Archived: Levanto Residential Care Home

Updated 12 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was conducted by two inspectors.

Service and service type

Levanto is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Levanto is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed the information we had received about the service since the last inspection. We used all this information to plan our inspection.

During the inspection

We spoke with ten members of staff including the registered manager, who is also the provider. We reviewed a range of records including four peoples’ care notes that had been completed since our last inspection. We sampled care plans and reviewed six peoples’ medicines records and medicines stock. We spoke with eight people living at the service and made observations within the communal areas. We spoke with four health professionals. Following our site visit we spoke to a further seven members of staff on the telephone. Because we had spoken with 12 peoples’ family members during the course of our previous inspection, 15 days prior to this inspection commencing, we did not contact family members for any further feedback during this inspection.

We raised our on-going concerns about the safety of the service with the local authority during our site visit.

Updated 12 January 2023

About the service

Levanto Residential Care Home (hereafter referred to as Levanto) is a residential care home providing accommodation and personal care to up to 20 people. The service provides support to older people who are living with dementia. At the time of our inspection there were 16 people using the service.

Accommodation is provided over the first and second floors, with the registered manager and deputy manager's office being on the third floor. The second floor is serviced by chair lifts. Some bedrooms have ensuite facilities. There are two communal lounges and a dining room. There is a small veranda at the front of the property with comfortable seating.

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

We completed our last inspection at Levanto on 16 June 2022. During that inspection we identified breaches in relation to safeguarding, safe care and treatment, premises and equipment, person-centred care, dignity and respect, consent, staff training and recruitment, complaints, notifications and governance and leadership. We raised safeguarding alerts in relation to eleven people and the local authority responded by initiating a large-scale safeguarding adults enquiry.

Following our last inspection, a member of staff had contacted us to raise concerns about a medicines error. They had reported this to the registered manager but were concerned that no action had been taken. During this inspection we found three people had new and unexplained bruising, and staff raised further concerns about one person’s safety at night, and the impact of their behaviour on others. The registered manager had not recognised or reported any of these concerns as safeguarding concerns and had failed to investigate the medicines error. We notified the local authority of our concerns relating to five people.

Medicines were not being managed safely and stock was not being controlled. Some people had more medicines than they should have, one person had medicines missing and there was a large amount of paracetamol in the home that had not been recorded on people's medicines records. Care plans did not contain sufficient information to enable staff to meet people's needs safely and staff did not take action in response to people's declining health. Infection control continued to be poorly managed and no action was taken to prevent the spread of infection when four people displayed symptoms of infectious disease.

Staff told us managers were more present in the home since the last inspection, however, the culture of the service still meant staff were still reluctant to raise concerns. One said they felt it had been difficult to raise concerns because some staff members “hold a grudge, and never forget it”. Managers had not identified the additional concerns we identified during this inspection. Changes in the senior staff team had led to confusion over what staff were responsible for and this had impacted on people.

Following the concerns raised after our last inspection, at this inspection we saw the local authority had begun to take action to mitigate some of the risks identified. For example, they had begun to assess people's needs, had provided equipment to support people to mobilise safely and had provided agency staff both day and night.

Changing the culture of a service takes time. Due to the short time span between our last inspection and this inspection, it would not have been reasonable to expect the provider to have made any significant progress in regard to this. The provider had begun to make some changes, for example introducing a choice at mealtimes. The registered manager had reflected on the last inspection report, and now acknowledged that they had failed to keep their own skills and knowledge up to date and this had impacted on their ability to identify shortfalls within the service.

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

Rating at last inspection and update

The last rating for this service was inadequate (15 July 2022).

At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received immediately after our last inspection about medicines, people's wellbeing and the management of Levanto. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains inadequate based on the findings of this inspection.

Following our last inspection, the local authority took action to reduce the risks to people. This included providing equipment to help people mobilise safely and providing agency staff who were trained to use the equipment. The agency staff were in place 24 hours per day at the time of this inspection. The provider was working with the local authority to make improvements, and at the time of this inspection that work was ongoing, with assessments beginning to be completed for people living at the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Levanto Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to safe care and treatment and good governance.

We cancelled the providers registration.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.