Lound Hall

Lound Hall is a residential care home providing accommodation for persons who require nursing or personal care to up to 30 people. At the time of the inspection the home was not providing nursing care. The service provides support to people older adults, some of whom were living with dementia. At the time of our inspection there were 18 people using the service. Lound Hall is an adapted building accommodating people over three floors.

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

People were kept safe by staff who were trained to meet their needs. Staffing had improved and people were happy with the care they received from staff. Risks associated with people’s individual health needs were assessed and measures were in place to reduce the risk.

The home was managed well and there were ongoing refurbishments works to improve the environment.

People were supported with their medicines well.

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.

The home had a new registered manager who had made significant improvements and understood their duties. Staff and people had confidence in the registered manager.

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 14 July 2022). The provider completed an action plan after the last inspection 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

We carried out an unannounced comprehensive inspection of this service on 25 May 2022. 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 good governance.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Lound Hall on our website at www.cqc.org.uk.

Follow up

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

Lound Hall is a residential care home providing accommodation for persons who require nursing or personal care to up to 30 people. At the time of the inspection the home was not providing nursing care. The service provides support to people older adults, some of whom were living with dementia. At the time of our inspection there were 22 people using the service. Lound Hall is an adapted building accommodating people over three floors.

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

There were not always enough staff. Staff, people and relatives all felt, and our observations confirmed, there could be more staff on each shift to be able to support people in a more personalised way. Risks associated with the environment were not always being identified and mitigated. People who had been admitted into the service most recently did not always have risks associated with their health and wellbeing assessed.

We made a recommendation around risk management.

The home did not have a manager in post at the time of inspection. This resulted in some managerial duties not being completed and a general lack of day to day oversight in the service.

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 supported people to take their medicines in a safe way. The home was kept clean and measures where in place to prevent the spread of infection. Staff understood how to protect people from the risk of abuse.

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 3 May 2019).

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. 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 Lound Hall on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to the management and oversight of the service as well as staffing. Please see the action we have told the provider to take at the end of this report.

We have published a recommendation in relation to risk management at the service.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lound Hall is situated in Retford, Nottinghamshire and is operated by MPS Care Limited. The service accommodates up to 30 people. At the time of our inspection there were 23 people living at the home. Lound Hall is staffed by registered nurses and care staff and primarily supports older people, some of whom are living with dementia.

At our last inspection in July 2017 the service was rated Requires Improvement. One breach of the legal requirements was found, this was in relation to safe care and treatment. At this inspection we found the quality and safety of the service had improved. Consequently, the service was compliant with the legal regulations.

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

Further work was needed to ensure people were protected from staff that may not be fit and safe to support them. People told us they felt safe at Lound Hall and there were systems and processes in place to minimise the risk of abuse. Staff had a good knowledge of safeguarding adults and in the majority of cases referrals had been made to external agencies when required. Since our last inspection improvements had been made to risk management. Risks, such as falls and pressure ulcers, were effectively assessed and managed to ensure people’s safety. Staff had a good knowledge of measures in place to ensure people’s safety and equipment was used safely. Risks associated with the environment were identified and managed. Accidents and incidents were reviewed and analysed to try to prevent future incidents. Medicines were stored and managed safely and people received their medicines as prescribed. There were enough staff to provide care and support to people when they needed it. Overall, the home was clean and hygienic. However, some areas of the home required refurbishment or replacement to enable effective cleaning and promote the control and prevention of infection.

People were supported by staff who received training, supervision and support. Staff were knowledgeable and were provided with opportunities to further develop their skills. 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 had enough to and drink, and overall, mealtimes were positive sociable experiences and people were offered choices. Where people had risks associated with eating and drinking these were well managed. People had access to healthcare and their health needs were monitored and responded to. There were systems to share information between services to ensure care was person centred. The home was adapted to meet people’s needs and further improvements were underway to ensure the needs of people living with dementia were met by the environment.

People were positive about the caring approach of staff. Staff treated people with warmth and affection and responded quickly to meet their need. Staff treated people with respect and upheld their right to dignity. People’s right to privacy was promoted. People were enabled to have control over their lives and were supported to be as independent as possible. People had access to advocacy, if they required, to help them express their views. Staff understood what was important to people and they used this to provide a person-centred service to people.

People received the support they required from staff who had a good knowledge of their needs, wishes and preferences. Care plans were detailed, thorough and clearly reflected people’s needs. Routines were based upon people’s preferences and this had a positive impact upon their wellbeing. People were given the opportunity to discuss their end of life wishes and were given compassionate support at the end of their lives. People were offered a range of opportunities for activity. People’s diverse needs were recognised and accommodated. People were supported to raise issues and concerns and there were systems in place to respond to complaints.

