Loyd House

Loyd House is a care home providing nursing or personal care to up to 17 people. The service provides support to adults with acquired brain injury. At the time of our inspection there were 16 people using the service.

People’s experience of the service and what we found:

Systems and processes were not always effective in monitoring and mitigating risks to the health, safety and welfare of people using the service. Improvements were needed in relation to medicine management and infection prevention and control practices. Staff training was not always up to date and improvements were required to ensure all staff were consistently supported in their roles.

People were supported to have a healthy balanced diet but the overall mealtime experience could be improved to ensure staff were encouraged to support a more relaxed and sociable occasion. Care was task focused with, at times, little interaction with people.

People were respected and their dignity maintained but their privacy was not always protected.

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 could be assured they received care from staff who knew them well. People were involved in their care and there were detailed care plans in place. Staff supported people to remain in contact with family and friends and provided them with a variety of activities and entertainment to stimulate and occupy them.

People were listened to and knew how to raise a complaint if they needed to. People and relatives were confident the registered manager would act upon any concerns they raised.

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 Good 17 April 2018

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in regulation in relation to systems and processes being effective in monitoring and mitigating risks to the health, safety and welfare of people using the service. Safe management of medicines, infection prevention and control and staffing.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

4 Christchurch Court provides care and support to adults with acquired brain injuries.

At the last inspection in October 2016, this service was rated overall as requires improvement because although changes had been made to improve the quality of the service we needed to be sure they were maintained. At this inspection, we found that improvements had been made and sustained and the service was rated overall good.

There was a registered manager in post at the time of our inspection. 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 service demonstrated an excellent commitment to providing outstanding care, which was embedded into the practices of the staff and the management team. The service put people's views at the forefront and designed the service around their needs. Staff were encouraged and enabled to work creatively which achieved consistently outstanding outcomes for the people receiving care and support. There was a strong system of quality assurance led by the provider and registered manager that ensured people consistently received exceptional care and support.

The registered manager was inspiring and dedicated to providing care, which met the highest of standards. They strived for excellence through consultation, research and reflective practice. They were passionate and dedicated to providing an outstanding service to people. They led with a dynamic approach and continually reflected on how to improve the service further. They demonstrated a strong and supportive leadership style, seeking feedback in order to further improve what was offered. The provider's vision and values were understood and shared across the staff team.

The service responded to people's needs and preferences. People were supported by a service that was devoted to getting to know the people they supported. Relatives told us the service was responsive and well managed. The service sought people's views and opinions and acted upon them.

People were supported with care and compassion and there was an ethos of care which was person centred and valued people as individuals. People received a personalised service that was responsive to their individual needs, there was an emphasis on each person’s identity, and what was important to them from the moment they moved into the service.

There were sufficient staff to meet people's needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks.

People were supported to take their medicines as prescribed and medicines were obtained, stored, administered and disposed of safely. People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person and people were actively involved in decisions about their care and support needs.

Staff had received training in the Mental Capacity Act 2005 (MCA) to make sure they understood how to protect people's rights. There was guidance in relation to the MCA and people were asked for their consent before staff carried out any care or treatment. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager, registered provider and staff ensured that people were supported in ways that did not restrict their freedom and were supported appropriately to uphold their rights.

A variety of choices of food and drinks were offered at the home. Staff supported people to eat and drink with patience and dignity. People were able to access the provider’s own multi-disciplinary team which consisted of rehabilitation therapists and psychotherapists. People told us they had good access to their GP, and other health professionals. Staff at the service had good links with healthcare services and people told us they were involved in decisions about their healthcare.

Care plans were written in a person centred manner and focussed on giving people choices and opportunities to receive their care how they liked it to be. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to raise complaints and there was an easy read guide to support people through the process.

Robust quality assurance reports had been developed, incorporating all elements of requirements relating to legislation, Care Quality Commission (CQC) guidance, best practice guidelines, along with evidence of how each area was being met. Continual auditing was carried out to ensure the safety and quality of care that was provided, using information from the audits to drive continual improvement.

The service was accredited approved headway provider status which evidenced they were competent to support people with complex acquired brain injuries. Headway is an approved scheme for services specialising in acquired brain injury care.

