to the person but did not speak to them for ten minutes, before offering assistance.

Staff were not properly supervised and there was no direct leadership within the areas. Not all staff had received sufficient training in dementia or positive behaviour management. A range of training which was deemed mandatory by the provider had been arranged but some staff had not completed all topics. Training in subjects associated with older age and people’s nursing needs had not been recorded.

Agency staff were used to cover staff sickness, annual leave and vacancies. However, not all agency staff were given clear information about people before supporting them. This did not ensure they had an understanding of people’s needs, to maintain safety.

The home was not clean. There was food debris down the side of armchairs, on over-bed tables and on dining room chairs. The kitchenettes were dirty with spillages and food debris down the side of the cupboards. Flooring in the lounges was stained and surfaces such as window sills were dusty. Other items were difficult to keep clean due to their state of repair.

There was a defensive culture from management, which did not encourage shortfalls to be properly raised and addressed. Staff were worried about the consequences of sharing their views. Others felt they had raised their concerns but no action had been taken.

A range of quality audits were in place to assess the quality of the service but these were not effective in identifying shortfalls. Information, such as the number of infections, was not always properly analysed, to minimise further occurrences. There was not a clear, accurate management overview of the service. Monthly management reports and information sent to us to comply with the condition of registration were not accurate and did not identify shortfalls.

The registered manager had a clear vision for the service. This was to ensure each person had something positive in their day to remember or experience. There were some positive interactions. This included staff offering reassurance by smiling and stroking a person’s arm. Staff were caring and attentive when giving people their medicines. Some staff knelt down to the person’s level to communicate. They smiled and used the person’s preferred name.

People were supported to access a range of services to meet their health care needs. This included the tissue viability specialist nurse, care liaison and the speech and language team. Detailed wound treatment plans were in place for those people who had a skin tear or pressure ulcer.

Staff were aware of their responsibilities to report a suspicion or allegation of abuse. A record of incidents reported to safeguarding was maintained. There was a copy of the complaint procedure in the passenger lift and main entrance of the home. The record of complaints showed all had been addressed, usually by speaking to staff and reminding them of their responsibilities.

While some records were in place we were unsure if all care, accidents and incidents were recorded. This did not allow robust quality assurance systems to be in place.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.