Archived: Lawford House Residential Home

The inspection took place on 11 April 2017 and was unannounced.

There was no registered manager at this service, and there had been no registered manager in post since March 2015. However, a manager had been appointed and was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

At our previous inspection on 18 and 22 November 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing, safeguarding service users from abuse or improper treatment, person-centred care, dignity and respect, meeting hydration and nutrition needs, and good governance. As a result, we asked the provider to complete an action plan to detail the steps they would take to improve the quality of care provided to people. The home remained in special measures, meaning significant improvements were required, or enforcement action would be taken.

People and relatives expressed concern over staffing levels and deployment of staff. The physical environment was not conducive to people's safety. Staff did not always sign to confirm they had given people their medicine , so it was not always possible to know people had received their medicines safely and as prescribed.

Health professionals had not always been consulted when people were in need of medical attention. People’s dignity was not always maintained, and terminology used was not always respectful.

People's preferences and interests were not always taken into account, or known by staff. Where people had expressed interest in a particular hobby, this had not always been pursued by staff.

There was no registered manager in post. The registered providers had not taken action when risks and concerns were brought to their attention. Staff felt unsupported in their roles by the providers, and the manager was not given guidance or direction.

Staff had received training which was relevant to their roles and had enhanced their understanding of people's needs. Staff understood the legislation underpinning their daily practice, and what this meant for the people they cared for.

People enjoyed a variety of food and were given choices in what they wanted to eat and drink. People's weight was monitored and action taken where concerns were identified.

People's individual communication needs and styles were known by staff. People's independence was promoted as much as possible.

People could enjoy group outings and more in-house entertainment was provided. People's and relatives' views were sought, and there was a system for capturing and acting on complaints.

The overall rating for this service is 'Requires Improvement.' However, we are placing the service in special measures. We do this when services have been rated 'Inadequate' in any key question over two consecutive comprehensive inspections. The 'Inadequate' rating does not need to be in the same question for each of these inspections for us to place services in special measures.

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The inspection took place on 18 and 22 November 2016. The inspection on 18 November was unannounced. The inspection on 22 November was announced because we needed to ensure the provider would be at the home.

There was no registered manager at this service, and there had been no registered manager in post since March 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

At our previous inspection on 12 April and 23 May 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, dignity and respect, person-centred care, receiving and dealing with complaints, and good governance. As a result, we asked the provider to complete an action plan to detail the steps they would take to improve the quality of care provided to people. The home was also placed into special measures, meaning significant improvements were required, or enforcement action would be taken.

At this inspection, we found that people were not always protected from harm or abuse. Where people had suffered harm or abuse, the relevant authorities had not been notified and action had not been taken to protect people from further abuse or harm.

There was no mechanism in place for determining adequate staffing levels, or deployment of staff. Staffing levels were not sufficient to meet people's needs or ensure their freedom was promoted.

People did not have choice in the meals provided. Food was not stored appropriately and food items in the home were not safe for human consumption as they had passed their expiry dates.

People’s privacy was not always respected and maintained. People were not always treated with dignity, and were placed in undignified situations.

People could not always enjoy their hobbies and interests. Although people's feedback was captured, it was not always acted upon.

The provider had not rectified the issues and concerns we had previously brought to their attention, nor had they identified additional shortfalls in the quality of care provided. The provider did not comply with their regulatory responsibility to notify the CQC of allegations of harm or abuse.

People had access to healthcare professionals when required. People received their medicines safely.

People enjoyed positive relationships with staff. Staff knew people's needs well and how to meet those.

Staff were positive about the training they had received and the ongoing support from the acting manager.

The overall rating for this service is ‘Inadequate’ and therefore, the service remains in special measures.

Services in special measures will be kept under review; if we have not taken immediate action to propose to cancel the provider’s registration of the service, it 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.

The inspection took place on 12 April 2016 and on 23 May 2016 and was unannounced.

There was no registered manager at this service, and there had been no registered manager in post since March 2015. The acting manager had resigned from their post shortly before our inspection and was providing managerial cover only until a new manager was appointed. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

Not all individual risks were known by staff, the acting manager and provider and consequently, were not always managed, which placed people at risk of harm and abuse. There was no mechanism in place for determining adequate staffing levels, or deployment of staff.

People’s changing health needs were not always responded to. Staff did not always refer to other healthcare professionals when necessary.

Not all staff had been given an induction or training when they started work at the home. Not all staff had undergone pre-employment checks to ensure they were suitable to work with people.

People were not always treated with dignity and respect and did not always have their privacy maintained.

The provider had not followed the principles of the Mental Capacity Act 2005. People’s liberty had been deprived without the necessary authorisation from the local authority.

The service lacked managerial stability. Staff were unsure what was expected of them and what the values of the service were. The provider did not have a whistleblowing policy in place, and staff did not know how to make a whistle blowing report. There were no quality checks or audits carried out by the provider, no mechanism for the provider to monitor the quality of care people received, or to involve people in how the service should be developed.

People who used the service received their medicines safely. People had choices in how their care was provided to them, and their preferences were known by staff and acted on accordingly.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review; if we have not taken immediate action to propose to cancel the provider’s registration of the service, it 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.

During this inspection we found that the providers were now doing monthly reports to help them and the manager look at the quality of the service in an organised way. These reports provided the foundations for an effective system although some additional developments were needed.

We learned that in future people living at the home and their families would be specifically asked for their views during reviews of their care. The manager told us these would be done every three months. We saw some examples which showed that people had been asked for and given their views. These reviews provided the foundations for an effective system although some additional developments were needed to these.

The introduction of the provider reports had brought about some specific improvements at the home. In particular the standard of the accommodation had improved. The manager thought this was because they and the providers now had a plan to work to.

There was clear information that described the care and support that each person needed. We saw that the staff group were attentive to people's needs. The manager and care workers knew people well and showed that they understood their care needs.

The staff group were experienced and showed consideration and respect for people living at the home. The manager had arranged more training following our last inspection. This meant that most staff were up to date in essential training topics.

The building and some of the furnishings and decoration were described by some people as being, 'in need of a facelift'. We observed examples of this including worn carpets and chairs and shabby paintwork.

Arrangements for the secure storage of personal information about people living at the home and staff had been improved following our last inspection. This meant that information was more secure than it had been before.

The provider did not have an effective system to identify and plan for improvements that were needed to the premises and other aspects of the service.

There was clear information that described the care and support that each person needed. We saw that the staff group were attentive to people's needs and were able to explain these needs to us confidently. During the inspection we observed that the staff were prompt to give people the help they asked for.

The home had safe arrangements for the management of people's medicines and for supporting people to deal with this themselves if they had the ability to do so.

The staff group were experienced and showed consideration and respect for people living at the home. Some important training for staff including fire safety, moving and handling and infection control had not been updated for two years.

Arrangements for the secure storage of personal information about people living at the home, and staff needed to be improved.

The providers did not have effective arrangements for assessing standards at the home and making sure that they attended to improvements that were needed.