The home was well led. People were positive about the service provided. The management team were warm, open and approachable and had a positive impact on the quality of the service. People living at the home could express their views in relation to how the service was run and this was used to inform improvement. Staff felt supported, had a good understanding of their roles. There were effective systems in place to monitor and improve the quality and safety of the home.

At the last inspection in March 2017 we found five breaches of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these breaches were in relation to person centred care, dignity and respect, safe care and treatment, meeting nutritional and hydration needs and governance of the service. We asked the provider to take action to make improvements to the quality and safety of the service and we received an action plan in April 2017 which stated that all actions would be complete by July 2017. During this inspection we found that improvements had been made but some improvements were still required, this resulted in us finding one ongoing breach of the Health and Social Care Act 2008 Regulations (2014). You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place at the time of our inspection. 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.

During this inspection we found that risks associated with people’s care and support were still not always effectively managed. There was a risk that people may not be adequately protected from the risk of choking, the provider took immediate action to address this. Other risks associated with people’s care and support were effectively assessed and managed.

People told us they felt safe and they were supported by staff who knew how to recognise and report concerns about their safety. People’s medicines were stored and managed safely and people received their medicines as prescribed. There were enough staff to provide care and support to people when they needed it and safe recruitment practices were followed.

People were supported by staff who had received adequate training to enable them to provide safe and effective support. Staff felt supported but they were not always provided with regular supervision. There were plans in place to make improvements in this area.

Improvements had been made to ensure people’s nutritional and hydration needs were met. People were offered a choice of freshly prepared food and drink and were provided with assistance when required. People’s day to day health care needs were met, although some improvements were required to records to ensure that people received support as their health needs changed.

Where people had capacity they were encouraged to make decisions about their care and support. Some further improvements were required to ensure that people’s rights under the Mental Capacity Act 2005 were respected at all times. Staff understood how people communicated and they were supported to maintain their independence. Staff understood the importance of treating people with kindness, dignity and respect and we observed this in practice. Staff also respected people’s right to privacy.

Improvements had been made to care plans but some further improvements were required to ensure that they contained adequate detail of the support people required. However staff had a good knowledge of people’s need and people told us they received the support they required.

People had the opportunity to get involved in social activities and told us that they had enough to do with their time. There were systems in place to gain feedback from people who used the service and to respond to and investigate complaints.

The provider had made progress in developing systems and processes to monitor the quality and consistency of the service. However these were still not always effective at identifying improvements needed. Staff felt supported in their roles and were confident to raise concerns or make suggestions about how to improve the service. The management team were responsive to feedback and swift action was taken to address some areas of concern raised during this inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We inspected this service in October 2016 and the service was rated as requires improvement. During this inspection we found that the required improvements had not been made and found concerns in relation to the quality and safety of the service. This resulted in us finding multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to person centred care, dignity and respect, safe care and treatment, meeting nutritional and hydration needs and good governance.

There was no registered manager in post at the time of our inspection, the previous registered manager deregistered in June 2016. 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. There was a service manager in place during our inspection who had taken over responsibility for the day to day running of the service in October 2016. They informed us that they would be submitting an application to register as manager for the service. We will monitor this.

During this inspection we found that the systems in place to reduce risks associated with people’s care and support were not always effective and this exposed people to the risk of harm. In addition to this people were not protected from risks associated with the environment.

Medicines were not managed safely and people did not always receive their medicines as prescribed. We found multiple concerns relating to how people were supported to eat and drink. People were not supported to maintain adequate hydration or nutrition and this placed people at risk of malnutrition and dehydration.

People did not always receive appropriate care and support as there were not enough staff employed and staff were not always deployed effectively. Staff did not always receive suitable training or support to enable them carry out their duties effectively and meet people’s individual needs. Staff were not provided with regular supervision and support.

People’s day to day health needs were met, however, there was a risk that people may not receive appropriate support with specific health conditions due to a lack of information in care plans.

People’s rights under the Mental Capacity Act (2005) were not always respected. Where people had capacity to make decisions they were not consistently asked for their consent before staff provided support or assistance.

People’s right to privacy was not respected and they were not treated with dignity. Some staff were kind and caring in their approach, however other staff were focused on tasks and had limited interaction with people who used the service.

People were not provided with the opportunity for meaningful activity and many people who used the service spent their time unoccupied. Staff did not always respond appropriately to people’s needs for support and reassurance.

