Archived: Littlebourne House Residential Care Home

Littlebourne House Residential Home provides personal care and accommodation for up to 64 adults. Accommodation is flexible with a detached house with a new extension for 42 people, a separate detached house, the King William for 18 people and four one bedroom self-contained flats. At the time of the inspection 64 were living at the service.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

We last inspected this service in August 2016. We found shortfalls in the service. The provider did not have sufficient guidance for staff to follow to show how risks were mitigated to keep people living with diabetes, epilepsy and behaviours that challenge as safe as possible. Staff were not recruited safely. The service had not been working within the principles of the Mental Capacity Act 2005. There was a lack of oversight of the service, there were no quality assurance systems in place to monitor and drive improvements within the service. Staff had not received training appropriate for their role, staff were not deployed effectively to meet people’s needs.

We asked the provider to provide an action plan to explain how they are going to make improvements to the service. At this inspection we found that improvements had been made.

At the last inspection, there were no detailed guidelines for staff to mitigate risks to people and keep them safe. Improvements had been made. There were risk assessments in place to identify potential risks to people’s health and safety. The risk assessments gave staff detailed guidance to mitigate risks to individuals living with diabetes, epilepsy and behaviours that may challenge. Accidents and incidents were analysed for trends and action had been taken to prevent them from happening again.

Improvements had been made in the recruitment of staff and their development. Staff were recruited safely and received training to perform their roles. Staff received supervisions and appraisals to discuss their development. There were sufficient numbers of staff. The provider had reviewed the deployment of staff, as recommended at the last inspection, to meet people’s needs.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

At the last inspection, staff had not received training about MCA and were not working within the principles of the Act and DoLS applications had not been made when appropriate. Improvements had been made at this inspection. Staff had received training and were aware of their responsibilities under MCA. Appropriate DoLS applications had been made and some had been authorised.

At the previous inspection, there were no effective systems in place to assess and monitor the quality of the service provided. There were no formal checks to ensure that all records were up to date. Care plans and assessments had not been consistently reviewed. Improvements had been made, care plans and assessments were reviewed monthly and before if needed. There was now a system in place to check the quality of the service, shortfalls had been identified and action plans had been put in place to rectify the shortfall.

People told us that they felt safe living at Littlebourne House. Staff knew how to keep people safe from abuse. Staff were confident that if they had any concerns they would be addressed quickly by the registered manager. People received their medicines safely and on time.

People enjoyed a choice of healthy meals and told us they had enough to eat and drink. Relatives were able to eat with their loved ones. People’s health was assessed and monitored. Staff took prompt action when they noticed any changes or a decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

People said they were happy living at the service and that their privacy and dignity were respected. Staff spoke with and engaged with people in a kind, caring and compassionate way. People, when able, were involved in the planning of their care and support and told us that care was provided in the way they chose. People’s confidentiality was respected and their records were stored securely.

Each person had a care plan that contained details of their choices and preferences, and how they wanted their support to be provided. People’s religious and cultural needs were recorded and respected.

Staff supported people to maintain friendships and relationships. People’s friends and family could visit when they wanted and there were no restrictions on the time of day. People were encouraged to be as independent as possible.

There was a range of activities and outings available to people, staff including the activities co-ordinator spent time with people on a one to one basis.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy. Resident and staff meetings were held so that suggestions about improvements could be made. The management team had implemented suggestions made at the meetings. Quality assurance surveys had been sent to people, staff and stakeholders such as GP’s and the results were being analysed.

People spoke positively about how the service was run. The management team were visible and people were comfortable with them. People and staff told us the management team were very approachable and supportive. The management team and staff understood their roles and responsibilities and shared a vision for the service.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Littlebourne House Residential Home provides personal care to up to 64 adults. Accommodation is flexible with a detached house with a new extension for 42 people, a separate detached house – King William for 18 and four self-contained one bedroom flats. At the time of our visit, there were 63 people who lived in the home. People had a variety of complex needs including onset of dementia, physical health needs and mobility difficulties.

There was a registered manager at the home. 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 home had risk assessments in place to identify risks that may be involved when meeting people’s needs. However, the risk assessments did not show ways that these risks could be reduced. Risk assessments were not individualised to meet people’s needs safely.

