Layden court Care home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all quality statements for this key question. At the last inspection we found breaches of regulation because the provider had failed to robustly assess the risks relating to the health, safety and welfare of people. Medicines were not managed safely and the provider had not ensured people were protected from the risk of abuse. Previously, there were not enough staff to support people safely and the provider had failed to ensure staff had the qualifications, competence and skills to support people safely. During this assessment we saw enough improvement had been made and the provider was no longer in breach of regulation. People felt safe. The provider had systems in place to safeguard people from the risk of abuse. Care records had been improved, although there was room to include more detailed information. Staff knew people well. The provider's recruitment policy helped them recruit suitable staff. Overall, people received their medicines safely and there were improved systems to monitor the safety and cleanliness of the home. Staff understood their responsibilities to report any concerns about people’s care. People commented positively about the staff and managers and overall, there were enough staff on duty to keep people safe. Staff received an induction when starting work in the home and further, ongoing training to make sure their skills were appropriate and up to date. People were supported to move safely into the service, having been assessed prior to admission. During our visit some areas were identified for improvement, which had not been identified by the provider’s audit process. Following our visit the provider took appropriate action to address this. This is referred to in the Well-led section of this report.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us communication was proactive and the manager and staff were open, honest and dealt with issues well. One person said, “On the whole, the day-to-day running is very good.” A relative told us, It’s only fair that I commend Layden Court as I believe it warrants it.”

Staff told us meetings and handovers kept them up to date on changes made in the service, such as any lessons learned from incidents, accidents and concerns. Staff told us provider promoted a culture of honesty, openness and learning. They were encouraged to raise concerns and were confident they would be listened to and supported.

Accidents and incidents were recorded and included in the accident and incident audit analysis. The log included the time of incident, the details of the event, the immediate actions taken, and the longer term measures that were put in place to reduce future risk. The registered manager and wider management team analysed incidents, accidents and complaints to identify themes and patterns, and any lessons to be learned. Action was taken to address shortfalls. This included making changes in people’s care plans and in how the service was run, and providing relevant training and information to staff. The management team used handovers, meetings, 1 to 1 supervision sessions, and team meetings to share learning with staff. This helped the team to reflect and share ideas on how to improve the service.

People and relatives told us the admission process went well and people settled in well with help from staff. One relative said,” The moving in process was fine, due to [person’s] relationship with the staff, who seem dedicated to the job.” They added, “The staff always have a smile on their faces, and they are capable of meeting [person’s] needs, including emotional, which you could see from the way they helped [person] to settle in.” The person agreed and went on to say, “They knock on the door, and I say, “Come in”. They are very lovely. I have a good relationship with them.” Another relative said, "[My family member] has been here a few weeks. Moving in went well. We came to have a look around and spoke to staff, we know there have been issues in the past, but it is well run now. They are a 100% upfront and well trained, I cannot fault the staff at all, if you ask about anything it is done straight away. [My family member] is waiting for their permanent stay here to be sorted, and we are so relieved they are getting the care."

Staff told us the service undertook an assessment of people’s needs to make sure people experienced a safe transition into the service. The person and those close to them were involved in the assessment. If this was not possible, for instance, if a person was admitted during an emergency, the service gathered as much information as possible electronically and by phone. This was so the service would be aware of, and equipped to meet people’s needs.

When needed, staff referred people to other services, such as community mental health teams, speech and language therapy or social services for additional and specialist help and support.

Records showed staff communicated with other professionals and services to make sure people experienced smooth transitions when using or moving between other care healthcare and services. Changes in people’s needs and any new admissions were discussed within the staff team at handovers and meetings to make sure the service kept pace with people’s needs.

People we spoke with told us they felt safe in the home. One person said, “I feel safe with the staff, they look after me. I can lock my door.” One relative said, “The staff are very caring and super kind to [my family member] always. They don’t have time to chat as they are extremely busy and they work long shifts. He receives emotional support from the nurse.”

Staff were familiar with the provider’s safeguarding policy and received safeguarding training. They knew how to report concerns. Staff said they were confident the management team would take appropriate action in relation to any concerns were raised. The team took safeguarding seriously and were committed to taking action to keep people safe from abuse. The registered manager was aware of their responsibilities in safeguarding people and committed to making sure people were protected from abuse. Records showed where appropriate, accident and incidents were reported to safeguarding for investigation.

Information about safeguarding people was available in an accessible format and displayed around the home. This helped people and their visitors to know how to report concerns. People were relaxed with staff and felt able to ask for support. We saw lots of positive interaction between people and staff, who treated people with kindness and respect.

There were policies and procedures in place regarding safeguarding and whistleblowing, to provide staff with guidance. Records showed concerns referred to the local authority safeguarding team appropriately and in a timely way. When necessary, the registered manager investigated safeguarding concerns, worked with the local authority and took action to protect people from harm. The management team analysed any incidents and concerns to identify any emerging themes or patterns to improve the care provided. Some people would be at risk if they did not have continuous supervision. Where this was the case, the provider applied suitable Deprivation of Liberty Safeguards (DoLS). These safeguards make sure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty. DoLS applications were submitted to the local authority when people’s liberties were restricted. This was monitored by the registered manager and reflected in people’s care records. Some paperwork was not as clear as it could be in one person’s file and this had not identified by the provider’s audits. We have referred to this in the Well Led section of this report.

People and relatives were involved in reviewing people’s care. People told us staff understood their needs, respected their wishes and supported them to keep safe. For instance, relatives said, “[My family member] is safe here” and “The best thing is the safety”.

Staff told us they encouraged people to maintain their independence safely and we saw they attended to people promptly when they needed assistance.

