We found the following examples of good practice
The provider ensured PPE supplies were plentiful and accessible throughout the buildings. We saw staff were using PPE appropriately at all times.
Staff and people were regularly tested and national guidance for the prevention and control of infection was followed.
We found the following examples of good practice.
• Visiting policies and procedures were in place. Visitors were required to complete Covid-19 screening questionnaires and risk assessments prior to entering. Thermal imaging technology was used to check visitors’ temperatures and to ensure they were wearing a mask.
• People were supported by staff who wore Personal Protective Equipment (PPE) in line with current guidance and were trained regarding infection prevention and control.
• People’s positive social and emotional wellbeing was promoted. People were supported to engage in activities that were compliant with social distancing guidelines.
• Clear risk assessments relating to Covid-19 were in place. Where risks relating to Covid-19 had been identified, measures had been put in place to mitigate risk to people.
• Staff wellbeing was promoted. Staff risk assessments were completed and measures were put in place to keep staff who were disproportionately at risk of Covid-19 safe. Covid-19 debriefs took place to discuss how staff were feeling and what support they needed during the pandemic.
Further information is in the detailed findings below.
People’s experience of using this service:
•People were positive about the care and support they received. One person said, “The staff are kind and friendly.” A relative told us, “The staff have been wonderful, they all seem so very caring.”
•The provider had made improvements to the service since our last inspection.
•Governance of the service had improved. Effective checks and audits were carried out to determine the quality of the care. The provider had acted promptly to address areas identified for improvement.
•Risks to people were monitored and procedures were in place to help keep people safe.
•There were safe systems for the management and administration of people’s prescribed medicines.
•People were supported by adequate numbers of staff who were safe and competent to work with them.
•People were protected from the risks associated with the control and spread of infection.
•Staff understood the importance of ensuring people’s rights were understood and protected.
•People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
•People’s health care and nutritional needs were monitored and understood by staff.
•People told us staff understood their needs and were kind, caring and compassionate.
•People had opportunities for social stimulation and were able to maintain links with the local community.
Rating at last inspection: The service was rated Requires Improvement at the last inspection in February 2018.
Why we inspected: This was a scheduled inspection based on the previous rating.
Follow up: We will continue to monitor intelligence we receive about the service until we return to
visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
More information is in Detailed Findings below.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Following the last inspection, we met with the provider on 17 January 2018 to confirm an action plan to show what they would do and by when to make improvements to meet the regulations.
At this inspection we found improvements had been made and the provider was meeting the regulations for safe care and treatment, safeguarding from abuse and staffing and governance arrangements.
Lightmoor view is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Lightmoor view accommodates up to 75 people across six separate units, each of which have separate adapted facilities. Most of the units provide support to people living with dementia. At the time of the inspection there were 69 people using the service.
There was not a registered manager in post at the time of our inspection. 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 provider had recruited a new manager and they had just begun their induction process and we were assured an application for registration would be completed in due course.
The systems in place to monitor people’s care delivery were not consistently effective and we could not be assured the systems were sustainable. The provider had made improvements following the last inspection, however further work was required to ensure this was sustainable.
People were supported by sufficient numbers of staff; however staff deployment required some improvement. People were supported to take their prescribed medicines, however administration recording and guidance for staff was not consistently recorded.
People had their needs assessed but further improvements were needed to how this informed people’s care plans. People were supported by knowledgeable staff, however further improvements were required in supporting people living with dementia. Improvements were needed to the environment to ensure it was suitable for people living with dementia.
People’s preferences were understood by staff. However this did not always inform people’s care planning. People were not consistently supported to follow their interests.
People were safeguarded from potential abuse. People were supported to manage risks to their safety. People were supported by staff who understood how to prevent the spread of infection. People were supported by staff that had been recruited safely. The manager had systems in place to learn when things went wrong.
People were supported to meet their dietary needs. People were given consistent care and support. People were supported to maintain their health and well-being. People had their rights protected by staff that understood and could apply the principles of the Mental Capacity Act 2005.
People received support from staff that were caring in their interactions and they were involved in decisions and had their choices respected by staff. People were respected and their dignity was maintained.
People understood how to make a complaint. People were supported in a way that met their wishes and effectively at the end of their life.
Notifications were submitted as required and the manager understood their responsibilities. We found people, their relatives and staff felt supported by the manager and able to be involved.
During this inspection we identified four breaches of the Health and Social Care Act 2008. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
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 and, if we have not taken immediate action to propose to cancel the provider's registration of the service, 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."
There was a registered manager in post at the time of our inspection. 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.
People were not supported by sufficient numbers of staff. People were not always supported to manage risks to their safety. People were not always safeguarded from potential abuse. Accidents and incidents were not always managed effectively. People were not always safely supported with their medicines. People were supported by staff that had been recruited safely.
People were not always supported by staff that were knowledgeable and staff did not always have the skills to meet people’s needs. People did not always receive the support they needed with their dietary needs. People were not always supported to maintain their health. People had their rights protected by staff that understood and could apply the principles of the MCA. People had a choice of food and drinks.
People did not always receive support in a way that maintained their privacy and dignity. People received support from staff that were caring in their interactions with people, however people sometimes experienced uncaring support due to staff not having the time to interact with them. People were involved in decisions and had their choices observed by staff.