There were sufficient numbers of staff. However, staff had not been adequately deployed to meet people’s needs. We have made a recommendation about this.

The provider had not operated safe recruitment procedures. While some files had at least two references, others do not have. There were no job descriptions and staff interview records on file.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. However, not all staff had received training in the Mental Capacity Act 2005. Staff had limited awareness of Deprivation of Liberty Safeguards. Hence, appropriate DoLS applications had not been made when we visited.

Training records showed that not all staff had completed training in a range of areas that reflected their job role, such as essential training they needed to ensure they understood how to provide effective care, and support for people. There were gaps in the training schedule which showed that not all staff had completed safeguarding, Deprivation of Liberty Safeguards (DOLS), Mental Capacity Act (MCA) amongst others.

Staff had not received regular individual one to one supervision meetings and appraisals as specified in the provider’s policy.

People’s care plans contained information about their personal preferences. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs. However, care plans were disjointed with information either not recorded in care plan but recorded in another document. We have made a recommendation about this.

Staff encouraged people to undertake activities. However, there was no activities coordinator who could motivate people. Also, some people were observed watching television throughout our visit with little or no engagement from staff. We have made a recommendation about this

Effective systems were not in place to assess and monitor the quality of the home. There were no formal checks in place to ensure that all records were up to date. Care plans and assessments had not been consistently reviewed.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager. Relatives felt their people were safe in the home.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Staff knew each person well and had a good knowledge of the needs of people who lived at the home.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The chef prepared meals to meet people’s specialist dietary needs.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

During this inspection, we found breaches of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. People were treated with respect and dignity by the staff. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We looked at five people's individual plans of care and saw that they had individual risk assessments in place to identify potential risks and to show how these could be avoided or minimised. We saw that the assessments were reviewed regularly, and provided clear directions for staff to follow. This meant that there were ongoing procedures in place to maintain people's safety.

We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.

Staff training records showed that all of the staff had completed mandatory training, which included subjects such as fire awareness, moving and handling, infection control and food safety. They had also completed training in relevant subjects such as managing challenging behaviour and autism awareness. This meant that people were supported by staff with sufficient training to enable them to provide safe and effective care.

Equipment at the home had been maintained and serviced regularly. We found that people that used the service were protected from infection because the provider maintained appropriate standards of cleanliness and hygiene.

We found that records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that where appropriate people had signed and confirmed that they had been involved in writing them and they reflected their current needs.

We found that the staff referred people appropriately to their GP and other health and social care professionals. This meant that people had the care and treatment that they needed.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as 'The staff are good, it is homely, the food is excellent, I have nothing to complain about'.

Is the service responsive?

The service was responsive. We found that the staff listened to people, and took appropriate action to deal with any concerns.

Care plans showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people. This meant that their health needs were being met.

Is the service well-led?

The service was well-led. Littlebourne House is a long standing family run business with the providers and family members being available in the home on a day to day basis. We were told that the manager of the home, who had been in post for many years, had recently retired. A new manager had been appointed and had just started work at the home.

There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

We found that when required people were referred to health care professionals to ensure they received the best support and treatment for their individual needs. When people were unable to make decisions for themselves, support and treatment was given in the person's best interests.

People told us that they felt safe and well looked after. They said that the staff were kind and caring. People said 'Oh, they (the staff) are very kind' and 'I really enjoy it here. They are all very good' and 'We are waited on hand and foot. They (the staff) want to help you all they can.'

People said they could talk about any problems to the manager and to the staff. People said that they would be listened to and any problem would be sorted out. Everyone we spoke with said they had no complaints about the service.

People told us that the food was very good and said 'The food is very good, very varied. We have lovely puddings with cream or custard. We have a roast at the weekend and fresh salmon.'

People's health needs were supported and the service worked closely with health professionals to maintain and improve people's health and well being. People said they enjoyed the outings and activities on offer. One person said 'We have a lovely summerhouse, I go out every day.' Another person said 'We go to Margate and Deal on outings and to garden centres. I love the quizzes.'