People were at risk of receiving inconsistent and unsafe support as care plans did not provide an accurate or up to date description of people’s needs. Action was underway to improve care plans and people and their families were involved in this work.

People and their families knew how raise issues and concerns, however systems in place to monitor and respond to complaints were not used effectively.

There was a lack of effective governance which put people at risk of receiving poor care. There was an absence of quality monitoring systems which meant that areas of concern had not been identified. In addition to this timely action was not taken in response to known issues.

People who used the service were not offered opportunities to give their views on how the service was run. Despite this people felt able to share concerns with the management team.

The management team were responsive to our feedback and developed an action plan in response to the concerns identified during this inspection.

Given the issues identified above the overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Lound Hall provides accommodation, nursing and personal care for up to 30 people with or without dementia. On the day of our inspection 17 people were using the service. The service is provided across three floors; with a passenger lift connecting the floors.

The service did not have a registered manager, but a new manager had been appointed and was due to start shortly after our inspection. 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.

People could not be sure that they received their medicines as prescribed as medicines were not stored safely and there was insufficient guidance as to when a person may require an ‘as needed’ medicine’. There were not enough staff deployed to meet people’s needs. People who used the service and those supporting them knew who to report any concerns to if they felt that they or others had been the victim of abuse. Risks to people’s safety were assessed and plans were in place to minimise identified risks.

The principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), had not been fully applied which meant that people’s rights were not protected. Staff had received training relevant to their role but were not fully supported as supervision meetings took place infrequently. People spoke positively about the food, choosing what they ate, and being supported to maintain a healthy diet when needed, people received support from healthcare professionals, such as their GP, and staff followed the guidance provided by healthcare professionals.

People were not always able to be involved in the planning and reviewing of their care but were supported to make day to day decisions. People were supported by staff who were caring and treated them with kindness, respect and dignity. There were no restrictions on friends and relatives visiting their family members.

People and their relatives were involved with the initial planning of their care and support provided, but not in subsequent review or updating of the care plans. People were not able to access the activities and hobbies that interested them. A complaints procedure was in place, although not all complaints had been recorded and details of how a complaint had been resolved was not recorded for all complaints.

Auditing and quality monitoring processes were in place, but these were not regular or robust. People's views on how the service was run was not sought. However, there was a positive atmosphere within the home.

The service did not have 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 Regional Manager told us that a new manager had just been recruited for the service and would be starting soon.

We carried out an unannounced comprehensive inspection of this service on 1 July 2015. Four breaches of the legal requirements were found. This was because the provider had not always ensured there were sufficient numbers of staff available to meet people’s needs and these staff did not receive all of the training and support required. Where people lacked the capacity to provide consent their rights were not protected. Additionally, records and systems were not being used effectively to check on the quality of the service and ensure that people had received the care they needed.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. We undertook this focused inspection on the 30 March 2016 to check that they had followed their plan and to confirm that they had now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lound Hall Care Home on our website at www.cqc.org.uk

At the focused inspection on the 30 March we found the provider had followed all parts of their plan which they had told us they would completed. All parts of the legal requirements had therefore been met.

There were sufficient staff to keep people safe. Peoples care needs had been assessed and the staffing had been planned to enable these needs to be met. People were supported by staff who had received the training and supervision they needed to support people effectively.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The principles of the MCA were being applied appropriately when decisions were made for people living at Lound Hall. Although no applications to the relevant authorising body had been made, staff aware of their requirements to ensure that people’s freedom was not unnecessarily restricted.

Records of the care provided to people were being maintained and the systems that the provider had to check on the quality of the service were being used. Any deficiencies that were identified were being addressed.

We used a number of different methods to help us understand the experiences of people using the service, including talking with them and an examination of their care planning documentation.

During the visit we spoke with five people who used the service, one relative and four staff members, including the manager and the cook.

All the people we spoke with who were living at the service said they were very happy there.

One person said they had felt much better since moving to Lound Hall and were able to do much more for themselves. They said, 'The staff are wonderful. I only have to use my call bell and someone is here to help me. The food is very good. I haven't got a big appetite but what they give me, I thoroughly enjoy.'

Another person said, 'I think they listen to us and make it easy to say if you're not happy with anything. I have lived here for more that two years and am very happy. The food is better than some top class hotels I've stayed in.'

A relative we spoke with told us, 'They are absolutely wonderful. I can't say a bad word about anything here.' They added, 'My relative is always clean, smart and comfortable.'