Staff had a good understanding of people’s needs and supported people in line with their care plans. Staff monitored people’s safety and provided support to people in safe and sensitive way.

People had person-centred care plans, including falls care plans, and risk assessments in place and reviewed regularly. However, there remained room to further personalise these and include further guidance for staff. For instance, where people were at risk of falls, or needed regular pressure relief. We have referred to this in the Well-led section of this report. The service used monitoring systems, such as sensor alarms. This helped to minimise nighttime disturbance for people, while reducing the risk of accidents and falls. We reviewed the provider’s falls audit and analysis and found there was an effective system in place to identify risks, trends and patterns.

People and their relatives felt the environment was pleasant and safe. They confirmed there were call bells in people’s rooms to enable then to call for staff support. Where people were unable to use their call bell staff checked on them regularly. For instance, a relative said, “Staff are trained well and have the skills to support [my family member] they pop in more frequently to check on them. We have seen them do that because [my family member] is a falls risk and cannot use their call bell.”

Staff demonstrated awareness of safety procedures and of their responsibilities around maintenance and health and safety in the home. They told us they received training in all relevant areas of health and safety.

The home was spacious and there were comfortable chairs and spaces where people could sit quietly away from the main sitting room. Furniture and equipment was well maintained. Care equipment, such as hoists and wheelchairs were subject to regular safety checks. The building was free from clutter and accessible for people with mobility needs.

Maintenance and health and safety were monitored, and records were well organised. Health and safety and maintenance checks were completed and safety certificates kept. Fire safety measures, such as equipment testing, and fire drills were in place. People had individual personal emergency evacuation plans to make sure key information about people’s support needs was clear and accessible for staff, in the event of an emergency. Where improvements were needed to the environment these were identified in an action plan and work was in progress. Risks relating to the environment were considered and mitigated. For instance, where people were at risk of falls, where appropriate, equipment was in place to alert staff if a person attempted to walk independently, so staff could provide prompt support. In the event of any incidents and accidents, referrals were made to the appropriate services, such as the falls team and community mental health team.

Overall, people and their relatives told us there were sufficient staff to keep people safe and they felt staff were competent. For instance, a relative said, “Things in general are done promptly. [My family member] is delighted with everything and enjoys being looked after. There are less staff at the weekend but adequate cover.” However, some relatives felt there was room to improve staffing levels. For instance, one relative said, “Things have improved since the last manager was here. Staff are more than capable of supporting people’s needs and safety, but I am not sure about emotionally, due to staffing levels. There is little interaction with residents, just on the odd occasion [staff] will sit and chat.”

Most staff told us staffing levels were sufficient to meet people’s needs. They felt they received appropriate training and felt well supported. However, a small number of staff did not feel there were sufficient staff to meet people’s needs. This was particularly in the area of the home where people were living with dementia. Members of the management team explained staffing levels were based on the dependency levels of people using the service. A dependency tool was used to support with this. Staffing was monitored by managers and people’s needs were reviewed to help make sure staffing levels were sufficient, and there would be safe staffing in the event of an emergency.

Staff worked well as a team to make sure tasks were completed, and they interacted with people in an appropriate way. On the day of our visit staff were visible and available in communal areas and people did not wait long for their support. Staff did not appear rushed. They engaged with people, asking how they were and whether they needed support.

The provider followed safe recruitment practices. This included requesting references from previous employers and checks with the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. There were processes in place to make sure staff received support they needed to deliver safe care, including supervision, appraisal and training that was relevant to the individual needs and risks of people using the service.

People told us staff washed their hands and wore aprons and gloves when appropriate. People said the laundry service was good and very little laundry went missing. Most people and relatives told us the home was clean. Typical responses included, “The place is clean and there are always cleaners about” and “They are 100% with the cleaning”. One relative said, “There have been lots of issues in the past with hygiene but it’s much better now.” However, another relative said there were still improvements to be made in keeping their loved one’s bedroom and bedclothes clean and fresh.

Staff knew how to protect people from the risk of infection. They had training in infection prevention and control (IPC), hand hygiene and the use of personal protective equipment (PPE) such as gloves and aprons.

Staff at all levels had clear roles and responsibilities around IPC. Staff had access to hand sanitiser, hand washing facilities and PPE. Overall, the people’s rooms we saw and the communal areas were clean and there were housekeeping staff undertaking cleaning tasks throughout the day of our visit. However, we did see some areas that required better organisation and cleaning and this had not been identified by the provider's audits. We have referred to this in the Well-led section of this report.

We saw some areas that required better organisation and cleaning during our visit, which had not been identified by the provider's checks and audits. We have referred to this in the Well-led section of this report. The provider had up to date infection prevention and control policies and procedures in place and the overall standard of cleanliness was not of concern.

We received positive feedback regarding medicines management from people and relatives. People told us they received their medicines at the correct times and pain relief when needed. One person said, “They [staff] tell me they have checked my medication, and I take a lot!’ A relative told us, “[My family member’s] medication is fine. They had a review recently.”

Staff told us they received training to manage medicines safely. Training records confirmed this. Staff told us there were systems in place to audit medicines, including daily checks and monthly audits.

On the whole, there were safe arrangements in place for managing people's medicines. Records showed medicines were safely received, stored, administered, and disposed of. Medicines were stored safely and were well organised. People who had been prescribed 'as required' medicine had guidance in place to show staff when this should be administered. The provider had improved governance and management systems to monitor and improve medicines management. This improvement needed further embedding into practice as we identified some areas for improvement in relation to people's topical creams, which were not identified by the provider's audits. We have referred to this in the Well-led section of this report.