People had their needs and preferences for care and support met by staff that understood them. However care plans lacked detail about people’s preferences. People could not always follow their individual interests or take part in social activities. People understood how to make a complaint and complaints were responded to.
The systems in place to monitor peoples care delivery were not effective. The registered manager did not always respond to and act on feedback about the service. The registered manager had failed to make required improvements following the last inspection. Notifications were submitted as required.
There was a registered manager in post at the time of our inspection. 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.
People were not always supported by sufficient staff. They sometimes had to wait to have their care and support needs met. People were supported to manage risks to their safety. People told us they felt safe and staff understood how to safeguard people from potential abuse and how to manage incidents and accidents. People were supported by staff that had been recruited safely. People were supported with their medicines safely and there were systems and processes in place to ensure medicine was administered safely.
People had support from staff that were knowledgeable and had the skills to meet their needs. People had their rights protected by staff that understood and could apply the principles of the MCA. People had a choice of food and drinks and received support to ensure their dietary needs were met. People had support to maintain their health.
People were not always involved in decisions and did not always have their choices observed by staff. People did not always receive support in a way that maintained their privacy and dignity. Staff did not always recognise when their actions and language impacted on people’s privacy and dignity. People received support from staff that were caring in their interactions with people.
People had their needs and preferences for care and support met by staff that understood them. Staff could tell us how they responded to people’s individual needs. However, people could not always follow their individual interests or take part in social activities. There was no understanding of what people liked to do. People did not always have their complaints managed effectively. Complaints were responded to; however records were not always available to show outcomes were shared with the person who made the complaint.
The system in place to monitor peoples care delivery was not effective. This had not identified the issues with accurate record keeping which meant monitoring care and support was difficult. The registered manager did not always act on people’s feedback about the service. People and staff could approach the management team. The registered manager and staff understood their roles and responsibilities.
This inspection took place 22 October 2014 and was unannounced. At our previous inspection no improvements were identified.
The home had a registered manager in post who was present for our inspection. 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.
Lightmoor View is registered to provide nursing and personal care to a maximum of 75 people who live with dementia. The home is arranged over three floors with each floor having two units. On the day of our inspection 74 people were living at the home.
Staff knew how to protect people against the risk of danger and harm and how to report concerns they may have. They understood how to help keep people safe and followed instructions to reduce risks that had been identified.
People were supported by sufficient numbers of staff who had the skills to meet their needs. Staff had received appropriate training and felt supported in their roles by the registered manager.
People’s medicines requirements were reviewed and managed safely to make sure it was appropriate to their needs. Arrangements for meeting people’s health care needs were in place and people saw health care professionals when they needed to.
Staff knew how to support people in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had made appropriate applications to the local authority in accordance with DoLS and was following legal requirements.
People were supported to express their views and be involved in making decisions about their care. Where appropriate relatives were involved in identifying people’s preferences and we saw these were respected. Care records were personal to each person and gave clear information on the needs of the person and their life histories. This helped staff to support people as individuals and be aware of their hobbies and interests.
Feedback from relatives about how staff cared for their family members was positive. We saw staff treated people with kindness and compassion and were aware of each person’s needs. People’s privacy and dignity was respected and staff encouraged them to maintain their independence.
The home had a stable management system in place. All relatives and staff we spoke with told us communication within the home was open and honest. Relatives were comfortable raising concerns and complaints with the manager. Staff were encouraged to report concerns and question practice if needed.
We saw that systems were in place to monitor and check the quality of care and to make sure the environment was safe and well maintained. There was evidence that learning from incidents and investigations took place and changes were put in place to improve the service.
We observed that people received caring support from staff on duty. We observed care that was not rushed and the staff knew the people and their individual personal needs.
We considered that people who lacked the ability to manage their own care received caring support that was responsive to their changing mood and need. Care records were in place that provided staff with instructions on how people should be cared for and why.
Staff understood the importance of keeping people safe from harm.
The provider had robust systems in place to assess and monitor the quality of the service provided. People knew how to complain and considered the level of communication with the manager and staff was good. This meant that the service was effective and professionally led.
We spoke with seven people who used the service, eight staff and four relatives/visitors.
We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs which meant they were not able to tell us of their experiences. We used the Short observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spent half an hour in two of the units to carry out this short period of observation of activity.
Two relatives of people who used the service told us that staff always came promptly when their relative needed help. They said staff talked to them about how they liked their relative's care to be provided.
People's visitors said there was always enough staff on duty and staff never seemed rushed. They said that the staff were helpful and cheerful and always acted professionally.
One person said, 'Staff tell me what is going on and have encouraged me to ask questions about what they do. I know how to make a complaint and expect the manager to look into it'. Staff spoke of their awareness of how to keep people safe from harm.
During this inspection we looked at a sample of nine out of 75 medicine administration records to determine whether these records could show us whether people living in this service were receiving their medicines as prescribed by their doctor. We found that the service, in the majority of cases, was able to demonstrate that people were receiving their medicines as prescribed.
We spoke with staff who had different roles in the home. They told us they enjoyed their work and were well supported. They said they were provided with training opportunities to meet the specific needs of the people who used the service and to keep them safe. One person said, 'I do enjoy my role, I like giving assistance to people who can't make decisions for themselves anymore'.
People's visitors said they had the opportunity to complete a survey once a year. They said they could attend meetings and staff spoke to them about their care.