Littleborough Home for the Elderly

Littleborough Home for the Elderly is a purpose-built care home situated in Littleborough, Rochdale. Accommodation is provided over two floors. Littleborough Home for the Elderly is registered to provide personal care and accommodation for up to 26 people. At the time of our inspection there were 23 people living at the home.

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

Relatives told us they were very happy with the home and its staff. People were supported by caring staff who respected their privacy and dignity and helped them be as independent as they could. Care was person-centred and staff helped people make choices and respected their decisions.

The service had effective safeguarding systems. These helped to protect people from abuse. Risks to people’s safety were identified and managed correctly. There were enough staff to support people in the way they wished. The provider carried out checks on new staff to ensure they were suitable to work with vulnerable people.

People received the support they needed to take their medicines. Staff were trained in infection prevention and control and people were protected against the risk of infection. Although some parts of the home had been redecorated some further improvements were needed, particularly to the toilets. A refurbishment plan was in place to make these changes and further enhance the environment.

Staff had completed appropriate training and received regular support and supervision. People were provided with a balanced diet. The registered manager and staff worked with local health services to ensure people’s health was maintained.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and people's rights were protected. 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.

We received mixed comments about the provision of activities. However, there were plans to recruit an activities coordinator and develop links with the local community. A procedure was in place for managing complaints. With the support of local and specialist services, staff supported people as they reached the end of life.

The home was well managed by the registered manager, with support from an area manager and the provider. Minor issues we found during our inspection were promptly dealt with.

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 25 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

Follow up

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

At the time of our visit 22 people were living at the home.

We found the following examples of good practice.

The home had policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis. People who tested positive for COVID-19 were supported to self-isolate. However some people were unable to self-isolate, these people were closely monitored by staff to ensure they were not coming into close contact with others.

There was a good supply of personal protective equipment (PPE) for staff and any visitors to use. Staff had received training on the use of PPE and we observed staff wearing it correctly during our inspection. Clear signage and information was in place throughout the home to remind staff of their responsibilities.

People living in the home and their next of kin were supported to maintain contact through a range of methods including pre-booked ‘window’ visits, video calls and the telephone. A newly constructed ‘POD’ had been erected in the car park to facilitate future visiting arrangements. The manager had also identified a potential room that could be adapted to allow people to see their nominated relative safely within the home in accordance with new government guidance.

Daily cleaning schedules were implemented and these were enhanced with additional touch point cleaning.

In accordance with guidance from the local health protection team the frequency of regular COVID-19 testing for both people in the home and staff was implemented. Screening procedure were also in place for visitors to the home.

People in the home and some staff were participating in the COVID-19 vaccination programme.

At the last inspection in May 2015 the service was rated Good. At this inspection we found the service remained Good.

This inspection visit took place on 27 September 2017 and was unannounced.

People who lived at the home told us staff were all caring, kind and respectful. One person who lived at the home said, “The staff are so caring and kind.”

The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify different types of abuse and had received training in safeguarding adults.

Medicines were stored in a clean and secure environment. We observed staff followed correct procedures when they administered medication during the day of our visit. They fully completed associated records so people received their medication on time and correctly. In addition medication audits were now in place regularly to ensure procedures were monitored.

People who lived at the home had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

The management team had sufficient staffing levels in place to provide support people needed. We found by our observations and talking with people who lived at the home staff were not rushed and able to spend time supporting them. This was confirmed from our discussions with staff members.

The service had safe infection control procedures in place and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff told us the management team were supportive in their work and approachable should they wish to discuss any issues. They felt a part of the team to improve the home for people who lived at the home.

People who lived at the home were complimentary and told us they enjoyed meals provided and choices available. One person who lived at the home said, “What a good cook, try her home made cakes they are lovely.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

People who lived at the home had access to advocacy services. This ensured their interests were represented by professionals outside of the service to act on their behalf if needed.

People who lived at the home told us staff were all caring and respectful. Relatives and friends made positive comments about the kindness showed to their relatives who lived at the home in surveys returned in 2017.

Staff knew people they supported and provided a personalised service in a caring and professional manner.

The registered manager had a complaints procedure which was made available to people on their admission to the home and their relatives. No complaints had been received.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff and ‘resident’ meetings to seek their views about the service provided and their opinions to improve the home. They also had a suggestion box in the hallway of the building for people to pass any comments about the home.

Below is a summary of what we found. The summary is based on our observations during the visit, speaking with five people who used the service, four members of staff, the assistant manager and one professional visitor. In addition we spoke with two relatives, one of whom was also the activity coordinator at the home, and looked at records.

Is the service safe?

We spoke with five people who used the service. They did not express any concerns about their safety in the home.

People were not protected against the risks associated with the unsafe management of medicines. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Recruitment procedures were not sufficiently robust to ensure people were protected against the risks of unsuitable staff. This is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Improvements needed to be made to ensure people were cared for in premises which were adequately maintained. This is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service effective?

People were assessed by a manager from the home before they were admitted to help ensure their individual needs could be met.

To ensure that safe and effective care was provided, staff continued to update their skills and knowledge with regular training and updates.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. However we found two care files contained inaccurate information in relation to the care people required. This meant people might be at risk of receiving inappropriate care and is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service caring?

We saw limited evidence of positive interactions between most staff and the people who used the service. Most people we spoke with did not make any comments about the quality of staff. However, one person told us, 'The old staff used to care and have a word with you, but the new staff don't seem to bother".

Is the service responsive to people's needs?

People who used the service were offered limited opportunities to make decisions about the care and support they received. This is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people in the home.

Is the service well-led?

The home had a manager who was registered with the Care Quality Commission and was qualified to undertake the role. However, from information gathered during the inspection, we found people might not fully understand who was legally responsible for the care provided at Littleborough HFE.

Quality assurance processes in place in the home were ineffective and did not adequately protect people against the risks of unsafe or inappropriate care. This is a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Regular meetings were held with staff. These provided the opportunity for staff to discuss any concerns or practice issues in the home. Staff told us they enjoyed working in Littleborough HFE and felt supported by the manager.

People visiting said, 'He only does what he wants to do. His speech isn't very good but they seem to understand what he is saying'. 'She is quite vulnerable but she can make her wishes known and will only do what she wants to do'. 'They are always pleasant to people and never impatient, I've never seen any different and I visit often'.

Staff were trained to support people at risk of falling, developing pressure ulcers or who may not eat enough. Professional help was sought when needed.

People were cared for by staff that were supervised and trained. People had opportunities to give their views about their care and treatment.

Through discussion with staff and examination of the staff duty rosters we found that sufficient staff were on duty at all times to meet the needs of the people using the service.

Staff told us that no formal 'on-call' support system was in place however they were able to access additional support during the night should this be needed. Following our visit we were told that more formal 'on-call' arrangements had been put into place.

We found that medicines were generally recorded and saw that care workers administered medicines safely and appropriately. Information was available to care workers that enabled them to support people living in the home to take and use their medicines appropriately.

We spoke with two people living in the home who described the care workers as 'kind', 'caring' and 'lovely'.

During the visit of 8 October 2012 we returned to check compliance. We did not speak to people using the service. We spent our time checking to see if the medicines were being handled safely. We also checked to see if the way that staff were recruited was safe. We found there had been some improvement in the way that medicines were being handled but further improvements were needed. The recruitment of staff was safe.