Archived: Laverstock Care Centre

Updated 28 April 2017

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.

This inspection took place on 1 December 2016 and was unannounced. We returned on 2 December 2016 to complete the inspection.

The inspection was completed by two inspectors. We reviewed the report from the last comprehensive inspection in June 2016 and the information submitted to us by the provider following that inspection. This enabled us to ensure we were addressing potential areas of concern. We also looked at the notifications sent to us by the provider. Notifications are information about specific important events the service is legally required to send to us.

During the visit we spoke with 10 people who use the service, five relatives and 14 staff, including nurses and care assistants. We spoke with the registered manager, deputy manager and regional manager. The registered manager was available throughout both days of the inspection. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spent time observing the way staff interacted with people who use the service and looked at the records relating to care and decision making for nine people. We also looked at records about the management of the service.

Updated 28 April 2017

Laverstock Care Centre is a care home which provides accommodation and nursing care for up to 80 older people. At the time of our inspection 62 people were resident at the home.

This inspection took place on 1 and 2 December 2016 and was unannounced.

At the last comprehensive inspection in June 2016 we identified that the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks people faced were not managed effectively, people’s medicines were not always safely managed, there were not always sufficient staff deployed in the home, care plans did not always contain up to date information about people’s specific needs, staff did not always treat people with dignity and respect and quality assurance systems did not always identify shortfalls in the service provided. We issued requirement notices as a result of the concerns we identified.

Action had been taken to improve the safety of the medicine management systems, although further work was needed to ensure medicated topical creams were managed effectively and medicine administration was recorded accurately.

Improvements had been made to the way risks people faced were managed. Staff had identified most risks and had planned with people using the service how those risks should be managed. Staff had a good understanding of the risks and the action that was planned. The plans were regularly reviewed and updated when people’s needs changed. However, we identified further work was needed in relation to the support for people to stay safe when the fire alarm was activated.

Staffing levels had been reviewed and there were sufficient staff deployed to meet people’s needs. During our observations we saw that staff were available to provide support to people when needed. Staff were available to provide support for people to eat, drink and move around the home safely. Requests for assistance from people were responded to promptly. People and their relatives were positive about staffing levels in the home. Comments included, “Staff come quickly when I use my call bell”, “The staff all work together very well” and “There are enough staff around. They always hoist (my relative) and they know what they’re doing. They provide good pressure care and turn her every two hours”.

Staff told us there were enough of them available to be able to provide safe care and meet people’s needs .Comments from staff included, “Generally staff cover is good. There is enough time to sit and chat to residents”, “We are now able to provide the care that people need. There is better team work. It is much better than at the last inspection” and “We were short staffed but this has improved over the last two months. We are able to provide the care that people need”.

We found that the provider had taken action to improve the information set out in the care plans, but further work was needed to ensure plans always reflected people’s specific needs. Most plans contained clear information about people’s needs and there was evidence that the plans were updated when people’s needs changed. We saw two examples of plans relating to people’s dementia care needs that did not give staff clear, specific information about the support that was required.

People told us they were treated well and staff were caring. Comments included, “I am very happy here. The staff are kind and treat me well” and “They (staff) are very kind to me”. Most relatives we spoke with were also positive about the caring approach of staff, with comments including, “The care here is exemplary” and “I am very happy with the care (my relative) receives”. One relative was not happy with the approach of some staff. Although we did not see any examples of poor care, we made the registered manager aware of these concerns. The registered manager said they would continue to work with the person to address their concerns.

People who were at risk of malnutrition and/or dehydration were supported to ensure they had sufficient food and fluid intake. People were offered regular drinks and where they required support with these, staff assisted them.

Staff were taking suitable action when they identified that people did not have capacity to consent to their care or treatment and had made applications to authorise restrictions on people’s liberty.

Staff told us they received training and support which gave them the knowledge and skills needed to do their job effectively. Comments from staff included, “Training is good quality and we are able to keep our skills up to date”, “There’s lots of on-line training, but I’m not a big fan of this. We do have face to face sessions as well, which helps us to address specific issues” and “The dementia training is very good”. Registered nurses told us they were able to maintain their continuous professional development, to ensure they kept up to date with current best practice.

Staff felt the changes that had been made to the management of the service since the last comprehensive inspection had been positive. Comments from staff included, “There is now better support from management (since the last inspection) and a higher staff presence. (Management) is very supportive”, “It is more organised than before and staff are more professional. Residents are respected” and “It’s a lot better now – a different place. (The management team) have given us the correct tools and we now have good direction. I feel residents and staff are happier and we have fewer incidents. I’m happy to work here now”.

At this inspection we found that action had been taken to improve the quality assurance systems in the service. The registered manager told us she had reflected on the findings of the inspection in June 2016 and had worked hard to address the concerns. However, despite the improvements that had been made, there were still areas of the service that required further improvement, which had not been identified by the quality assurance systems.

Following the last comprehensive inspection in June 2016 we placed the service in 'special measures' because it was rated as inadequate. Following this inspection we have removed the service from special measures, because of the improvements that have been made and because no area of the service was assessed to be inadequate. However, further work is needed to improve the service and ensure people receive a consistently good service.

During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for which we are taking action and will report on this when it is concluded.