Archived: Latimer Grange Limited

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

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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.

Latimer Grange is a residential care home that provides personal care for up to 27 older people. At the time of our inspection 21 people were using the service.

At our last inspection in February 2017, the service was rated ‘Good’. At this inspection we found that the service required improvements to make it safe, effective and well led.

The service had a registered manager. 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.

Action had not been taken to support a person who had experienced significant weight loss and a series of falls. Other people who had experienced a number of falls, but these were not analysed nor was action taken to mitigate further falls occurring. Action was being taken by the management team to address this at the time of our inspection.

Not all people had assessments of their mental capacity to make decisions about their care and support where it was appropriate to do so.

People were supported to receive their medicines safely, but there was no guidance for staff about the use of PRN medicines.

When staff were recruited no assessment of their suitability was recorded at or following their interview. There were enough staff to provide care and support to people to meet their needs.

Staff knew how to recognise and report any signs that people were abused or at risk of abuse. The provider had procedures in place for staff to report concerns and for those concerns to be investigated and acted upon. Staff were familiar with those procedures.

Staff were supported through supervision and training by the deputy manager to carry out their roles and responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring and they treated people with respect and dignity. People’s privacy was respected.

People had care plans in place that included assessments of their needs. Staff referred to people’s care plans to provide support in line with people’s personal preferences.

People were supported with their hobbies and interests. A recently appointed activities coordinator was in the process of developing a wider range of activities, including activities suitable for people living with dementia.

People and their relatives felt they could raise a concern. The provider had a complaints procedure but four people told us they were not aware of it.

People’s and relative’s feedback about the management and running of the service was positive.

The provider had arrangements for monitoring the quality of the service people experienced. These had not always identified risks to people or resulted in actions being taken to protect people from harm. The provider was in the process of improving their procedures for monitoring the service.

We found one breach of regulation because a person had not received care that met their needs.

You can see what action we have told the provider to take at the back of the full version of the report.

A registered manager was not in post as the previous post holder had recently voluntarily cancelled their registration. 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. The provider had taken steps to register a new manager and this process was on-going when we inspected.

People continued to be kept safe by sufficient numbers of appropriately recruited staff that had the skills and training they needed to do their job competently.

People continued to be treated with dignity and their individuality was respected. Their needs were met in a timely way by a staff team that was caring, friendly, and attentive to people.

People were encouraged and enabled to make choices about their care. Decisions made by staff that affected the care and treatment of people that lacked capacity were implemented in the least restrictive way and in the person’s best interest.

People were safeguarded from harm and poor practice. Risks associated with people’s capabilities to do what they could for themselves were assessed, reviewed, and acted upon to minimise the likelihood of accidents.

People’s medicines were appropriately and safely managed. People received timely treatment from other community based healthcare professionals when this was necessary. People were supported to maintain good health and nutrition.

People continued to be cared for by staff that had access to the support, supervision, and training they needed to work effectively in their roles. There continued to be good leadership with regard to the management of the home.

Latimer Grange accommodates and cares for up to 27 older persons with a range of mainly age related dependencies, including some people with dementia care needs.

A registered manager was in post. 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.

People benefited from being cared for by sufficient numbers of experienced staff that had received the training they needed to do their job safely. Staff knew what was expected of them when caring for older people, including those with dementia care needs, and they carried out their duties effectively and with compassion.

People’s care needs had been assessed prior to admission and they each had an agreed care plan. Their care plans were regularly reviewed, reflected their individual needs and provided staff with the information and guidance they needed to do their job. People’s individual preferences for the way they liked to receive their care and support were respected. People were enabled to do things for themselves by staff that were attentive to each person’s individual needs and understood their capabilities.

People had enough to eat and drink and received the care they needed. People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon when required. People who needed support with eating and drinking received the help they required.

People’s healthcare needs were met and they received treatment from other community based healthcare professionals when this was necessary. People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People were safeguarded from abuse and poor practice by care staff that knew what action they needed to take if they suspected this was happening. There were robust recruitment procedures in place to protect people from receiving care from staff that were unsuited to the job.

People, and where appropriate, their representatives or significant others were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction.

