Life Care Corporation Limited

Life Care Corporation Limited is a residential care home providing personal care that can support a maximum of 41 people. Many of the people were living with dementia. At the time of the inspection 15 people were supported at the service. There are 25 staff employed. The service is split into two wings, within a large detached home. Each wing accommodates people across three floors. A communal lounge and dining room is located within each wing, with communal grounds offering access to outside space. One side of the building was closed due to the number of people living at the service.

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

Changes were made to ensure risks from the premises and equipment were mitigated. Examples included changes to design, signage and water temperature safety. Medicines were being safely managed. People were protected against abuse and neglect. The service had reviewed and implemented the guidelines for care homes during the pandemic. Improvements were still required for some infection prevention and control practices.

Improvements were made to ensure people’s care was more effective. People were asked about their preferences, likes and dislikes and these were considered to help staff provide individualised care. Documentation of people’s choices had improved. The building was decorated to ensure a better environment for people living with dementia. Improvements to the environment were in line with practice guidelines. Consent for care and treatment was obtained in the right way. The service had not obtained valid consent for the use of people’s photos on social media websites. We made a recommendation about consent.

People said they were happy with the care workers and support received. During the pandemic, the service received regular complimentary feedback from families, even when they were not able to visit due to restrictions. Staff tried to keep people connected with their families and friends.

People’s care plans and daily notes were more individualised. During the lockdowns, the staff had made an extra effort to prevent social isolation of people; the service recognised people were confined to their rooms more. Additional activities and more one-to-one time was provided to keep people entertained and stimulated.

There were improvements to the quality assurance systems. However, the service’s continuous improvement plan was not always updated with the results of multiple audits completed each month. The statement of purpose did not contain the required information. There was satisfactory support from the provider’s clinical lead and operations manager. Incidents and accidents were being correctly reported and there was review of the information by the registered manager. The service and management team worked collaboratively with the local authority, commissioners and other stakeholders.

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.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published 13 May 2020). 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 5 July 2019. 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.

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 coronavirus and other infection outbreaks effectively.

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.

Life Care Corporation Limited is a residential care home providing personal care that can support a maximum of 44 people. Many of the people were living with dementia. At the time of the inspection 30 people were supported at the service. Two of whom were away from the service during the inspection.

The service is split into two wings, within a large detached home. Each wing accommodates people across three floors. A communal lounge / dining room is located within each wing, with communal grounds offering access to outside space.

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

Concerns related to medicine management had not been resolved since the last inspection. Covert medicines were administered without the correct guidelines in place. Stocks of medicines were unaccounted for. Double signage was not completed where medicines were handwritten on administration documentation. There were concerns related to as required medicine guidance, that could lead to incorrect medicine administration.

There were concerns related to the management and prevention of infection control. Clinical waste was not correctly and securely stored. This had spilled onto the external premises tarmac, within the bin storage area, that was left open and accessible. We found concerns related to storage of foods.

Risks related to people were not always mitigated. Call bells had been removed from people’s bathrooms and communal areas, without measures being implemented to manage the risk. Risk assessments in place did not accurately advise of action to take if the risk should occur.

Whilst it is recognised that the provider had made changes to the environment to make it more dementia friendly, issues remained prevalent. Concerns pertaining to room identification had not been picked up although people were known to enter other people’s rooms. Risks related to lack of handrails were identified at this inspection and at the last. One bedroom did not have a light switch that could be accessed from the room. The person would need to exit their room in order to turn on or off the light leading to potential risk of fall not identified in the person’s care plan.

People’s dining experience remained of concern. Lack of choice for seating, poor tableware and choice of foods meant people were not being supported to have their meal preferences met.

Care plans had been rewritten and reviewed since the last inspection but were not person centred. Conflicting information was reported in the records which meant people may not be supported in the most appropriate way. Staff recording was inaccurate and ad hoc therefore an accurate picture of support could not be determined.

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 the MCA.

Governance remained an on-going concern following on from the last inspection. Audits, although completed, were ineffective in accurately capturing information. The registered manager, as a result, was unaware of the issues identified during the course of the inspection.

Staff received comprehensive training that was delivered by an external professional. Staff reported being supported and received regular one to one discussions with their line manager.

Interactions between staff and people were dignified and respectful. People reported staff were always polite and maintained their privacy whilst supporting them.

Safeguarding concerns were correctly reported to the Commission and to the relevant agencies. Staff had a comprehensive understanding of how to report and manage concerns. Sufficient staff were deployed to keep people safe from harm. Recruitment processes ensured people were supported by staff who had been appropriately screened and vetted.