Following our inspection in July 2016 the service was rated as ‘Inadequate’ in one area and overall requires improvement due to concerns about the safety and well-being of the people who lived there. The Care Quality Commission placed a condition on the provider which meant that no more than 15 people could live at the home until improvements to quality and safety had been made. At the time of this inspection we found that there had been improvements in the way that the home operated and in relation to the way in which care was being provided.

The service did not have a registered manager in post. At the time of our inspection a manager had been appointed and was in the process of applying to the Care Quality Commission to become a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There was a clear protocol in place to support new admissions into the home and to guide staff however we were unable at this inspection to assess its effectiveness because there had been no new admissions to the service since our last inspection. Rehabilitation programmes were not always reviewed in a timely manner and staff had not reported their uncertainty of care or the lack of rehabilitation to the senior management team or the multi-disciplinary team for prompt action to be taken. The provider took immediate action on our feedback.

People felt safe in the home. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed however this needed to be kept under close review as the provider begins to admit more people into the service. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks. People were supported to take their medicines as prescribed and medicines were obtained, stored, administered and disposed of safely.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person and people were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to maintain good health and had access to healthcare services when they were needed.

People received care from compassionate and supportive staff and people and staff had positive relationships with each other. Staff understood the needs of the people they supported and used the information they had about people to engage them in meaningful conversations. People were supported to make their own choices and when they needed additional support people’s relatives were also consulted.

Care plans were up to date and reflected people’s current assessed needs and focussed on giving people choices and opportunities to receive their care how they liked it to be. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People were able to choose where they spent their time and what they did. People were able to raise complaints and they were investigated and resolved promptly.

People and staff were gaining confidence in the new management structure of the home and felt listened to and supported. People were able to provide feedback and this was acted on and improvements were made. The service had audits and quality monitoring systems in place And identified actions were taken in a timely manner. Policies and procedures were in place which reflected the care provided at the home.

The service did not have a registered manager in post. At the time of our inspection a manager had been appointed and was due to take up the post shortly. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were not sufficient numbers of staff deployed to safely meet the needs of people who used the service. People were not always treated with dignity and respect as they were left waiting for personal care and support.

Care plans and risk assessments were in place which gave staff detailed instructions as to how to support people and mitigate any identified risks. However, the staff did not always have the time to read the plans so were not always aware of people’s needs.

Care staff did not receive appropriate supervision to enable them to fulfil their responsibilities. This meant that people were not always protected against the risk of avoidable harm as staff were not aware of their responsibilities with regards to safeguarding people who lived at the home.

People were able to provide feedback, however this was not always acted on. When staff had identified that some of the accommodation was not always suitable to meet the needs of people no action had been taken and the provider was slow to respond to information about broken equipment.

The provider had not ensured that there were clear lines of responsibility and accountability at all levels. Leadership was poor and staff were not fully aware of what was expected of them. The lack of leadership on a day to day basis had significantly impacted on the quality of care that people had received. Staff morale was very low, staff felt devalued and unsupported.

People were actively involved in decisions about their care and support needs and how they spent their day. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Assessments of people's needs and associated care plans had been reviewed regularly. People received planned person centred therapeutic interventions in line with their assessed needs.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have taken can be seen at the end of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. The service did not have a registered manager at time of the inspection visit. An application form for registering the manager for the service had been received by Care Quality Commission.

Is the service safe?

The staff on duty had good understanding of how to meet the needs of people who used the service. We saw that people were relaxed and comfortable in the presence of staff.

Staff received regular training and support which helped them to provide safe care. Staff training included the safeguarding of vulnerable adults. Staff knew who they should contact, should they have any concerns about the treatment of people who used the service.

Risk assessments were in place which identified any specific risks for people who used the service. People and staff were involved in fire drill training so they knew what to do if there was a fire at the service. We observed this practice on the day of the visit and saw it was carried out well. Health and safety checks were carried out to make sure the premises and people using the service were kept safe.

Is the service effective?

People’s health and care needs were assessed and plans of care were put in place to meet their needs. Information about how people communicated their needs and wishes were clearly identified in care plans which helped ensure that all staff were able to provide appropriate care. We saw that care plans were being updated by staff when people’s needs changed. This ensured staff had information about people’s new needs.

