About the service Ledbury Nursing Home is a residential care home providing personal and nursing care to 31 people at the time of the inspection. The service can support up to 36 people.
Peoples experience of using this service and what we found
The service was not always well- led. The provider’s governance systems were not consistently effective to identify shortfalls, maintain continuous improvement and ensure compliance with regulations.
The provider was not able to evidence people were supported to have maximum choice and control of their lives in relation to their consent to receive a test for COVID-19.
Medicines were not always managed safely with people not always receiving their medicines as prescribed. There was evidence to demonstrate people’s medicines were not administered and stored safely.
Care plans were not always up to date and did not therefore always contain accurate information about people’s care and support needs. Records to evidence the care and support provided were not always in place or maintained to evidence how staff had support people to have their individual needs met. Terminology used within care records was not always in line with person centred care.
Staffing levels were assigned using a tool based upon people’s support needs. Staffing vacancies were met using agency staff. People enjoyed the food provided however some people’s dietary needs were not always met in a timely way.
People felt safe living at the home and staff were aware of their responsibility to keep people safe.
Staff were seen undertaking additional cleaning and using personal protective equipment to reduce the risk of cross infection. Staff received training to support their roles and provide them with skills and knowledge. Gaps in training were known to management for them to action and resolve.
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 good (published 07 February 2020).
Why we inspected
We received concerns in relation to staffing levels, the deployment of agency staff and training. We had also received concerns about the management of medicines.
As a result, we undertook a focused inspection to review the key questions of safe, effective 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.
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.
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.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led relevant key question sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ledbury Nursing Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to keeping people safe in relation to their medicines, risks and care planning as well as the governances of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.