Lothian House Care Home

Updated 15 February 2019

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

This inspection took place on 4, 11 and 13 December 2018. The first day of the inspection was unannounced which meant the provider did not know we would be visiting. The second and third days of inspection were announced so the provider knew we would be returning. The inspection team was made up of one adult social care inspector and one 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.

We reviewed information we held about the service, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

The provider completed a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We contacted the commissioners of the relevant local authorities, the local authority safeguarding team, and other professionals who worked with the service to gain their views of the care provided at Lothian House.

During the inspection we spent time with people living at the service. We spoke with 10 people and four relatives or visitors. We also spoke with the registered manager, the deputy manager, two senior care assistants, four care assistants, the administrator, the head housekeeper, the assistant chef and two members of housekeeping staff. We spoke with one advanced nurse practitioner and three social workers.

We reviewed four people's care records and four staff recruitment files. We reviewed medicine administration records for 12 people as well as records relating to staff training, supervisions and the management of the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 15 February 2019

This inspection took place on 4 December and was unannounced. Subsequent days of inspection took place on 11 and 13 December 2018 and were announced.

Lothian House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lothian House provides personal care for up to 48 people. At the time of our inspection there were 47 people living at the home who received personal care, some of whom were living with a dementia.

A registered manager was in place at the time of our inspection. 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.

At our last inspection in March 2016 we awarded an overall rating of good and rated the key question ‘is this service caring?’ outstanding. At this inspection we rated the key questions ‘is this service responsive?’ and ‘is this service well led?’ outstanding. Therefore, the overall rating has now improved to outstanding.

The service was extremely person-centred. Person-centred means the person was at the centre of any care or support plans and their individual wishes, needs and choices were considered. People received personalised care that was extremely responsive to their individual needs. Without exception, people told us staff went ‘above and beyond’ to make sure people’s full range of needs were provided for.

People’s spiritual needs were actively promoted and supported. The service had excellent links with the local community; people told us how much they valued this. Feedback from professionals on the quality of care provided was excellent.

People, relatives, staff and external health and social care professionals consistently gave us exceptional feedback about the visibility and skills of the registered manager. Staff we spoke with were clearly proud of the service and how they contributed to supporting people with their needs in an holistic way. Staff were highly motivated to develop the service and said they were actively encouraged in this by the registered manager.

There were excellent quality improvement systems in place to ensure constant monitoring of and improvements to the care provision at this service.

Staff had received training in safeguarding and knew how to respond to any concerns. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service.

Staff training in key areas was up to date. Staff received regular supervision sessions and appraisals and told us they felt supported.

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 were supported to have enough to eat and drink and attend appointments with healthcare professionals.

People and relatives told us staff were kind, caring and respectful. People’s independence was promoted without risks to their safety.

Care plans were detailed and person-centred and contained important information about people’s life stories so staff could get to know people well.

People and relatives knew how to make a complaint and were happy approaching staff or the registered manager if they had any concerns.