Archived: Lancam Nursing Home

Updated 12 August 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We undertook this unannounced focused inspection of Lancam Nursing Home on 05 May 2015. The inspection was to check that the provider had addressed the legal requirements that they were in breach of after our 07 January 2015 inspection. The inspection team comprised of two inspectors and a specialist professional advisor on nursing care. The team inspected the service against four of the five questions we ask about services: Is the service safe, effective, responsive and well-led? This was because the service was not meeting some relevant legal requirements in those areas.

We used a number of different methods to help us understand the experiences of people living in the service. We observed care in the communal areas of the service and met some people in their rooms. We used the information we gathered to track that the care people experienced matched what was planned in their records. We checked aspects of the physical environment used at the service.

The manager told us that there were seven people using the service at the time of our visit. We spoke with six people using the service. We interviewed members of the management team and four staff members. We looked at five people’s care records, duty rosters, and various records used for the purpose of managing the service.

Updated 12 August 2015

Lancam Nursing Home provides accommodation and nursing care for up to 16 people. Its services focus mainly on caring for adults of all ages including those with physical disabilities and people with dementia. There were seven people living in the service at the time of this inspection.

We carried out an unannounced comprehensive inspection of this service on 13 and 17 October 2014. Breaches of legal requirements were found. We served enforcement warning notices on the provider in respect of two breaches that had the greatest impact on people, in the areas of safeguarding and quality assurance.

We carried out an unannounced focussed inspection on 07 January 2015. We found that a number of breaches of legal requirements continued to occur, including breaches in relation to our warning notices. This put people using the service at significant risk of receiving inappropriate or unsafe care and treatment.

We undertook this unannounced focused inspection, of 05 May 2015, to check on the progress the provider had made with plans they sent us following the January inspection, and to check on the standard of care and treatment people using the service were receiving. We inspected the service against four of the five questions we ask about services: Is the service safe, effective, caring and well-led? This report only covers our findings in relation to these questions. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for this service on our website at www.cqc.org.uk

Whilst we found evidence to demonstrate that some aspects of the provider’s plans had been followed, we found that other parts had not been addressed. We found that a number of breaches of legal requirements were occurring. This continued to put people using the service at significant risk of receiving inappropriate or unsafe care and treatment.

At this inspection, we found that the passenger lift had not been working for seven days. This followed people being stuck in the lift for a short period of time on two occasions. There were no records of these incidents made available to us on request. Whilst there was evidence of contracted professionals being called to fix the lift, this process lacked urgency, and meant two people using the service had not been able to come downstairs safely during this period.

We found that the fire alarm system was displaying fault signals. When we asked for the system to be tested, to show that it would activate when needed, devices to test it could not be located. We found other concerns about fire safety such as a fire door being wedged open which would not help to prevent the spread of fire. We raised our concerns with the local fire authority, who promptly visited the service and required the provider to keep them updated on actions being taken.

The provider’s system for assessing and monitoring the quality of services remained ineffective. Whilst there had been audits at the service, these were not comprehensive and action had not been taken to address all the identified shortfalls in service delivery. Despite there being records of occasional incidents of behaviours by people that challenged the service, there continued to be no record of auditing incidents so that learning could take place with the aim of minimising the risk of harm to people using the service and staff. This ongoing inability to address the shortfalls identified and breaches of the regulations meant that the provider continued to fail to protect people using the service and staff against the risks of inappropriate or unsafe care and treatment.

Whilst improvements had been made to the consistency of the staff team’s skills and support in their work, we found that the provider had further reduced staffing levels despite a previous breach of regulations and concerns being raised by members of the staff team. We found a further occasion where staffing arrangements were not promptly made to cover staff sickness. This continued to compromise the health, safety and welfare of people using the service.

We found that care and treatment risks to people using the service had been reviewed, and that the care provided to people was aimed at meeting their needs. For example, people were safely supported to eat, and the service was paying attention to people’s skin integrity so that pressure sores did not develop. However, the service had not taken prompt action to address two requests for the results of a health procedure for one person, which compromised the effectiveness of their treatment from a visiting healthcare professional. We also found delays in acquiring a new charger for the weighing equipment after reports that the previous charger had been lost, which meant people’s weight had not been monitored effectively for five weeks.

Whilst action had been taken to address our previous concerns about people being treated with respect, we found different ways in which people were improperly treated. This included insufficient attention to supporting people with their appearance, and cases of not listening to people in respect of support requests and refusals.

There was no registered manager in post. 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. We cancelled the registration of the previous manager due to ongoing breaches of regulations at the service which put people using the service at risk of inappropriate or unsafe care and treatment. A new manager had been appointed since our last inspection, whom we met during this inspection. They had started the process of applying to be the registered manager. However, due to the many concerns that we found including some that were evident at the previous inspection, we did not have confidence in the manager and provider’s oversight of quality and risk at the service, and concluded that the service was still not well-led.

We found overall that people using the service continued to be at risk of receiving inappropriate or unsafe care. We found several breaches of the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following this inspection we continued with our enforcement action. The action we took was to serve notices proposing to cancel the registration of the provider and manager. Due process was followed and we served a Notice of Decision to cancel the provider’s registration which meant that Lancam Nursing Home was closed by the Care Quality Commission on 31 July 2015.