Archived: Lotus Care Home Limited

Lotus Care Home Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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. Lotus Care Home Limited is registered to provide personal care and accommodation for a maximum of two people. At this inspection there were two people living in the home with learning disabilities.

At the last inspection in February 2017 we found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect Regulation16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to receiving and acting on complaints. The registered provider did not keep a record of several complaints made by a relative together with action taken in response. During this inspection, we found that the provider had still not kept records of several complaints made by a relative together with action taken in response.

Our last inspection also found a breach in respect of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to good governance. The registered provider did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service. During this inspection in August 2018, the provider had still not established effective quality assurance systems.

During this inspection in August 2018, some areas were not well maintained and kept clean. There were some gaps in the laminate flooring and an emergency lamp was not in working order. We found that the sides of the cooker and the tops of the fridge freezer had not been fully cleaned.

The recruitment records of a care worker were not available for inspection. We could therefore not verify that this care worker was fit to work with people who used the service. Two care workers had worked excessive hours. There was no documented evidence that they had taken days off during a ten-day period. There were insufficient care workers deployed to meet people's needs.

People who used the service appeared happy and interacted well with care workers. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory.

People’s care needs and potential risks to them were assessed and documented. The regular care worker we spoke with were aware of these risks and people's care needs. People’s healthcare needs were monitored and arrangements had been made with healthcare professionals when required. The service had arrangements for assisting people with their dietary needs. Activities had been provided for people to ensure that they received social and therapeutic stimulation.

Some checks and audits had been carried out. We however, noted several deficiencies which the service had failed to identify and rectify. These included the lack of cleanliness in some areas of the home, care workers working excessive hours, a defective emergency lamp and complaints not recorded in the complaints book. The staff rota preceding the current staff rota been thrown away when they should have been kept to evidence that there was adequate staff deployed to meet the needs of people.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

At our last comprehensive inspection on 2 February 2016 with one exception, the service met the regulations we inspected and was rated Good. At that inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. We inspected the service again on 12 January 2017 and we found that the service had taken action to comply with the requirement. The service had a system of checks to ensure people received the care they needed. Audits had been carried out since the last inspection. At this inspection we found some deficiencies and have rated the service as Requires Improvement.

There was a registered manager in place. 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.

Arrangements were in place to keep people safe. Care workers understood how to safeguard the people they supported. There was a safeguarding adults policy and care workers had received training in safeguarding people. They knew what action to take if they were aware that people who used the service were being abused.

People's individual needs and risks were identified and managed as part of their plan of care and support. Risk assessments contained guidance to care workers on minimising potential risks to people.

There were arrangements for ensuring fire safety. Fire alarm tests and drills had been carried out. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out.

There were suitable arrangements for the recording, storage, administration and disposal of medicines and we noted from the records that people had been given their medicines as prescribed.

Care workers had been carefully vetted and the appropriate checks prior to them being employed had been carried out. The staffing levels were adequate. Care workers had received essential training, supervision and appraisals from the registered manager.

There were arrangements for the provision of meals to ensure that people’s varied and diverse dietary needs and preferences were met.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had not made a DoLS application for a person who’s liberty had been restricted for their own safety

Care workers were aware of the human rights of people and the importance of treating people with respect and dignity and promoting their independence. There was a policy on promoting equality and valuing diversity (E & D) and respecting people’s individual choices, beliefs, culture, sexuality and background. Care workers were aware of the importance of treating people as individuals and ensuring that their diverse needs were attended to.

People received personalised care and they indicated to us that they were happy living in the home. Their care plans were informative and included details of people’s individual preferences and needs. This enabled care workers to provide people with the care and support they needed. One person’s care had not been formally reviewed with them and their representatives within the past twelve months. Another relative stated that they were not given sufficiently notice of a care review. This meant that people’s representatives were not able to attend the care reviews. We have made a recommendation in respect of this.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings had been held for people and the minutes were available for inspection. The home had an activities programme and people were encouraged to be as independent as possible and participate in social and therapeutic activities.

There was a complaints procedure and relatives knew who to complain to. The complaints book however, did not contain a record of several complaints made by a relative. The registered manager stated that this would be rectified.

Checks and audits had been carried out. We however, noted several deficiencies which the service had failed to identify and rectify. These included not having a comprehensive fire risk assessment of the premises, a DoLS application had not been made for a person who’s liberty had been restricted for their own safety and some complaints made had not been recorded.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

At our last comprehensive inspection on 2 February 2016 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service.

After the comprehensive inspection, the registered provider sent us an action plan telling us how they would meet legal requirements. We undertook this focused inspection on 12 January 2017 to check they had followed their plan and to confirm they now met legal requirements in relation to good governance.

This report only covers our findings in relation to good governance. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Lotus Care Home Limited’ on our website at www.cqc.org.uk’.

At this focused inspection, we found that the provider taken action to comply with good governance. Checks on the quality of care provided by the service had been carried out. These included checks on care documentation, condition of the premises, medicines administration charts and temperatures of the room where medicines were stored. These audits of the service had been carried out by the registered manager of the home.

A satisfaction survey of relatives had been carried out. Only one completed form had been received. This was positive and indicated that the relative concerned was satisfied with the services provided. One suggestion had been made regarding the care provided. This was responded to soon after the inspection. Two professionals we spoke with informed us that people who used the service were well cared for. .

