Archived: Lydfords Care Home

Updated 16 July 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection was carried out by one inspector, a specialist nurse advisor and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

Lydfords Care Home provides accommodation, nursing and support for up to 50 older people. It accommodates people on both a long term and respite basis. People who lived at the home had varied needs associated with old age and frailty, some people were living with dementia and conditions such as diabetes. People in care or nursing homes receive accommodation and personal care. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection was unannounced.

What we did:

Before the inspection: We reviewed information available to us about this service. We checked the information that we held about the service and the service provider. This included previous inspection reports, the provider’s annual information return and statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events, which the service is required to send to us by law. We used all this information to decide which areas to focus on during our inspection.

During the inspection we looked at:

• Audits and quality assurance reports

• People’s care records and medicine records for four people

• Records of accidents, incidents and complaints

• Training and recruitment records

During the inspection we spoke to:

• Seven members of staff (activities coordinator, deputy manager, regional manager, two carers and two nurses)

• Two visiting health professionals

• 15 people using the service and four relatives

After the inspection;

We received feedback by email from two health professionals. These health professionals gave us permission to quote them in this report. We also spoke to the registered manager after the inspection.

Updated 16 July 2019

About the service: Lydfords Care Home provides accommodation, nursing and support for up to 50 older people. It accommodates people on both a long term and respite basis. At the time of our visit 37 people were living at the service.

Accommodation was provided over two floors. There were communal areas, including two lounges, a family meeting room, dining room and an activities room. People had their own rooms. People had access to gardens at the rear of the home.

People’s experience of using this service:

We received mixed feedback about staffing levels from people, relatives and external health and social care professionals. Staff rotas showed that there were enough staff to meet people’s needs, but we recommend that the registered manager makes improvements to how staff are deployed.

At the last comprehensive inspection in October 2016 we recommended that the provider seeks guidance on how to safely assess, monitor and review call bell response times on a regular basis as call bells rang constantly. At this inspection, the registered manager and provider had installed a new system which gave them oversight of call bell response records. Despite this we did not see how the registered manager used the records to monitor responses to call bells to check that call bells are responded to promptly. We recommend that the registered manager continues to improve how they check that call bells are responded to promptly

In the last focussed inspection, we recommended that guidance for giving as and when needed medicines (PRN) and on steps to take before administering these as and when medicines was needed. At this inspection protocols for as and when (PRN) medicines continued to not comprehensively guide staff on steps to take before administering medicines. Despite this, people were not at risk of harm. Medicines were administered and stored safely.

Staff told us they had training and were supported to complete qualifications in health and social care. New staff completed an induction with mandatory training and the Care Certificate. Despite this, not all staff had received all training to meet people’s needs. We looked at training records and saw gaps. For example, two staff out of 35 had completed training in nutrition and hydration and only seven staff had completed training end of life care. Following the inspection, the registered manager provided us with further evidence to show that 12 staff had completed modules of the dementia care framework and dementia experience training since the inspection.

At the last comprehensive inspection, we recommended increasing and improving meaningful activities offered to people that are cared for in bed due to health needs or that chose to stay in their rooms. At this inspection, people cared for in bed continued to be at risk of social isolation. Activities staff had been supported to give dedicated time in people’s rooms, but this was only for 15 minutes per week per person. We gave this feedback on the inspection and immediately following the inspection the provider acted to recruit a full-time activities coordinator who was dedicated to spending time in people’s rooms. A structured activities programme was available to people and external entertainers visited once a month.

Systems of quality monitoring were in place but how the provider used the systems to learn from and improve the quality of care continued to be area of improvement. Mechanisms were accessible for relative’s, people and staff to give feedback about the service. Staff attended team meetings three times a year and relatives and resident meetings were held twice a year. People and relatives could give anonymous feedback at any time by using a tablet device displaying a feedback survey in the reception.

People told us they felt safe at Lydfords. Risks to people were minimised. People were protected as risks were assessed and managed. Staff knew how to keep people safe in an emergency such as a fire.

Records showed people have input from a range of health and social care professionals. The people living at Lydfords benefit from the being part of an enhanced GP care programme that links the service to a local GP.

The service met the characteristics of Requires Improvement in all areas. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection: Good. The last inspection report was published on 27 November 2017, this was a focussed inspection on the key questions of Safe and Well-led. The last comprehensive inspection received a rating of Good, that report was published on 14 October 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Enforcement: At this inspection we found three breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Follow up: We will review the service in line with our methodology for ‘Requires Improvement’ services. If any concerning information is received, we may inspect sooner.

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