Archived: Leopold Nursing Home

Updated 8 January 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 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.

We undertook this comprehensive inspection on 24 September 2015 to check that improvements had been sustained from previous inspections on 12 January 2015 and 13 April 2015. We also wanted to see if the service had independently identified shortfalls and were taking action to address them.

The inspection team consisted of two inspectors and an Expert by Experience. An Expert by Experience is a person who has experience of using or caring for someone who uses this type of service. The Expert by Experience had experience of older people and people living with dementia.

We reviewed the previous inspection reports to help us plan what areas we were going to focus on during our inspection. We looked at other information we held about the service including notifications they had made to us about important events. We also reviewed all other information sent to us from other stakeholders for example the local authority and members of the public.

We spoke with 10 people who were able to verbally express their views about the service and three people’s relatives/visitors. We used the Short Observational Framework for Inspectors (SOFI). This is a specific way of observing care to help us understand the experiences of people. We also observed the care and support provided to people and the interaction between staff and people throughout our inspection.

We looked at records in relation to four people’s care. We spoke with five members of staff, including the registered manager, nursing and care staff. We looked at records relating to the management of the service, recruitment, training, and systems for monitoring the quality of the service.

Prior to our inspection we had received concerns about the service provided; these had been reported to and investigated by the local authority. The local authority had kept us updated with the support that they were providing to the service to assist them to improve the care and support provided to people. During our inspection we looked to see what action had been taken as a result of these concerns.

Updated 8 January 2016

We carried out an unannounced comprehensive inspection of this service on 12 January 2015. The service was rated as inadequate. Breaches of legal requirements were found. These related to medicines, staffing levels, staff training and support, how people were treated with respect and dignity and how people’s consent was obtained. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We also found that the service required improvements in how they ensured the care and welfare of people who used the service and how the service ensured that they were providing a good quality service. We issued warning notices and told the provider when they should make improvements by 16 March 2015. We undertook a focussed inspection on 13 April 2015 and found improvements had been made and that the provider needed to, sustain these improvements over time and to independently identify shortfalls and take appropriate and timely action to address them.

Leopold Nursing Home provides accommodation, nursing and personal care for up to 32 older people, some people are living with dementia. There were 19 people living in the service when we inspected on 24 September 2015. This was an unannounced inspection.

Although some improvements had been made we found multiple breaches of regulation that affected the well-being of people using the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

There was a registered manager in post. 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.

The leadership of the service was not robust enough to independently identify and address shortfalls. There had been some improvements which were ongoing but these were not made in a timely manner to ensure people were provided with a good quality service at all times.

There had been some improvement made in staff training. However, further improvements were needed, staff did not know enough about people or the care they needed to ensure that they received consistent and safe care at all times.

People’s privacy was not always respected.

Improvements were needed in how support and equipment were provided to people to maintain their independence, choice and cultural needs when eating and drinking.

People who were upset by others living in the service were not supported by staff to reassure them. In addition to this appropriate action was not taken to advise people on how their actions could upset others.

People’s care records had been reviewed and updated, however further improvements were required.

There were now appropriate arrangements in place to ensure people were provided with their medicines safely and when they needed them.

There were sufficient numbers of staff to meet people’s needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty (DoLS) which applies to care homes. Staff had been provided with training in Mental Capacity Act 2005 (MCA) and DoLS. The systems in place to obtain and act in accordance with people’s consent had been improved to respect people’s rights and choices.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.