At our last inspection on 15 September 2014 the service met all the regulations we looked at.

The home has a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

One person and two relatives informed us that they were satisfied with the care provided for people who used the service. They stated that people had been treated with respect and people were safe living in the home. Four social care professionals we spoke with informed us that people were well cared for and they had no concerns regarding the safety and welfare of people. One person who used the service did not provide us with any verbal feedback. However, we observed that this person appeared well cared for.

There was a safeguarding adults policy and suitable arrangements for safeguarding people. Staff were caring and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and this information was easily accessible to staff. Staff prepared appropriate and up to date care plans which involved people and their representatives. Personal emergency and evacuation plans were prepared for people and these were seen in the care records. People’s healthcare needs were monitored and attended to. Staff worked well with social and healthcare professionals to bring about improvements in people’s care. This was confirmed by professionals who informed us that they were satisfied with the care provided for people and there had been improvements made in people’s welfare.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings had been held for people and the minutes were available for inspection. The home had an activities programme and people were encouraged to participate in social and therapeutic activities both in and outside the home.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. One person informed us that they liked the meals provided while another nodded when we asked if they had food they liked. There were arrangements for the recording, storage, administration and disposal of medicines and we noted from the records that people had been given their medicines as prescribed. Audit arrangements were in place and one person confirmed that they had been given their medication.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their manager. There were enough staff to meet people's needs. Teamwork and communication within the home was good.

One relative and two social and healthcare professionals expressed confidence in the management of the service. Staff were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence. Checks and audits had been carried out. However, these were not sufficiently comprehensive as these checks failed to identify and rectify certain deficiencies noted such an outdated safeguarding policy and medication policy which did not contain guidance on storage temperature. The portable appliances certificate was not obtained until after the inspection. We also noted that there had not been any satisfaction survey in 2015. There was a complaints procedure and relatives stated that they knew who to complain to. One person made a complaint during this inspection. This was promptly responded to by the registered manager.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report

During the inspection we spoke with the two people using the service, a relative, two care workers, and the registered manager.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

Is the service safe?

The relatives of the people using the service told us they were confident people using the service were safe. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager knew when an application for deprivation of liberty would need to be submitted for authorisation.

The home was kept clean and there was a good system in place for ensuring the risk of infection was kept to a minimum. The home had systems in place to identify, assess and manage risks relating to the health, welfare and safety of people who used the service.

We saw that there were enough suitably qualified staff to ensure people were cared for in a safe way.

Is the service effective?

A relative of a person who used the service told us they were happy with the way their loved one was treated and that staff were, 'very good and very caring'.

Risk assessments had been carried out where necessary and these were used in the planning of effective care.

There was a effective system of communication between staff and they were guided by formal information and documentation, which ensured there was continuity in the care that was delivered.

Is the service caring?

We saw people were given the opportunity to participate in activities within the local community and staff supported people to take part in religious services. We observed the care people were receiving and how staff interacted with them. We saw people using the service were spoken to respectfully and staff used a caring approach. There was an obvious trust between those using the service and the staff who cared for them.

Is the service responsive?

The home had a system in place for learning from incidents and complaints. Staff completed records of people's health and care and made changes in response to people's individual needs. People received person centred care that was responsive to their interests and preferences. A variety of activities were available for people to participate in as they chose. We saw that the staff integrated the advice given by various health professionals into the care that was provided to people.

Is the service well-led?

The home was led by an experienced manager who understood their role and took steps to ensure care was of a standard people would expect. Staff meetings took place regularly and staff views about the service were taken into account.

Staff told us the manager was very visible within the service and was always approachable if they required them .

We spoke with the relative of one of the people who lived in the home. They said, 'We are delighted. The home suits the person well. We've seen such a big improvement since they moved to Lotus Care Home.' They told us that they had never had to raise any concerns about the service. However they were not aware of the provider's complaints procedure and they told us that if they did have any concerns they would address these with the local authority.

Where people did not have the capacity to consent, the provider had involved social services, the GP and the families of people who use the service in completing forms for decisions concerning medical treatment and finances.

The daily records for each person showed that they went out every day, for example to the local shops, library or for a walk in the park. One person told us that they were able to choose what to do and what they wanted to eat.

The manager and staff were familiar with safeguarding procedures, including how to recognise and respond to signs of abuse.

Staff we spoke with told us that they attended regular training sessions with the local authority. They had regular one to one supervision with their manager so that they could discuss their work and any training and any personal needs.

We spoke with the relative of one of the people who live in the home. They told us that the person was now more outgoing than before they moved to the home. They told us that the person was able to choose the things that they liked to do, and this included going on day trips and going on holiday. They said, '(The person) is quite happy, and I have no concerns about the care they receive.'

Where people did not have the capacity to consent, there was no evidence that the provider acted in accordance with legal requirements. There was no evidence in the care plans of any assessment of people's capacity to take individual decisions in line with the Mental Capacity Act 2005, for example for management of their finances and for medical treatment.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained. However water temperatures of the bath and shower were not monitored to ensure that people who use the service were protected against the risks of scalding. There was no risk assessment to manage the risk of scalding from the hot water in the kitchen sink.