Layden court Care home

Layden Court is a care home. The service can accommodate up to 92 people in a purpose-built building and provides personal and nursing care for older people, including people living with dementia. There were 49 people using the service at the time of the inspection.

People’s experience of the service and what we found

Risks associated with people's care were not always managed in a safe way. People's care records did not accurately reflect their needs. Risks to people had not been fully assessed and there was not always guidance for staff on how best to manage these risks.

Incidents and accidents were not always recorded in detail or investigated to reduce further risks. Medicines were not being managed safely. People were not always protected from the risk of abuse or neglect as staff were not always reporting or investigating allegations.

The registered manager completed a dependency tool and a staff rota. However, staff were not effectively deployed to meet people's needs.

Staff had received mandatory training but required further training in relation to dementia care and the management of behaviour that may challenge the service. Staff told us they felt supported, and management were approachable.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; we were not assured the policies and systems in the service supported this practice.

There was a lack of robust management oversight to ensure the quality of care. The provider had increased the management presence in the service and was working on making and embedding improvements. The provider operated effective and safe recruitment practices when employing new staff.

People had access to health care when needed and assessments of people's care were undertaken before they moved in. People told us they enjoyed the food served at Layden Court. Staff were kind and caring in their interactions with people, where time allowed this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 17 March 2023).

Why we inspected

The inspection was prompted due to concerns received from the local authority commissioners. These were regarding systems to safeguard people from abuse, safe care and support and ineffective governance and management of the service.

We undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Layden Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, systems and processes to safeguard people from abuse and oversight and governance at the service.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will

re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than12 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.

Layden Court is a care home. The service can accommodate up to 92 people in a purpose-built building and provides personal and nursing care for older people, including people living with dementia. There were 46 people using the service at the time of the inspection.

People’s experience of using this service

People had benefitted from improvements to the quality and safety of the service. Following our last inspection. The registered manager and provider had devised an action plan and continued to make improvements and embed these changes into the running of the service. There were still some minor improvements required in regard to medicines management and the environment. However, these had been identified by the provider’s quality monitoring system and were part of their ongoing improvement plan.

We have made a recommendation that documentation of medicine management is consistent and embedded into practice.

Relatives felt listened to and told us complaints were appropriately dealt with and resolved. People told us their views were obtained to continually drive improvements. Feedback from staff was extremely positive about the improvements to the service, they worked better as a team and were well supported.

Staff ensured people's safety and people told us they felt safe. Staff understood safeguarding and whistleblowing procedures. There were sufficient staff employed to meet people’s needs and staff responded to people’s needs in a timely way. The provider operated a robust recruitment process and monitored accidents and incidents, which ensured staff learned lessons when things went wrong. Risks to people were identified, assessed and managed. People were protected from the risk of infection.

Staff were well-trained and received supervision and support. They were knowledgeable about people needs and provided person-centred and individualised care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were looked after by dedicated staff, who were motivated to provide safe, high quality and individualised care and support. People and their relatives told us how staff were caring and kind. People received appropriate care and support in line with their needs, and documentation around people's care and support helped evidence this.

The registered manager had worked hard to make the required improvements, this demonstrated their commitment to driving improvements in the safety and quality of person-centred care. The registered manager was aware of their regulatory responsibilities and obligations. The service worked in partnership with a wide range of healthcare professionals and external services, to ensure people had access to care and support appropriate to their needs, and to prevent unnecessary admissions to hospital. Professionals working with the service gave positive feedback about the improvements in the care and support people received.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 10 August 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Layden Court on our website at www.cqc.org.uk

Follow Up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Layden Court is a care home providing personal care and nursing. It can accommodate up to 92 people. Some people using the service were living with dementia. There were 47 people using the service at the time of the inspection.

People's experience of using this service and what we found

There was a new manager appointed following our previous inspection and they were registered with The Care Quality Commission (CQC). They had reviewed and improved the quality monitoring systems with the support of the nominated individual. We found the systems being used were predominantly effective in identifying areas for improvement to ensure the service improved outcomes for people who used the service. These systems required embedding into practice and sustained to continue to drive improvements.

