Lulworth House Dementia Residential Care Home

Lulworth House is a residential care home providing personal care for to up to 42 older people living with dementia. Thirty seven people were living at the service at the time of inspection. There were a variety of communal areas for people such as a conservatory, dining room and two lounges which included an additional dining space. The garden was easily accessible. The lift gave access to the upper floors.

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

The service was not consistently well-led. Whilst systems were in place to monitor the quality and safety of the service, they had not been effective in identifying inconsistencies in people’s risk assessments and safe recruitment. Staff were able to feedback their views and felt supported in their roles. The manager acted openly and responsively during the inspection ensuring they took immediate action to remedy any areas of improvement we identified.

Environmental risks were well managed to keep people safe and individual risks to people were identified and actioned appropriately. People were supported by staff who understood the appropriate action to take should they be concerned about their safety. People’s medicines were well managed by trained staff.

People received effective care. The requirements of the Mental Capacity Act 2005 were being 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. People were supported to receive appropriate healthcare in line with their specific needs. Staff had training around people’s needs. People were supported to eat and drink meals of their choosing and were positive about meals provided.

People received support that was caring, compassionate and kind. We received positive feedback about the care staff. People were encouraged to be involved in all aspects of their care in regular meetings. People had their dignity and privacy respected.

People received care that was responsive to their needs. People had a wide range of activities available to them that met their individual interests. Activities were regularly reviewed making them person centred and focused on the well-being of people. People had received end of life care that was individual to them. All staff including activity staff were actively involved in making people’s end of life meaningful.

Rating at last inspection

The last rating for this service was good (published 21 July 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Lulworth House Dementia Residential Care Home provides personal care and accommodation for up to 42 adults. There are two lounges and a dining room. Lifts access the upper floors. Four bedrooms have en suite facilities. There are gardens with a patio area. The house is located in a quiet residential area of Maidstone. Local shops are nearby with the town centre approximately one mile away.

At the last Care Quality Commission (CQC) inspection on 18 and 19 March 2015, the service was rated Good in all domains and overall.

At this inspection we found the service remained Good overall with an outstanding rating in responsive.

The service had a registered manager. 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.

The feedback we received from people and their relatives was excellent. People that used the service expressed great satisfaction and spoke very highly of the registered manager, deputy manager and the staff. Staff were motivated and committed to ensuring people lived a happy and fulfilled life the way they wanted to. There was an open culture where the management team led by example to ensure people received a high quality person centred service.

People received a consistently high standard of care because staff were led by an experienced and proactive registered manager. The registered manager and staff team were highly motivated, passionate, and committed to ensuring each person had a good quality of life. People were treated as individuals and received a person-centred service, where their wants and needs were placed at the centre of everything staff did. The registered manager and management team were committed to providing a high quality service to people and its continuous development. People were involved in the running of the service and were continually asked for their views, ideas and suggestions.

People received care and support in a personalised way. Staff knew people well, understood their needs and supported people to achieve a sense of self-worth and well-being. People’s independence was actively encouraged. The registered manager and staff were committed to making a positive difference to people’s lives. Activities for people were innovative, activities and events were well thought through and varied. These were specific to people’s likes and interests.

There were systems in place to monitor the safety and drive the continuous improvement of the quality of the service provided. A comprehensive programme of audits and checks were in place to monitor all aspects of the service, including care delivery, accidents and incidents, health and safety, infection prevention and control and medicines. Feedback was continually sought and acted upon to improve the service people received.

The safety of people using the service continued to be taken seriously by the management team and staff members who understood their responsibility to protect people’s health and well-being. Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse.

Risks to people’s safety had been assessed and measures put into place to manage any hazards identified. Staff followed appropriate guidance to minimise identified risks to people’s health, safety and welfare. The premises were maintained and checked to help ensure people’s safety. Medicines were managed safely and people received them as prescribed.

People’s needs had been assessed to identify the care and support they required. Care and support was planned proactively with people and their relatives and regularly reviewed to ensure people continued to have the support they needed. People were treated with dignity and respect by staff who also maintained people’s privacy.

Staff had a full understanding of people’s care and support needs and had the skills and knowledge to meet them. People received consistent support from the same members of staff who knew them well. People were fully involved in the care and support they received and, decisions relating to their lives. Staffing levels were kept under constant review to ensure that the right staff were available to meet people’s assessed needs. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

People had access to the food that they enjoyed and were able to access drinks and snacks throughout the day. People’s nutrition and hydration needs had been assessed and recorded. Staff met people’s specific dietary needs and received specialist training where required.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely. Systems were in place to ensure medicines were ordered, obtained, stored and returned as required.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The management team and staff understood their responsibilities under the Mental Capacity Act 2005.

Further information is in the detailed findings below.

At this visit two inspectors visited the home. We spoke with the management team, staff, people who lived in the home and visitors. Most of the people who lived in the home were experiencing dementia and were unable to engage directly in the inspection process. We spent time observing how people were supported throughout the day. People told us that they had seen improvements in the service. Staff told us about the improvements in the home and had confidence in the new manager. We spoke with relatives who told us they had seen, 'Significant improvements' and that they, 'Had confidence in the care provided'.

We spoke with the Local Authority who confirmed that they had seen improvements in the service.

There were effective quality assurance systems in place to continually monitor the quality of the service people received.

Records were up to date and accurate, providing information for staff to enable them to provide appropriate care and support for people who lived in the home.

Overall we found that the service had achieved compliance with the standards we inspected. We have made some comments that the provider may find it useful to note to make sure that the home continues to provide a good service.

Care plans reflected the current needs of the people who lived in the home.

Staff were busy but because of the reduced numbers of people who lived in the home had more time to interact with people and make sure they had the support they needed.

Staff had an improved understanding of how to manage and support people who exhibited challenging behaviours.

Since our last visit the registered provider had employed a management company on a short term basis to review their practices. The manager, who was employed at the time of our last visit, had left and a new manager had been employed. At the time of our inspection the provider did not have a registered manager in post.

The lack of consistent and robust management of the home since our last visit had impacted on the on-going monitoring of the home. There had been a lack of robust systems to assess and monitor the quality of the service provided. This meant that although people's daily care needs were being met and people were safeguarded against the risk of harm, people were not benefitting from a service that provided effective and safe management of the quality of the care.

The activities coordinator was proactive and kept people engaged. Where people were not involved in activities they tended to be left to sit in chairs with little stimulation or conversation as care staff were busy and unable to make time to check on their welfare. Generally care staff were kind and respectful to people.

People's changing needs were not identified in the care plans so the assessment, planning and delivery of care were not coordinated. This meant that the service did not promote safe effective care, treatment and support.

People were not safeguarded from possible abuse because staff did not recognise where people's behaviours impacted on their own and other people's health, safety and welfare.

People were at risk where skin conditions were neglected as creams were not applied in line with the prescriber's instructions and when peoples cream ran it was not replaced.

The quality assurance processes in the home failed to manage risks relating to the health, welfare and safety of people who used the service.

Inadequate record keeping meant that people were not adequately protected against the risks of unsafe or inappropriate care and treatment.

We highlighted some areas in the report which the provider may find it useful to note to make sure compliance is sustained.

People who lived at the home were experiencing dementia and were not always able to tell us about their experiences. We used a number of different methods to help us understand the experiences of people using the service. We observed how people interacted with staff and the management of the service. We saw the atmosphere in the home was calm and relaxed.

People we spoke with told us that staff were 'very kind'. People told us they liked their meals at lunchtime.