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 (supplementary report published 2 October 2019) with a number of breaches identified. As a result the service was placed in special measures. We imposed conditions on the provider’s registration in September 2019 that they must ensure: a) people receive person centred care that is reflective of their personal preferences and choice (b) care plans and risk assessments are sufficiently details and are person centred outlining how staff are to support people (c) people are supported to participate in activities that they are interested in (d) the premises are suitable for supporting people living with dementia (e) effective audits and analysis of systems and processes is implemented to ensure improvement (f) Effective systems are in place to ensure safe medicine management, records are reflective of people’s needs and kept up to date, and health and safety is appropriately met. The provider completed an action plan after the last inspection to show us how they would meet these conditions. A monthly report was sent to the Commission detailing progress. At this inspection not enough improvement had been made or sustained by the provider, therefore the service was still in breach of regulations. The service retains an Inadequate rating.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider still needs to make improvements. Please see all sections of this full report to identify areas where improvement continues to be required. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has not changed. This is based on the findings at this inspection.

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

Enforcement

We have identified continued breaches in relation to Regulation 9 (person centred care), Regulation 12 (safe care and treatment), Regulation 15 (premises and equipment) and Regulation 17 (good governance) . The service was also in breach of Regulation 11 (need for consent).

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

We are mindful of the impact of 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.

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. In addition, we will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will 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 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.

People’s experience of using this service:

Risks to people's safety and well-being were not always managed effectively and this placed people at risk of harm. The provider failed to consistently ensure people at risk of malnutrition and pressure ulceration were managed in a safe way.

Medicines management was not always safe. Where people were prescribed 'as required' (PRN) medication, the service did not have protocols or guidance in place to ensure that staff knew when to administer PRN medicine.

Care plans were not regularly reviewed and amended when people’s needs changed or if new information came to light. Records were not always kept up to date.

People were not always kept safe from risk of harm in the event of an emergency as individual personal emergency evacuation plans were inaccurate and equipment for signalling for support was not always accessible to people.

We found that there were limited activities on offer to people living in the home. People were not supported to enhance social and recreational pursuits.

The design of the premises was not suitable for the needs of the people with dementia. Equipment was not available to support people who are diagnosed with dementia to maximise independence.

We observed some caring interactions between staff and people that they supported. However, some interactions were not undertaken in a kind and compassionate way.

People were kept safe from the risk of being supported by unsuitable staff, because the service had adequate recruitment processes in place. Staff were up to date with training that the provider deemed mandatory.

Staff were trained in protecting people from abuse. Staff knew how to report abuse and were knowledgeable about safeguarding and identifying the signs of abuse.

The provider was working within the principles of the MCA; however, staff didn’t always understand the principles of the Mental Capacity Act (2005). Staff did sought permission from people before supporting them.

Staff were provided with personal protective equipment and understood the importance of infection control. However, some areas of the home were found to contain hazardous items which did not promote safety, infection control and prevention.

Rating at last inspection:

The service was inspected in September 2016 and report published (October 2016) and was rated good. We conducted a focussed inspection in June 2018 due to information of concern. We looked at the domains safe and well led, and the service was rated Good in these domains. This inspection report was published (July 2018).

Why we inspected: This was a planned unannounced inspection based on the rating at the last inspection

Enforcement:

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

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will 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 / 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 of the publication of this report

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.

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

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Life Care Corporation 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. The home accommodates up to 41 people. One the day of our inspection 33 were living at the home.

The home is divided into two wings. Most people in the home were living with dementia.

People were safe living in the home. There were sufficient staff to meet people's needs and staff had time to spend with people. Risks were managed. Risk assessments were carried out and included risks associated with moving and handling and challenging behaviour. People received their medicines safely.

The service followed safe recruitment procedures ensuring staff were suitable to safely work with vulnerable people. Staff were aware of their responsibilities to report any concerns relating to abuse. The home was clean and free from malodours. Staff worked in line with the services policy on infection control to reduce the risks associated with cross infection.

There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service was led by the interim manager. A new manager had been recruited who was registering with the CQC.

The interim manager monitored the quality of the service and looked for continuous improvement. Staff told us they felt supported by the interim manager and believed the service was well run. The service worked in partnership with local authorities, healthcare professionals, GPs and social services.

The service is provided in a large detached building which is located near to public transport. The home provides a range of services for older people, some of whom may be living with dementia. The home is divided into two units each arranged over two floors.

The home is managed by a registered manager. 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. Relatives and staff felt the service was well managed. The registered manager was felt to be accessible and listened to the views of others and acted on them.

People were kept safe because health and safety issues were effectively monitored, servicing and safety checks were carried out regularly and prompt action was taken to address issues. Staff understood their role in keeping people safe from harm and knew how to recognise and report any concerns about abuse. They were confident management would respond appropriately and act on anything they reported. Staff were trained in and understood how to protect people in their care from harm or abuse. People and their relatives told us they felt safe and could talk to staff and the manager about any concerns they had.

Individual and general risks to people were identified and were managed appropriately. Care records had been updated to a new format and relevant and up to date information was readily accessible. People’s medicines were administered safely. Staff were appropriately trained and their competence was assessed. People’s health needs were effectively monitored and supported.