People’s health and care needs had been assessed and care plans were in place. There was evidence of people being involved in assessments of their needs and planning their care. People told us that they were happy with the care they received. Staff had received the information, training and support they needed to meet people’s needs effectively.

One person using the service told us, “I tell the staff if I don’t feel well, they ring the doctor”. They told us that there were enough staff to look after them and most of the time they did their activities, which was recorded on their schedule.

Is the service caring?

People were treated with dignity and respect by the staff. We saw staff approached people who used the service in a caring manner. People’s preferences, interests, and needs had been recorded and care and support had been provided accordingly.

All the people we spoke with told us that the staff were very “nice” and they would speak to them if they had any concerns and they would listen. One person told us that they had one to one meetings with a member of a staff called a keyworker and felt supported by them.

We saw staff interacted with people in a kind, and good humoured approach. They encouraged people to engage in activities and spoke with them in a kind and respectful manner. The staff told us that they enjoyed working at the service and with the people. They had staff meetings about how to help people using the service achieve their goals. We saw staff supported people to maintain contact with their families and friends.

Is the service responsive?

We saw that staff were available to support people who used the service. One person told us that they had meetings with their keyworkers and they listened and supported them to meet their needs. We saw people had residents’ meetings and discussed activities, menus, concerns, and any issues that they were not happy with at the service. They told us that the advocate who took the meeting listened to them and acted on their feedback by discussing the information with management. This meant people’s views were listened to by an advocate who was impartial and spoke up on behalf of the people.

People also told us that that they had meetings with health professionals who were employed by the organisation. To discuss their care and treatment plans. The staff told us that they followed the action plans put in place by the health professionals and provided them information about how these plans were working in meeting people’s needs.

Is the service well-led?

We found that the service was being well managed by the new manager and there were systems in place to identify and make improvements where necessary. Staff received training, supervision and support from the manager which helped them to provide safe and effective care.

The provider had monitoring systems in place to ensure that medication administration records were fully completed. Staff training records and people’s care plans were updated to meet their current needs. We saw that health and safety checks were also undertaken regularly to ensure all systems were up to date and kept people safe.

People who used the service told us that they felt safe living at the service. One person told us, 'I do make tea. I do have choices for breakfast'. 'My plans followed well and there is a time table in my room'. Another person told us, 'I do the things on my plan and I get to go out to the park and shopping with staff and I go to the day centre'.

However some people told us that they wanted to go out more and spend more time talking with staff. One person said, 'Sometimes we talk when staff are not busy'. They told us, 'We should be able to talk more'. Another person said that they wanted to go out for coffee more often, but this did not always happen due to being short of staff.

Most of the people who used the service told us that they knew how to make a complaint. One person told us, 'I would just go straight to the manager. Another person said, 'I'm not shy. I've had times I needed to discuss, but never got to the point where it got to complaint stage'.

We saw that people's meetings were held on a monthly basis at the service. We saw that health and safety, fire drill, people's activity programmes, food menus, and in-house issues were being discussed at this meeting.

Throughout our inspection we observed people who used the service had a good relationship with staff and saw all staff spoke to people in a dignified and kind manner.

We saw that the provider had a complaints system in place to ensure that any complaints raised were handled appropriately. However, we found that people did not always receive care that met their individual needs. We also found that there were not always enough staff on duty to meet people's needs. We found that the staff did not receive regular one to one supervision meetings with their manager to ensure that their training and development needs were being discussed and met.

of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

During the inspection visit, we spoke with four people who used the service to find out their views of how their needs were being met by staff at 4 Christchurch Road. We also spoke to the registered manager and four staff on duty.

All the people we spoke with told us that they liked living at 4 Christchurch Road because the place was homely and one person said 'it is nicely decorated and has comfortable leather sofas'. Another person said 'I can walk to the shops with staff to get my ingredients for cooking my meal'. People also told us that the food was 'excellent and hot and tasty' and they had two choices of meals and this also included a vegetarian option. They told us that they were involved in planning their care and had weekly programmes of activity to meet their goals.

People told us that they had different meetings to discuss activities, menus, and any other issues about their care or the running of the home. They said they were all aware of how to make a complaint to staff if they were not happy about any thing. One person told us that the manager and staff spoke to them when they were 'feeling down' and said staff 'are always there for me'.