Archived: Lockermarsh Residential Home

Lockermarsh is a residential care home providing personal care for up to 24 people. At the time of our inspection there were 18 people using the service. Some people were living with dementia.

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

Systems in place to monitor the service remained ineffective. The governance systems failed to identify and action concerns. People did not always benefit from a positive culture which promoted person centred care.

Since our last inspection the provider had made changes to the medication system to ensure staff felt more confident. However, we continued to find medicines were not always managed safely. For example, we found concerns in relation to safe storage and recording. Protocols in place for people prescribed medicines on an as and when required basis, lacked detail.

Risks associated with people’s care were not always written in line with people’s current needs. Staff knew people well and could explain how risks were managed and we found no evidence people were harmed.

Since our last inspection the registered manager had been working with the local authority to address infection control. We found some improvements in this area, however, seating in the main lounge required attention and some storage rooms were cluttered. The provider was aware and was in the process of addressing these concerns.

The provider had a system in place to safeguard people from abuse. Staff were safely recruited. We found staff were responding to people in a timely way. However, there was no catering team, and this was impacting on the whole staff team. The registered manager was actively recruiting for these positions.

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.

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 5 August 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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 26 June 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 safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. 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 remained 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 Lockermarsh on our website at www.cqc.org.uk.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to medication management and governance. 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.

Lockermarsh is a residential care home providing personal care for up to 24 people. At the time of our inspection there were 17 people using the service. Some people were living with dementia.

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

Risks were not always managed to ensure people’s needs were met. Although we found no evidence people were harmed, the documentation in place did not always detail how to meet people’s needs safely.

The registered manager had a system in place to monitor incidents and completed an analysis to identify trends and patterns. However, this did not always show what action had been taken to minimise future incidents. The provider’s systems did not always evidence that people received their medicines as prescribed.

Staff we spoke with told us they were recruited safely, and pre-employment checks were carried out prior to them commencing work at the service. From our observations and speaking with staff, we found there were enough staff available to assist people to meet their needs.

The home was not always clean, and staff did not always wear appropriate personal protective equipment (PPE). PPE was available at several points throughout the home.

Staff confirmed they received safeguarding training and knew what actions to take if they suspected abuse. As part of this inspection we raised a safeguarding concern to the local authority.

The provider had systems in place to monitor the quality of the service. This process had not always identified issues we found on inspection. Where issues had been noted as a result of internal audits taking place, actions to rectify them had not been completed in a timely way.

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 18 February 2021).

Why we inspected

We received concerns in relation to infection control, personal care and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 good 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 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 ‘Lockermarsh’ on our website at www.cqc.org.uk.

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.

Lockermarsh is a residential care home providing personal care to seven people at the time of the inspection. The service can support up to 24 people.

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

People were safeguarded from the risk of abuse. Staff confirmed they received training in this area and knew what actions to take if they suspected abuse.

Risks associated with people’s care had been identified and plans were in place to minimise risks occurring. The manager had a system in place to monitor incidents and completed an analysis to identify trends and patterns. The provider had systems in place to ensure people received their medicines as prescribed.

Staff were recruited safely, and pre-employment checks were carried out prior to them commencing work at the service. From our observations and speaking with staff we found there were enough staff available to assist people to meet their needs.

The home was clean and there were Personal Protective Equipment (PPE) stations situated at several points throughout the home. The provider had managed the current pandemic well and implemented effective procedures. We noted some minor issues on inspection but were assured these were previously known to the provider and were in the process of being resolved.

The provider had systems in place to monitor the quality of the service. This process helped identify issues and gave clear actions to rectify them in a timely way.

People we spoke with felt involved in the service and relatives felt they were communicated with well.

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 20 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about infection control and incident monitoring. A decision was made for us to inspect and examine those risks. 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 remained good.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lockermarsh is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate up to 24 people in a converted and extended property.

The service had a registered manager in post 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.

People who used the service told us they felt safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored.

There were good systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staffing levels were maintained to ensure that people's care and support needs continued to be met safely and there were safe recruitment processes in place.

People received their medicines as prescribed. Although, we found some documentation could be improved, this was addressed immediately by the registered manager.

The service was clean and maintained. The registered manager had a maintenance and renewal plan in place and the registered manager had identified areas that could be improved further.

A nutritious, varied and balanced diet was provided and people’s dietary needs and choices were met. Although we found documentation could be improved.

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 received appropriate healthcare support.

We observed people had good relationships with the staff. Without exception all people we spoke with told us the staff were kind, considerate and caring. Staff respected people’s privacy and dignity and promoted their independence. People were also supported in decisions regarding their end of life wishes.

There was a varied and appropriate activity programme; we saw people enjoying activities and activities were arranged so people could have access to the community.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

The service was promoting an open and inclusive culture to encourage communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

We saw that the operations manager and the registered manager had improved systems to maintain effective monitoring and auditing to ensure the quality and safety of the service was continued to be improved and that systems were embedded into practice.

We saw that people who used the service and their relatives were involved in the development of the home and could contribute ideas.

Further information is in the detailed findings below

Lockermarsh Residential Home is situated close to Thorne town centre, within easy reach of local amenities. The home provides accommodation and personal care for up to 24 people. It is a detached, listed building. Accommodation is on two floors and there is a passenger lift. The communal areas are located on the ground floor, including lounges and dining room. The gardens are easily accessible for people who use the service.

