Archived: Lands House

Updated 15 March 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the required improvements had been made to the service following our inspection in July 2015. As the inspection was a comprehensive inspection we also looked at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 20 and 25 January 2016 and was unannounced. The inspection team consisted of three inspectors.

We used a number of different methods to help us understand the experiences of people who used the service. We observed care and support within the home. We spoke with five people who used the service, three relatives, two registered nurses, four members of care staff, the cook and the administrator. We also spoke with the provider and deputy manager. We spent time observing care and support being delivered. We looked at a number of people’s care records and other records which related to the management of the service such as training records and policies and procedures.

Prior to our inspections we normally ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We did not ask the provider to complete a PIR on this occasion. We reviewed all information we held about the provider. We contacted the local authority safeguarding and commissioning teams and the clinical commissioning group to ask them for their views on the service and if they had any concerns. As part of the inspection we also spoke with two health care professionals who regularly visited the service.

Updated 15 March 2016

The inspection took place on 20 and 25 January 2016 and was an unannounced inspection. On the date of the inspection there were 16 people living in the home. Lands House Nursing Home provides accommodation and nursing care for up to 30 people at any one time. The home is located in Rastrick, Brighouse with accommodation spread over two floors. The client group was mainly older people, some of whom were living with dementia.

A registered manager was not required as the provider was a single individual who also undertook management duties within the home. Following the previous inspection, the home had appointed a nursing manager in November 2015 to provide nursing oversight of the service. Sadly they had died unexpectedly in early January 2016. At the time of the inspection, there was no nursing oversight of the home, with only two registered nurses available to work days. Due to shortages of nursing staff the clinical lead was unable to work any supernumerary time allocated to nursing management duties.

People and their relatives told us that the service was safe and it provided good, effective care. They said staff were kind and caring and treated people well. They said that they felt safe from abuse in the company of staff.

At the last inspection in July 2015 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found some improvements had been made, for example to care planning documentation and the management of nutrition. We found interactions between staff and people who used the service were improved.

However there was insufficient improvement made in a number of other areas, including the management of risk and the evaluation and improvement of nursing care. Concerns remained about the management teams understanding of a number of key topics including the Mental Capacity Act and safeguarding.

We found some aspects of the medicine management system had been improved. For example the administration of Warfarin was better managed and for boxed medication, there were no gaps on Medication Administration Records (MAR) demonstrating people were regularly receiving their medicines. However there was a lack of appropriate procedures and care planning to support the safe and consistent administration of medicines. We found two people did not receive the medicines at the times they needed them.

Staffing levels were sufficient to ensure safe care. Requests for care and support were responded to promptly by staff.

At this inspection we found there was better recording of incidents which had occurred within the service. However we were concerned that the management team were not correctly identifying incidents as safeguarding and referring onto the local authority. We found risks to one person were not appropriately managed and risks assessments put in place were not robust enough to provide us with assurance that further incidents would not occur.

The home was not complying with the legal requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where DoLS were in place the conditions were not being complied with and the management team had a lack of understanding of the correct processes to follow.

Improvements had been made to the way the service managed risks associated with poor nutrition.

There was a lack of systems in place to provide nursing staff with proper and worthwhile clinical supervision. There were some gaps in the training records which showed some nurses had not received their mandatory training.

We observed staff were kind and caring and treated people well. People were listened to and their choices respected with regards to daily life within the home.

Since the previous inspection care records had been improved. In most cases, they demonstrated a better assessment of people’s individual needs. However further improvements were needed to some records to ensure they accurately reflected people’s care and support needs. The provider acknowledged this process was not yet fully complete.

Records showed that people were involved in a number of activities to help keep them occupied.

A range of audits were undertaken by the service and we saw evidence these were used to improve a number of aspects of service delivery. Regular meetings with staff groups had also been used as a mechanism to improve the service. However the provider acknowledged that further improvements were required, however these were not formalised into a structured action or improvement plan.

There was a lack of systems in place to assess, monitor and improve the quality of nursing care within the home. We were concerned that audits of nursing care plans and investigation into nursing incidents were being completed by the provider who was not a registered nurse.

We were concerned that some issues we found at the previous inspection such as not working within the legal framework of the Mental Capacity Act (MCA) and a failure to manage risks appropriately were still present. This showed a lack of action taken to fully address these areas based on our feedback.

Overall, we found significant shortfalls still remained in the care and service provided to people. We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.