Lorna House

Updated 21 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was conducted by one inspector.

Service and service type

Lorna House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Lorna House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed the monthly reports the provider submitted in line with the conditions imposed upon their registration. We used all this information to plan our inspection.

During the inspection

We reviewed a range of records including four people’s care records, records relating to fire and safety checks, five staff recruitment files, training and supervision records and quality monitoring tools. We reviewed a selection of the providers policies and reviewed medicine administration charts. We spoke with five people and observed people in the communal areas including at lunchtime. We received feedback from seven relatives. We spoke with ten members of staff, including the registered manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We contacted seven health professionals for feedback and received feedback from four.

Updated 21 January 2023

About the service

Lorna House is a residential care home providing personal care to up to 24 people. At the time of our inspection there were 13 people using the service. Accommodation is over two floors of a large period property with bedrooms on the first floor serviced by a stair lift. Most bedrooms have ensuite facilities. There is a large communal lounge, a dining room, conservatory and pleasant, well-maintained gardens.

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

Following our last inspection, we imposed conditions on the provider’s registration which required them to complete a selection of audits and report their findings to CQC. The provider did not complete all of these audits within the required timescale. This meant it was a considerable length of time before the provider began to address some of the failings identified at our last inspection. For example, staff working without safe recruitment checks and people living with restrictions without the appropriate legal authority. The provider’s policies had not been reviewed and the audits they had completed did not always identify all areas for improvement. Some people’s relatives were unhappy about the lack of communication from the provider following the findings of the last inspection and did not feel they were open and honest about what had gone wrong, and what action they planned to take to address this.

People's risks were now being assessed and were well managed. People had appropriate equipment and accidents and incidents were regularly reviewed. People received their medicines safely and systems were in place to ensure people were protected from abuse. People, and their relatives, told us they felt safe. One person’s relative told us, “I am very confident [relative] is receiving safe care at Lorna House.” All restrictions relating to visiting had been lifted. One person’s relative said, “Visiting is much better, things have improved a lot.”

Not all staff had completed mandatory training or received a supervision, although the registered manager had begun to address this. Training was booked in and staff who had not completed training had been allocated courses to complete online.

People’s needs had been assessed and everybody living at Lorna House now had a care plan in place. Care plans reflected people’s individual needs and personal preferences and work was ongoing to expand the detail within people’s care plans. People and their relatives had been involved in creating the care plans and staff involved other health professionals where appropriate. People were supported to eat and drink a balanced diet and improvements had been made to the environment which was clean, tidy and odour free. Restrictions and routines that had previously been in place had been removed and staff told us people had more freedom. One staff member said, “The daily routines have changed. There’s no times to get up anymore.”

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.

We saw people being treated with dignity and respect and improvements had been made in the way staff communicated. People and their relatives gave positive feedback and felt the staff were kind and caring. A relative told us, “I find everyone kind and compassionate.” Another relative said, “I cannot speak highly enough of this care home where the various members of staff are all caring, helpful and friendly.” Staff had more time to spend with people and regular activities were taking place.

The registered manager had sourced and implemented a range of audit tools, and quality monitoring of the service had improved. Relatives acknowledged the registered manager, who took up their role during our last inspection, had worked hard to implement improvements and communication was improving. Staff gave positive feedback regarding the management of the service. One staff member said, “[Registered manager] has worked really hard to try and get things back on track.” The culture of the service was now person centred and staff, relatives and health professionals all commented on the improved atmosphere and standard of care. Staff worked in partnership with other health professionals who gave positive feedback about the registered manager and staff team.

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 inadequate (published 6 June 2022). The provider sent us monthly reports in line with conditions imposed on their registration.

At this inspection we found improvements had been made, however the provider remained in breach of some regulations.

At our last inspection we recommended that the provider ensure staff complete appropriate induction, supervision and training to ensure they have the knowledge and skills to meet people's individual health needs. At this inspection we found that not enough progress had been made.

At our last inspection we also recommended that the provider put systems in place to ensure the Accessible Information Standard is met and that the provider put systems in place to ensure complaints and concerns were recorded and responded to. At this inspection we found improvements had been made in relation to these recommendations.

This service has been in Special Measures since 6 June 2022. During this inspection the provider demonstrated improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led 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 Lorna House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to fit and proper persons employed, staffing and good governance at this inspection. Following our last inspection, we imposed conditions on the providers registration. These remain in place.

Please see the action we have told the provider to take at the end of this report.

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.