People received care from staff that were supported and encouraged by the provider and the registered manager to do a good job caring for older people. The quality of the service provided was regularly audited by the registered manager and the provider and improvements made when necessary.

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was hygienic, clean and well maintained. People had care plans in place which identified their needs and we observed that staff followed these. The equipment needed to deliver people's care was available for staff to safely meet their needs. There were increased numbers of care staff on duty to meet the needs of people but some staff had not received training to ensure they had the necessary qualifications and skills to safely meet people's needs. Staff had informed the management that they did not feel they had the necessary skills and training to safely care for people but there was little evidence of any action being taken to address the concerns. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

Staff were knowledgeable about people's needs and how their care was delivered. People told us that they were happy with their care. A relative told us "I could not ask for better. I would come here myself if I had to." Staff views were sought and these showed that some staff were concerned about the behaviour of their colleagues. There had been 13 changes to the staff team in the previous four months and there were inconsistencies in the training and induction that staff received. The registered manager had identified this but had not always been effective in addressing the concerns staff had raised.

Is the service caring?

One person said, “I like it, I really do, the staff are all very kind.” We saw that staff approached people respectfully and were caring in their approach, giving people time to communicate their needs. People were assisted to move around the home as they needed and the care we observed was not rushed, and took people's abilities in to account. We saw people were offered two choices of food they wanted to eat for their main meal of the day and this was prepared to meet their choice. Where people needed assistance to eat their meal, this was provided on a one to one basis and the mealtime was relaxed and supportive.

Is the service responsive to people’s needs?

We saw that care plans had been updated when people’s needs had changed and that referrals had been made to health and social care professionals when needed. Where people needed additional support or equipment then liaison with healthcare professionals took place for the necessary equipment to be obtained. People received their medication from staff who understood their needs and where new medications had been prescribed these were obtained in a timely way so people's changing healthcare needs were managed to promote their welfare. We looked at care records and found they reflected the care we observed being given.

Is the service well-led?

The provider had appointed a manager who was registered with the commission to manage the service on a day to day basis. Quality assurance processes were in place and we saw these were completed. However, the management had not ensured that shortfalls in relation to staff training, supervision and appraisal, identified as part of the home’s own quality assurance processes, were rectified. Staff personnel records did not contain all the required information to demonstrate that staff had been appropriately inducted. We also found that some new staff had not had all the training identified by the manager as mandatory to carry out their job role. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

We spoke with three people who lived in the home. They all praised staff for the helpfulness and friendliness.

We spoke with a relative of a person living in the home. The relative said that he had no concerns about his wife's care and he thought that staff were friendly and caring. He said; ‘’I am glad we found this home. I have never had any worries about anything’’.

This was a generally positive inspection. People said that they were satisfied staff. The relative we spoke with said that he had no concerns and thought his wife was being cared for properly. The essential standards we inspected were met.

We received a comment stating that the owner has a hands-on management style and had not allowed the manager to manage. This issue needs to be reviewed and acted upon as necessary.

We spoke with three people who lived in the home. They all praised staff but two people said that care was often late as staff were too busy.

We spoke with three relatives of people living in the home. They told us that the care that staff provided was good. One relative said: ‘’the staff are friendly and welcoming. I have never seen anything that has concerned me’’.

This was a mixed inspection. People said that they were satisfied staff but two people said care was often late. The relatives we spoke with said that care was good. However, we were concerned that people's needs were not always met with regard to their health and personal care needs.

There were comments about staff being under pressure to meet people’s needs. Staffing levels were not always sufficient to meet their needs.

the experience people have in living there.

The expert by experience spoke with seven people. They told us that staff were friendly and were meeting their needs.

In total we spoke with five relatives of people living in the home. They told us that the care that staff provided was very good. One relative said: ‘’The workers are competent in looking after my wife’s needs. I feel she is safe and in good hands’’.

This was a mixed inspection. People said that they were satisfied with the care they received. Relatives we spoke with people said that care was good. However, we were concerned that people's needs were not always met with regard to their health and personal care needs.

There were comments about staff being under pressure to meet people’s needs. Staffing levels were not always sufficient to meet their needs.