Lathbury Manor Care Home

Lathbury Manor Care Home is a residential care home providing personal care for up to 29 people including people living with dementia. At the time of our inspection 26 people were using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there was one person using the service who had a learning disability and or who are autistic.

Systems and processes to ensure management oversight required embedding into practice. Improvement had been made to audits, however not all concerns had been identified prior to the inspection.

Improvements had been made to risk assessments to mitigate known risks to people. However, some environmental risks had not been identified or assessed. However, these were mitigated immediately after the inspection.

People received their medicines by trained staff. Medicine administration records recorded the reason why a person did not receive their medicine. However, one person had not received their medicine as prescribed.

Safeguarding procedures had been followed and people were protected from abuse. However, improvements were required to ensure records of injuries and potential causes of the injury were recorded.

We received mixed views on staffing levels. Relatives did not always feel there were enough staff on duty. However, staff told us they had enough staffing. During the inspection we observed that staff were not deployed sufficiently. For example, we observed people at risk of falls being left unattended in communal areas. However, the provider had assessed staffing levels by using a dependency tool.

People were supported by staff who knew them well. Relatives and people were involved in care planning. Staff shared information with relatives regarding incidents, concerns, or changes to the person’s needs.

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 felt supported in their role and enjoyed working at Lathbury Manor. Staff were positive about the management and felt valued and listened to.

The management team were committed to improving the service. They responded well to the feedback given and were open and transparent throughout the inspection.

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 06 January 2023) and there were breaches of regulation. 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. However, the provider remained in breach of regulation 17.

Why we inspected

The inspection was prompted in part by historical lack of notifications of incidents following which people using the service sustained injuries. These are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of these incidents. However, the information shared with CQC about these incidents indicated potential concerns about the management of risk. This inspection examined those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 not changed from requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lathbury Manor on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to management oversight 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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

The provider had re-established monthly meeting and audits. However, they lacked sufficient evidence to demonstrate detailed analysis of incidents had taken place, to improve the quality and safety of people using the service.

Risk assessments and care plans had insufficient information on how to safely manage people’s expressions of distress that had placed people at risk of harm.

All staff received induction and ongoing training that included supporting people expressing distress/agitation.

We have made a recommendation about training on the use of physical intervention.

People received an appealing and nutritious diet. However, the way in which staff supported people at mealtimes, required enhancing to make the mealtime experience more pleasant for people.

Staff received training on the safe administration of medicines. Systems were followed for ordering, receiving, storing and the administration of medicines.

There were sufficient staff available to meet people's needs. The provider followed safe recruitment practices.

A maintenance and refurbishment programme was in place and some refurbishments had taken place since our last inspection. Further refurbishment work was planned.

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.

Timely action was taken to ensure people received support from healthcare professionals.

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 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 30 November 2021) and there were breaches of regulation. 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 the provider remained in breach of regulations.

This service has been rated requires improvement for the last two consecutive inspections.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lathbury Manor Care Home on our website at www.cqc.org.uk.

Why we inspected

The purpose of this inspection was to check if the provider had met the requirements of the warning notice we previously served, to check they followed their action plan and to confirm they have met legal requirements. This report covers our findings in relation to the key questions Safe and Well-Led which contain those requirements.

When we inspected more information was required on how the provider followed the principles of the Mental Capacity Act, so we widened the scope of the inspection to include the key question Effective.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

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.

Lathbury Manor is a residential care home providing personal and nursing care to 27 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

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

Quality assurance checks and audits of key areas of the service had lapsed. The main monthly audit completed by the manager did not identify required actions and improvements. The provider could not assure themselves that systems to assess, monitor and improve the quality and safety of the service were undertaken and implemented effectively.

The provider could not assure themselves of the quality and safety of care provision to people living in the service. Records of management oversight of people's care records were inconsistent. This included recording of accident, incident, falls and safeguarding follow up as well as oversight of people's individual care records.

People had a range of care plans and risk assessments in place. Processes to ensure these were reviewed regularly were in place but required strengthening.

Recent high turnover of staff meant a high reliance on agency staff at the time of inspection. This meant people did not always receive care from people who knew them well. However, there were enough staff on shift to ensure people's care needs could be met.

Some areas of poor practice were found with infection prevention and control measures and these were rectified immediately by the provider.

Safe recruitment processes took place and gaps found in staff files were addressed during the inspection. An electronic medicines system was used effectively. People received their medicines safely.

The provider was fully supportive of the inspection process and acknowledged the concerns found. The provider took swift action during and following the inspection to immediately rectify issues they identified, and we brought to their attention. Since the inspection the provider has re-established quality assurance processes which had lapsed, and are committed to ensuring these are embedded and sustained.

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 19 February 2021).

Why we inspected

We received concerns in relation to aspects of people’s care, the approach of the manager and high staff turnover. As a result, we undertook a focused inspection to review the key questions of safe 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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. 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 Lathbury Manor 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 how the service was run and people not always receiving safe care and treatment.

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.

Lathbury Manor Care Home is a residential ‘care home’ for individuals 65 and over, those with dementia and other physical and mental health conditions, including learning disabilities.