The staff recruitment process was robust and appropriate checks took place. Recruitment files contained the required evidence of the process. Staff received a thorough induction based on the national Care Certificate competencies. They received on-going training through the provider’s rolling programme. Staff were well supported through supervision, team meetings and annual appraisals. The service had a core of stable staff who communicated well with each other and had built good relationships with the people living in the home. There were sufficient staff on duty throughout the day and night to support people appropriately.

The service understood the relevance of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). Appropriate actions were taken in relation to people’s capacity to consent to a range of decisions relevant to the particular individual. Staff had received MCA training. The MCA legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. Deprivation of Liberty Safeguards (DoLs) provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm.

The house was well kept and repairs were dealt with promptly. Cleanliness was of a generally good standard and infection control procedures were adhered to and appropriate equipment was provided.

The service was subject to effective monitoring by the management team to ensure standards were maintained. Identified issues were addressed in a timely way. The management team were keen to develop and improve the service to ensure people’s changing needs were met. The views of people, families and staff about the service, were sought and acted upon.

The inspection team who carried out this inspection consisted of two adult social care inspectors and an expert by experience. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

As part of this inspection we spoke in private with six people who use the service and ten people during lunchtime in the dining rooms and lounges. We spoke with three visiting relatives, the registered manager, the acting manager, seven care staff and a visiting health professional. We looked around all areas of the home and grounds and observed the lunchtime meal on both wings. We reviewed records of people who use the service which included four care plans, community nurse recording, daily records and risk assessments. We also reviewed records relating to the management of the home which included eight staff recruitment files, a sample of organisational policies and a sample of audit documents.

Is the service safe?

People were protected from unsafe or unsuitable equipment but systems were not in place to ensure pressure relieving mattresses and bedrails were used correctly.

Effective recruitment and selection processes were not in place. Appropriate checks had not always been carried out before staff began work.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of a recent Supreme Court judgement changing the way a deprivation of liberty is determined. The acting manager planned to review all people at the home that the ruling may apply to and was aware of the process to follow should an application be required under DoLS.

Is the service effective?

CQC monitors the operation of the Mental Capacity Act 2005 which applies to all services providing care and support for people. We found that before people received any care they were asked for their consent and the staff acted in accordance with their wishes. However, arrangements were not in place for ensuring only those lawfully able to give consent were asked to do so where the person receiving the care lacked capacity to consent.

Equipment used to support people was clean and in working order but there was a lack of equipment that could support people with dementia in their day to day living and promote their independence.

Is the service caring?

All interactions observed between staff and the people living at the home were caring and professional. We saw staff showed skill when working with people with dementia and were calm and reassuring when helping people who were showing signs of agitation and anxiety. People living at the home told us they felt staff were usually available when they needed them and had the skills they needed when providing their care and treatment. One person told us: "The staff are very good, they come quickly if I ring."

Is the service responsive?

We observed call bells were answered promptly and staff we spoke with felt there were usually enough staff on duty to be able to provide the personal care people needed.

A visiting health professional told us they found the home worked closely with them and always followed any instructions or guidance given.

Is the service well-led?

Since our last inspection the provider had taken action and made improvements to ensure people were protected from the risk of infection because appropriate guidance had been followed.

The provider had also taken action and made improvements to ensure people were protected from the risks of inadequate nutrition and dehydration. People we spoke with said they liked the meals at the home and those that needed help with eating confirmed staff were available when required. One person told us the meals were: "Not bad." Another said the meals were: "Very good."

Care plans reflected people's individual needs and associated risks. We found people were provided with appropriate care to meet their needs. Care plans included appropriate plans to ensure people's nutritional needs were met. However, people told us on the day of the inspection that food was cold and we saw no evidence of alternative choices being offered to people. We saw there were no memory aids for people with dementia for menu choices.

We toured the building and found the standard of cleanliness within communal areas and bedrooms was good. Staff had completed infection control training and regular audits were undertaken. However, we noted that cleanliness and infection control was not adequate in some of the communal bathrooms and toilets.

Staff were supported by receiving regular supervision and annual appraisals. Staff received appropriate training and professional development to enable them to deliver care and support to people safely and to an appropriate standard.

A range of systems were in place for auditing and making sure that the service met people's needs.

We spoke with the manager who told us recruitment files for all members of staff had been reviewed and any gaps investigated. We reviewed ten of the 25 recruitment files.

We observed people being spoken to with respect and some positive interactions between staff and people who use the service. One person we spoke with said, 'the staff are lovely'

Care plans contained individualised information on people's needs, their personal preferences about how they liked their care to be delivered, and risk assessments.

We looked at two recruitment files. They contained some but not all the information required related to the recruitment of workers.

There were systems in place to ensure people were protected from abuse. Staff had safeguarding training. .