Lutterworth Country House Care Home

Lutterworth Country House is a care home providing accommodation and personal care for up to 66 people. At the time of the inspection 51 people were using the service.

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

People were safe because staff knew how to recognise the signs of abuse and how to report it. People and staff felt they would be listened to if they raised any concerns. Risks were assessed and managed while people’s freedom to make choices and take risks was upheld.

There were enough staff with the right skills and experience to meet people’s needs. People received their medicines in a safe way. Staff had the training and supervision they required to do their jobs and keep people safe. People enjoyed the meals provided. Staff supported people to eat and drink sufficient amounts and took action if they did not

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.

Staff were kind and compassionate. People were supported to have choice and control and to remain as independent as possible. People had opportunities to follow their interests and hobbies and to maintain relationships with friends and families.

There was a clear organisational structure and staff understood their roles and responsibilities. People, relatives and staff said managers were approachable and supportive. The provider monitored and managed risks at the service through checks and audits and action plans when risks were identified.

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 21 March 2021).

The provider completed an action plan 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.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• Cleaning schedules were in place and frequently audited to ensure the equipment and premises were clean, and on each floor dedicated cleaning staff were deployed. High touch areas were cleaned at least 4 times every 24 hours.

• Where government guidance changed the provider had systems in place to ensure this was promptly shared with managers who communicated these to staff, people and their relatives. This ensured the risk of acquiring and spreading infections could be reduced as far as practicably possible.

Lutterworth Country House Care Home is a care home providing personal and nursing care for up to 66 people. At the time of the inspection 43 people were receiving support.

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

People and relatives told us the service was safe, and staffing levels were sufficient.

Risk assessments were in place and covered the risk present in people’s lives. Regular reviews and updates took place to ensure assessments were relevant and up to date.

Medicines were stored and administered safely, and staff were trained to support people effectively. Staff felt confident in their roles.

Our inspection was prompted in part by concerns raised about infection control and falls within the service. On the day of our inspection, the service was clean, and staff were following infection control procedures. Staff wore appropriate personal protective equipment. People and staff we spoke with were satisfied the service was kept clean to a high standard.

Audits of the service were undertaken and any issues found were addressed promptly. Staff felt well supported by the management team and were motivated to provide good care to people.

Staff referred to external professionals as required and followed advise to ensure people’s needs were met.

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

The last rating for the service was Requires Improvement published on 10 March 2020.

We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Why we inspected

The inspection was prompted in part due to concerns about the high occurrence of falls, and infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. A decision was made for us to inspect and examine those risks.

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.

Lutterworth Country House Care home is a residential care home providing personal care to 35 people aged 65 and over at the time of the inspection. The service can support up to 66 people. The care home accommodates people on two floors, each of which has separate facilities.

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

The provider had deployed a senior manager to oversee the service and bring about the improvements required that were identified during our previous inspection. Not all of the improvements needed had been made at this inspection.

The audit system in place to monitor the safety and quality of the service was still not always effective in ensuring shortfalls would be identified and addressed.

People could not always be assured they would receive their medicines when they needed them. Procedures relating to the administration of medicines were not robust enough to ensure they were always safely managed.

People’s care records were not always updated when their needs changed and risks to people’s health were not always updated following an incident.

People remained at risk from their care needs not being met in a timely way because of the amount or deployment of staff at the service. Some staff, people and relatives shared their concerns of how the staffing arrangements continued to affect them.

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 September 2019) and there were multiple breaches of regulation. The provider completed an action plan to show what they would do and by when to improve. At this inspection some improvement had been made however, the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 26 and 27 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and governance at the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions ‘Safe’ and ‘Well-led’ which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same, requires improvement. 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 Lutterworth Country House on our website at www.cqc.org.uk.

Enforcement

Following the last inspection, we issued a Warning Notice against the provider in relation to the leadership and management of the service and staffing. The Warning Notice has been partially met but there is still a continued breach of regulation in relation to the leadership and management of the service.

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.

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.

Lutterworth Country House Care home is a residential care home providing personal care to 52 people aged 65 and over at the time of the inspection. The service can support up to 66 people. The care home accommodates people in two floors, each of which has separate facilities.