The building is adapted over 3 floors and can accommodate and care for up to 29 people who require accommodation and support with personal care. Twenty people were living at the service at the time of our visit.

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

The vision, values and culture of the service continued to be based on a person-centred approach, which placed people at the heart of care delivery.

People and relatives told us the service was safe, and there were suitable numbers of staff, who were recruited safely and in line with current legislation. Staff had been trained to meet people's needs and consent to care was sought and recorded.

Staff knew how to recognise and respond to concerns of ill-treatment and abuse. Risk assessments were thorough and covered the risk present in people's lives.

Medicines were stored and administered safely, and staff were trained to support people effectively. Staff were supervised well and felt confident in their roles.

The service was clean, and staff understood infection control procedures and followed them. Staff wore appropriate personal protective equipment.

Lathbury Manor Care Home continued to be well-led by a management team that people and staff found approachable and supportive and who they saw on a regular basis. Staff felt well supported by the management team and were motivated to provide good quality care to people.

The provider had systems in place to monitor the quality of the care they provided and where necessary made changes to drive improvements. Audits of the service were detailed, and any issues found were addressed promptly.

Staff referred to external professionals as required and followed advice to ensure people's needs were 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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

The management team and care staff promoted a positive culture in the service. People had experienced change to their usual routines during the pandemic period and people could not pursue some of the activities they usually enjoyed. Staff were proactive in supporting people with alternative activities. Relatives were supported to stay up to date with how their loved ones were getting on, and visits were facilitated as and when this was possible. This helped promote people's choices and independence even during the pandemic period when normal routines were disrupted.

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 10 May 2018).

Why we inspected

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 received concerns in relation to the management of staff. As a result, we undertook a focused inspection to review the key questions of safe 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.

The overall rating for the service has remained the same, good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lathbury Manor Care Home on our website at www.cqc.org.uk.

At our last inspection in April 2017, this service was rated overall as requires improvement. At this inspection, improvements had been made and sustained and the service is rated overall good. The inspection took place on the 23 April 2018 and was unannounced.

There was a registered manager in post. 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 received care from staff that knew them and were kind, compassionate and respectful. The staff were friendly, caring and passionate about the care they delivered. People had formed positive therapeutic relationships with staff and felt they were treated as individuals.

Detailed care plans were in place, which enabled staff to provide consistent care and support in line with people’s personal preferences and choices. End of life wishes were discussed and plans put in place.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

Staff were appropriately recruited and there were sufficient staff to meet people’s needs; staffing levels were kept under review. People were protected from the risk of harm and received their prescribed medicines safely. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

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 home supported this practice. There was a variety of activities available for people to participate in if they wished to and family and friends were welcomed to take part in events at the home.

Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day-to-day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

Staff had access to the support, supervision and training that they required to work effectively in their roles. Development of staff knowledge and skills was encouraged.

The service had a positive ethos and an open culture. The provider was committed to develop the service and actively looked at ways to continuously improve the service. There were effective quality assurance systems and audits in place; action was taken to address any shortfalls.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.

This was the second comprehensive inspection carried out at Lathbury Manor Care Home.

Lathbury Manor Care Home provides care and support for up to 23 older people with a wide range of needs for personal care and support. This includes people who may be living with dementia. There were 22 people using the service when we visited.

The service had a registered manager. However they were on sick leave on the day 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.

Recruitment practices were not robust and had not been consistently followed to ensure staff employed were suitable for their role. We observed that essential employment checks for some staff had not been obtained.

Records management was disorganised and records were not always fully completed. Some relatives felt that communication at the service did not keep them fully informed.

Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were risk management plans in place to protect and promote people’s safety. There were adequate numbers of staff available to meet people's fundamental care needs. People’s medicines were managed safely by staff that were trained to do so.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs. They felt they were well supported by the management team and had regular one to one supervision and annual appraisals. Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation. People were supported by staff to eat and drink enough to meet their dietary needs and to promote healthy eating. Staff supported people to access healthcare services.

People were treated with kindness and compassion by staff; and had established positive and caring relationships with them. People were able to express their views about their day to day routines. Staff ensured people’s privacy and dignity was promoted.

People’s needs were assessed prior to them receiving a service. Some people’s care plans did not contain information about their likes, dislikes and preferences. We were informed that this was being added as each person’s care was reviewed and 50% had been completed the time of our inspection. The service had a complaints procedure to enable people to raise a complaint if the need arose. Quality assurance systems in place to monitor the quality of the care provided.

During this inspection we identified areas where the provider was not meeting expectations and where they had breached a Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our visit we observed that staff spoke to people politely and asked for their consent before providing care and assistance. For example, we observed people being offered their medicines; the staff asked whether they needed any prescribed medicines for pain relief.

We looked at the care records for two people using the service. We found the care plans detailed the specific elements of people's care and treatment needs and staff had amended the care plans as and when changes were required.

We found that the provider operated effective recruitment procedures in order to ensure that staff employed at the service were of good character, had the qualifications, skills and experience necessary to their roles and responsibilities.

We found that the provider carried out annual quality assurance surveys to give people using the service, their relatives and other people involved in their care the opportunity to provide feedback about the service provision.