Loughton Hall

Loughton Hall is a care home providing accommodation for persons who require nursing or personal care to up to a maximum of 33 people. The service provides support to older people, including people living with dementia. At the time of our inspection 28 people were using the service.

People’s experience of the service and what we found:

People's medicines were not always managed safely. Environmental risks were assessed and monitored. People’s risk assessments reflected their current needs. There was enough staff to meet people’s needs. Recruitment oversight had improved. Safeguarding policies were being followed and reported appropriately.

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. The registered manager had oversight of monitoring records such as food, fluid and repositioning records. Appropriate action had been taken to undertake all required training and provide staff with support through supervision and appraisal.

Governance arrangements had improved. However, more work was required in relation to the oversight for medicines management.

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 requires improvement (published 6 December 2022) and there were 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 whilst some improvements were found the provider remained in breach of regulations.

At our last inspection we recommended the provider takes advice from a reputable source to review their recruitment practices in line with safe recruitment practice guidance. At this inspection improvements had been made.

The last rating for this service was requires improvement (published 1 June 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last 4 consecutive inspections.

Why we inspected

When we last inspected Loughton Hall in April 2023 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

Enforcement

We have identified continued breaches in relation to medicines and governance.

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

Follow Up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Loughton Hall is a residential care home providing accommodation and personal care to older people, some of whom maybe living with dementia. The service is provided in a large building set over three floors and can support up to 33 people. At the time of our inspection 21 people were using the service.

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

People's medicines were not managed safely, and staff competencies were either not in date or poorly assessed. Risks to people or the environment were not always assessed, monitored, and managed effectively. Following a visit from the local authority safeguarding referrals were now being sent, however not all these had been reported to CQC. We found gaps in staff recruitment processes. We have made a recommendation about staff recruitment. There were enough staff to support the number of people currently living at the service.

Records did not always show what support people were given. this included food and fluids intake and repositioning. People told us they enjoyed their food; however, work was needed to improve the choices available on the weekly menu’s. We were not assured people were having their oral care needs met.

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. Whilst people were supported, and encouraged, to make day to day choices, the policies and systems in the service were not supporting people to have maximum choice and control. This was because care records did not always evidence if less restrictive options had been explored prior to restrictions being in place or who was consulted in people’s best interests.

Quality assurance processes were not effective, and most audits had not been completed since 2022. A warning notice has been sent in relation to governance at the service.

A new manager had recently started in post and was beginning to review the quality of care and draw up action plans for improvement.

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 requires improvement (published 29 August 2022) and there was a breach 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 not enough improvement had been made and the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to safeguarding concerns, staffing, care practice and medicines management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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 Loughton Hall on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines, risk management, meeting people's nutritional needs, and governance at this inspection.

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.

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

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.

Loughton Hall is a residential care home providing accommodation and personal care to older people, some of whom maybe living with dementia. The service is provided in a large building set over three floors and can support up to 33 people. At the time of our inspection 28 people were using the service.

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

People told us they were happy living at the service and felt well supported. One person said, “The staff are first class we are well looked after.”

Some care plans needed to contain more detail to mitigate risks to people in a person centred way.

Medication records needed as required protocols, to ensure staff had the information they needed to provide medicines safely.

Audits and quality assurance was in place but needed some improvement to ensure the service continually improved and provided positive outcomes for people.

There were appropriate levels of staff to support people. People were safeguarded from the risk of abuse. Staff had received appropriate training to support people.

People were supported to have maximum choice and control of their lives and staff supported /did 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

The last rating for this service was requires improvement (published 18 June 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part by concerns we had received around staffing and care at the service. A decision was made for us to inspect and examine those risks in safe and well led. We found no evidence during this inspection that people were at risk of harm from this concern.

Please see the safe and well led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 improvements. Please see the safe and well sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to good governance at the service.

Following the inspection the provider took action to address issues we had raised with them and kept us up to date with their plans and actions taken.

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.

Loughton Hall is a residential care home providing accommodation and personal care to 18 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

Not all accidents and incidents had been reported appropriately as safeguarding referrals or as notifications to CQC. The service was working with the local authority to improve practice in this area and the provider has now reported any accidents or incidents that require a referral retrospectively.

There were inconsistencies in care records which were not always being kept up to date to guide staff on how risks were mitigated. However, staff we spoke with were clear about the risks associated with people’s care. The provider was in the process of updating all care records to an electronic system.

Despite no concerns being raised relating to staffing levels from people that used the service, we received some feedback from staff there was a risk of people's care needs not being met in a timely way as on some night’s numbers dropped if cover could not be obtained. We have recommended the provider assess the staffing levels at night.

People were protected from the risk of transmission of COVID-19 and other infectious diseases. The environment was clean and well maintained.

People were supported to have maximum choice and control of their lives and support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, improvements were needed to care plans in relation to capacity and consent and we have made a recommendation in this area.

People using the service were happy with the care they received. They told us staff were kind and met their needs.

Not all care records evidenced how people would want to be supported at the end of their life. We have made a recommendation about end of life care.

Audits on quality and safety were completed but had not identified all the shortfalls we found in areas such as reporting referring accidents and incidents and care planning.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, safeguarding concerns infection control and staffing. A decision was made for us to inspect and examine those risks.

This service was registered with us on 06 November 2019 and this is the first inspection.

The last rating for the service under the previous provider was good, published on [12 September 2019].

We have found evidence that the provider needs to make improvement. Please see the relevant key question sections of this full report.

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.