Archived: Latimer Grange Limited

Updated 13 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted by a police investigation of alleged neglect and ill treatment of people at Latimer Grange. This inspection did not examine the circumstances of the investigation or allegations. However, the information shared with CQC about the allegations indicated potential concerns about the management of risk relating to falls, unexplained injuries, unsafe medicines management, people’s health needs and whether people were being treated with dignity.

Inspection site visit activity started on 3 November 2017 and ended on 6 December 2017. We visited on 3 November 2017, 21 November 2016, 29 November 2017 and 6 December 2017. All of the inspection visits were unannounced.

The membership of the inspection team consisted of two inspectors on 3 November, 21 November and 6 December and an inspection manager and two inspectors on 29 November 2017.

We spoke with seven people and three relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with the interim manager, six care assistants, a cook, a cleaner and a maintenance person. We spoke with two health professionals who visited Latimer Grange to attend to people’s health needs. We looked at eight people’s care plans, every person’s medicines administration records and staff training records. We looked at the buildings maintenance records and service’s accident book.

At our visit on 21/11/2017 we spoke with an officer of the local authority safeguarding adult team who was visiting the service.

Updated 13 January 2018

The inspection took place over four visits on 3, 21 and 29 November 2017 and 6 December 2017. Each inspection visit was unannounced. We inspected the service due to concerns received about the provider, registered manager and two members of staff.

The last inspection of the service was on 3 July 2017, we found that the provider was in breach of Regulation 14 (1) (4) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because a person who was at risk of malnutrition had not had nutrition and hydration assessments carried out to ensure their nutritional needs were met.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to make the improvements required. We received an action plan from the provider on 14 September 2017 stating how they would make the necessary improvements. We found at this inspection that whilst action had been taken to make improvements these had not been sustained and as a consequence people’s nutritional and hydration needs were not being consistently met.

Latimer Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Latimer Grange is registered to accommodate 27 people in one adapted building. There are 23 bedrooms, 16 of which have ensuite facilities. There is a communal dining room, a communal lounge with three distinct areas and an enclosed landscaped garden with a covered seated smoking area.

The service has had a registered manager since 30 May 2017. A registered manager is a person who has registered with the 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.’ The registered manager was absent from the service from 18 October 2017 and the absence was expected to continue to 15 January 2018 and possibly for longer. The provider had not notified CQC in writing of the registered manager’s absence.

People we spoke with were unanimous saying they were satisfied with the care and support they received. People’s relatives were also satisfied. However, we found serious concerns about the safety of the service.

When people were discovered to have injuries such as bruising, there was no attempt to identify the cause of the injuries. Risk assessments were not carried out to identify how people could be protected from avoidable injuries.

People were not adequately protected from the risk of falls. Risk assessments were not reviewed after people experienced falls. This demonstrated that the provider did not have effective systems for identifying learning after incidents occurred and making improvements.

People’s nutritional health was not adequately monitored. A person’s records showed they had suffered a significant weight loss in the space of two months. However, no action had been taken to review their nutritional risk assessment. This demonstrated the person had not had safe care and support.

We found the management of medicines to be inadequate. Two people had repeatedly refused to take their medicines. There was no strategy in place to understand why or what steps could be taken to protect people from the risks associated with not having medicines they required for their well-being. There were concerns when a staff member handled a person’s medicines without wearing gloves. Medicines for disposal were not stored securely or returned to the dispensing pharmacist in a timely manner.

An information folder that was intended for fire and rescue emergency services was inaccurate and out of date with regards to which rooms people occupied and who lived at Latimer Grange. This could endanger fire and rescue personnel and staff if there were unable to evacuate people in the event of a fire.

Hot water pipes adjacent to baths were exposed. These posed a risk of scalding to a person if they fell in that area.

Cleaning products which were identified as substances hazardous to health were not stored safely and posed a risk to people. We made a recommendation about this.

We found that assessments of people’s mental capacity were too broad and did not include assessments of people’s capacity to understand specific aspects of their care and support. People who were under continuous supervision and control and were not free to leave Latimer Grange did not have a capacity assessments or best interest decisions in place to consent to arrangements for care and treatment. Applications to deprive people of their liberty had not been made. The interim manager told us they were not confident about carrying out assessments of people’s mental capacity.

The premises were not consistently well maintained. A potential structural defect visible in an office had not been risk assessed. There was accommodation above the office on the first floor of Latimer Grange but there was no risk assessment about the impact of the structural defect.

There was no dedicated storage space for equipment such as hoists and wheelchairs. This meant equipment, some of which was not used, was kept in communal areas which was intrusive of people’s home space.

The management arrangements were ineffective because the provider had not ensured an adequate level of support for the interim manager who relied on support from the local authority. After our inspection on 3 July 2017 we reported that the provider was beginning to implement more effective monitoring of the quality of the service people experienced. However, at this inspection we found no evidence this had taken place.

There was a lack of leadership and management that placed people at risk because areas requiring improvement were not being identified and acted upon. A new requirement, the Accessible Information Standard had not been implemented at the service which demonstrated a lack of leadership.

The provider determined what staffing levels should be. These were fixed and were not adjusted to respond to periods when people had increased needs, for example when they returned from hospital or if their health worsened.

Care was not consistently delivered in line with standard and evidence based guidance. For example, the service did not have food items that were specifically for people living with diabetes

.

People’s care plans had no information about their preferences or choices about their end of life care.

The provider had a staff training plan that was aimed at ensuring staff kept up to date with their training. However, no action was taken to follow up staff who had not attended training.

Staff followed the instructions of health professionals who visited the service to attend to people’s nursing and medical needs. People were supported to access health services when they needed them.

Staff sought and obtained people’s consent before they provided care and support.

We saw several examples of staff being kind and caring and people spoke highly of the staff. Staff were busy and were unable to spend as much time as they and people wanted to hold conversations.

People were able to spend time where they wanted, whether that was in communal areas or in the privacy of their room. We saw people being supported to go to different areas of the home.

People told us they felt comfortable about raising any concerns or complaints about their care and support if the need arose.

We found four breaches of regulations. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. You can see what action we told the provider to take at the back of the full version of the report.

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 to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. 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.