We identified some issues with infection, prevention and control, we were not fully assured that the provider was promoting safety through the hygiene practices of the premises. We discussed this with the registered manager and nominated individual, they acknowledged this could be improved. They developed a more robust audit system and sent us their completed audit and action plan. This evidenced issues had been picked up and were being addressed.

Staff we spoke with told us the service was much improved, they felt listened to and supported. Relatives told us they had seen improvements and that communication with the management team was better. The management team were promoting a positive culture that was person centred, staff were receiving training and support to embed this into practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published July 2022).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Layden Court is a care home providing personal care and nursing. It can accommodate up to 92 people. Some people using the service were living with dementia. There were 54 people using the service at the time of the inspection.

People’s experience of using this service and what we found

People were not always safe, risks were not effectively managed to ensure people’s needs were met and safety maintained. For example, risk of weight loss was not managed, people had lost considerable weight and there was a lack of systems in place to manage the risks. Infection prevention and control (IPC) practices were poor. We found many areas that were not clean and areas that were not well-maintained to enable effective cleaning. On our second site visit we found some improvements in cleanliness. However, we still found areas that were not clean, and staff did not always follow good IPC practices. For example, masks not worn properly and staff not changing PPE when required.

Staff received supervision; however, this was not always effective. Most staff we spoke with told us they did not feel supported. One staff member told us, “There is lack of communication from management, we [care staff] are not supported.” We observed poor practices that had not been picked up as part of staff supervision or quality monitoring. For example, poor IPC practices and staff lacking an understanding of person-centred care.

There was a dependency tool used to determine staffing levels. However, it was not clear if there was adequate staff on duty to meet people’s needs. We observed staff were not present in communal areas or available on units when people required assistance. Medication procedures were predominantly followed. However, we found some minor issues, regarding documentation and lack of oversight of records.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice. Staff received specific training. However, this was not effective as staff were not following best practice. The environment was not dementia friendly and staff did not understand how to meet the needs of people who were living with dementia. People’s nutritional needs were not always managed effectively. People were not given choices at mealtimes and there was lack of support. It was not clear if advice from health care professionals was being followed to ensure people received adequate nutrition.

People told us staff were caring and kind. However, we observed staff did not always support people appropriately. Their approach was not always person-centred and at times was task orientated. Staff did not always respect people’s privacy and dignity.

There was lack of social stimulation and activities provided. The registered manager had employed a new activity coordinator and they were commencing activities. However, there was no stimulation or appropriate activities provided for people living with dementia. Complaints were recorded in line with the provider’s policy. However, not all concerns had been documented and dealt with appropriately. This did not evidence actions had been taken to minimise issues reoccurring. End of life care plans were in place, but they were very brief and did not identify people’s preferences, religious beliefs or choices.

Systems and processes used to ensure the service was running safely were not robust or effective. We identified many shortfalls during our site visit that had not been identified as part of the quality monitoring. For example, IPC practices, person centred care, effectiveness of training and staff deployment.

Feedback from relatives varied depending on which unit their family member lived on. Some relatives did not feel involved in the day to day running of the home. They felt communication was poor and they were not kept informed of issues or general welfare of their loved ones.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 01/12/2021 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 29 January 2020.

Why we inspected

The inspection was prompted due to concerns received from the local authority commissioners. These were regarding, poor care and support provided, lack of robust infection prevention and control and ineffective governance and management of the service. As a result, we undertook an inspection looking at all five key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Layden Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person-centred care, consent to care and treatment, staffing, and leadership and oversight at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

The provider had a process in place to enable relatives to visit their family members in a safe way and in line with government guidance. Visitors were asked to show a negative test prior to entry to the home.

Professional visitors were required to show a negative lateral flow test and evidence of COVID-19 vaccination.

Infection prevention control (IPC) signs reminded everyone at the point of entry and throughout the home about procedures for infection control.

Access to regular testing had assisted the home in identifying an outbreak of COVID-19.

Hand sanitising stations were readily accessible throughout the home and we observed staff used these frequently.

Staff used personal protective equipment (PPE) appropriately and had received training in IPC and hand washing.

The home was visibly clean and well presented.