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

There were not enough care staff to meet people’s needs. They did not always receive care and support when they needed it. Staff and some relatives also felt there were not enough staff. Some staff were temporary and did not always know how to support people or know their needs well.

The registered manager had a quality assurance system in place to monitor the safety and quality of the service. However, this was not effectively used to assess, monitor and improve the quality and safety of the service provided to people.

People were not monitored closely enough to protect them from injury. This meant people were not always safe from avoidable harm.

Medication policies and procedures were not managed well. People’s reasons for requiring certain medicines were not always recorded.

Care staff treated people with kindness, but people’s dignity was not always preserved because of the level of staff available to support them.

People were protected from the risk of infection because staff followed the training they received.

People could be assured they would be protected from the risk of abuse.

People were provided access to health care services.

People had personalised their bedrooms and the communal areas were well furnished.

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 24 October 2018).

This inspection was prompted in part due to concerns received about staffing, management of medicines, and falls. A decision was made for us to inspect and examine those risks.

The inspection was also prompted by notification of a specific incident following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of falls and unsafe medicines management. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see all the sections in the full report for details of these.

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

The provider has in part taken action to mitigate these risks. No action has been taken in response to the concerns we identified with the staffing levels at the time of writing the draft report. However, action has been taken to support people who require medicines at night by the deployment of trained staff to administer them safely. People remain at risk following a fall as monitoring protocols are not routinely followed though the provider is working collaboratively with the local authority who are delivering training to staff to reduce the risk of people falling and what actions to take in the event of a fall.

Enforcement

We have identified breaches in relation to the staffing level at the service, how the service manages risks to people, the management of medicines, dignity and respect and the management of the service 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.

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.

Lutterworth Country House Care Home provides personal care and accommodation for up to 66 older people some of whom had dementia. On the days of our inspection there were 55 people living at the service.

We inspected on 25 September and 1 October 2018. The first day of our visit was unannounced. This meant the staff and the provider did not know we would be visiting.

The service had a registered manager. A registered manager is a person who has registered with the 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 registered manager had not fully understood their legal responsibility for notifying the CQC of deaths, incidents and injuries that occurred or affected people who used the service.

We have made a recommendation about people's plans of care. Whilst people had plans of care in place, not all were up to date or accurately reflected people’s current care or support needs.

Systems in place to monitor the quality and safety of the service being provided were not always effective.

Whilst the risks to people’s care and support had been assessed, the actions to minimise the risks had not always been followed.

People’s thoughts varied on the numbers of staff deployed to work on each shift. Whilst some felt there were enough staff members to meet people’s care and support needs, others did not. Observations identified times when there were no staff members available in the lounges and limited interactions between the people using the service and the staff team.

Not all of the staff team had been provided with an induction into the service or the necessary training. A training plan was received following our visit showing how this was being addressed.

The staff team supported people to make decisions about their day to day care and support and they were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had not always been completed to ensure any decision made on behalf of a person had been made in their best interest.

Records kept for people who had been assessed to be at risk of not getting the food and drink they needed to keep them well, were not always accurate.

People told us they felt safe living at Lutterworth Country House Care Home and the staff team were aware of their responsibilities for keeping people safe.

Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work there.

People had received their medicines as prescribed. Systems were in place to regularly audit the medicines held at the service and the appropriate records were being kept.

People had access to relevant healthcare services and they received on-going healthcare support. Nutritional assessments had been carried out and people were supported to maintain a healthy, balanced diet.

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 provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time with others, or on their own. Whilst not all of the staff team had received training in the prevention and control of infection they understood their responsibilities around this and the necessary protective personal equipment was available.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong to improve safety across the service.

People’s wishes at the end of their life were being explored.

People told us the staff team were kind and they treated people in a caring and respectful manner.

A formal complaints process was in place and people knew who to talk to if they had a concern of any kind. People were confident that any concerns they had would be taken seriously and acted upon.

Staff meetings and meetings for the people using the service and their relatives had been held. These meetings gave people the opportunity to discuss the service being provided and be involved in how the service was run.

The staff members felt supported by the management team and felt able to speak with one of them if they needed support or advice.

Further information is in the detailed findings below.