The inspection of Lister House Nursing Home took place over two days, 22 and 23 May 2017. Both days were unannounced. At our last inspection in March 2016, we rated the home as requires improvement. . There was one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for good governance. On this inspection we looked to see if improvements had been made.Lister House Nursing Home provides accommodation and nursing care for up to 31 people. On the days we inspected there were 31 people in the home, one of whom was receiving respite care.
There was a registered manager in post and they were available on the second day of the 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 told us they felt safe and we saw evidence of appropriate interventions when safeguarding concerns were raised. However, we found risks were poorly managed with a lack of suitable assessments, unclear and contradictory instruction for staff and limited personalised assessments. This was especially in regards to moving and handling as we observed numerous poor procedures with staff lacking confidence in their knowledge and judgements. Specific equipment had not been provided for individuals where required.
Staffing levels were not always appropriate for people’s level of need. Some people required one to one support which staff were not always able to give and many people remained in their rooms. It was not clear if this was their choice as there were no records to indicate this.
Medication was administered, stored and recorded appropriately.
Staff’s knowledge of person-centred care appeared lacking and they did not appreciate the significance of a Deprivation of Liberty Safeguard (DoLS). Mental capacity assessments were in place for most people unable to make decisions but these were not evident for every decision. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice.
People were supported to eat and drink and we saw appropriate records kept of their intake. However, due to the staff pressures and the number of people requiring assistance people had to wait for some time before receiving their meals.
External health and social care support was accessed as needed.
We observed staff interactions to be mixed. Some staff were very caring and attentive but others displayed brusqueness and irritation at times. We saw some people were ignored and staff did not actively engage with people.
Privacy and dignity was not always respected as some people had to wait for support to access the toilet and their needs were not kept confidential as staff shouted to each other requesting assistance.
Care records were mostly person-centred but did not always reflect people’s current needs and were complex to navigate. One care worker admitted to not reading them which meant care tasks could be missed.
Activities were arranged but not everyone engaged in them and there was little evidence of one-to-one interaction, especially for people in their rooms.
Complaints were handled promptly and effectively with apologies given where required.
Although some people expressed their satisfaction at living in the home, we found the atmosphere strained and tense at times, as staff struggled to meet people’s needs. There was limited evidence of senior leadership.
There was limited evidence of quality assurance which focused on individual concerns rather than overall practice issues. We found breaches of regulations in relation to dignity and respect, safe care and treatment, good governance and staffing. 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.