The service had a registered manager in post 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.

Risks associated with people’s care had been identified but instructions on how to minimise risks occurring were not always included in care records.

Staff were not always aware of infection control procedures within the home.

The provider had a safe and effective system in place for employing new staff. Staff confirmed that they had received an induction when they commenced employment.

Medicines were managed in a safe way. We found that medicines were stored correctly and that medication records had been completed accurately. On the day of our inspection we observed medicines being administered and we raised some concerns with the registered manager regarding this. The registered manager dealt with this immediately.

We observed staff interacting with people and we found that people’s needs were met in a timely manner. However, staff appeared task orientated at times.

Training was provided to staff to ensure they were kept up to date with their knowledge. Staff we spoke with felt supported by the registered manager and told us they received supervision n a regular basis. Supervision was one to one sessions with their line manager.

The service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager fully understood her responsibilities in meeting these requirements.

People were supported to eat and drink sufficient to maintain a healthy, balanced diet. During our inspection we observed snacks and drinks being served in addition to the meals provided.

People were supported to maintain good health and have access to healthcare services. We looked at care plans and found that people were referred to health services when their needs changed, but this was not always followed up.

Staff interacted well with people who used the service and respected their privacy. People’s choices and preferences were respected and people were treated with dignity. Staff engaged well with people’s family members and welcomed them when they visited the home.

We looked at care plans and found that they did not always reflect people’s current needs. Evaluations had been completed monthly but the care plans were not always updated to reflect any changes.

There was a lack of social stimulation in the home. There was no dedicated activity co-ordinator which meant that individual hobbies and interests were not taken into account and activities to meet people’s specific social needs did not take place.

The provider had a complaints procedure in place and we saw a record of concerns which captured issues that people had raised. We saw that the registered manager had taken appropriate actions to resolve concerns in a timely manner.

Audits were in place and had been developed by the registered manager. However, these needed further improvement and implementation to ensure they were effective as they had not highlighted the issues we found. The registered manager had asked some relatives for feedback about the service.

Lockermarsh Residential Home is a care home providing accommodation for older people who require personal care including people living with dementia. The home can accommodate up to 24 people over two floors which are accessed by a passenger lift. The service is situated in Thorne north of Doncaster.

The home had a registered manager. They had been in post since October 2015 and registered in March 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

During this inspection we looked to see if improvements had been made since our last inspection in November 2015. We found substantial improvements had been made across all aspects of the service and it was evident further improvements are in the process or are planned to be implemented.

We found that people had care and support plans in place and care records reflected the care they required. The plans had been reviewed and updated when people’s needs had changed. People’s risk assessments had also been reviewed to ensure their safety.

People were protected against the risk of abuse. Staff we spoke with were aware of procedures to follow and understood whistleblowing procedures.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. People we spoke with told us they enjoyed the food. However the meal time experience could be further improved to fully meet the needs of people living with dementia. The registered manager had identified this through the home’s monitoring systems and areas for improvement were planned in this area.

People were kept safe at the home. We found that staff had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.

Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, we identified some errors that meant these were not always followed.

There were robust recruitment procedures in place; staff had received formal supervision and an annual appraisal. Staff received training to be able to fulfil their roles and responsibilities.

Staff told us they felt supported and valued by the registered manager. They said they felt confident that they could raise any concerns with them and felt that they were listened to. Relatives told us they were happy to raise any concerns directly with the registered manager and told us they could see the improvements they had made since they had been in post.

There were systems in place to monitor the quality of the service provided. We saw these were completed and were effective. Improvements to the service continue to be identified and planned; these will need to be closely monitored by the Registered Manager and provider so that these become fully embedded into practice and ensure they are sustained.

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

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

Is the service safe?

We observed people being treated with respect and staff maintained people's dignity. People told us that the staff were good and one relative told us, 'My relative is well looked after.' Another relative said, 'The (the staff) keep me informed of any changes in my relatives' health.'

We found adequate quality monitoring systems were not in place. This did not ensure risks to people were identified and reduced. We found many areas that required improvement.

Appropriate arrangements for the recording, safe keeping and safe administration of medicines were not always followed, putting people at risk of not receiving medication as prescribed.

Staff supervisions and appraisals had not been kept up to date. Many staff had not had supervision for two years.

During our visit we observed there were not effective systems in place to reduce the risk and spread of infection. Many areas were not maintained to an appropriate standard of cleanliness.

Is the service effective?

Most people's health and care needs were reviewed, and if people were able they were involved in the reviews.

Audits and quality monitoring had not been carried out. These meant shortfalls had not been identified or rectified. There were not effective systems in place to ensure service improvement.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

We spent time observing lunch in the dining room. We saw the experience was not inclusive or supportive. People were left without staff support. Although the cook did come into the dining room and ask people if they would like seconds.

Is the service responsive?

The manager told us they were providing care to people living with dementia and wanted to specialise in this area. We identified the environment did not meet the 'best practice' in design to meet the needs of the people who used the service. All areas were decorated in the same light colours; no landmarks were present and no signage to enable people to find toilets, bathrooms or bedrooms. The service had not identified what environmental improvements could be made to improve the quality of life for people living with dementia.

Is the service well-led?

There was a registered manager in post.

Relatives we spoke with told us staff kept them informed of any changes in the health or wellbeing of their relatives. However, they told us there were no resident or relative meetings held to discuss any issues or concerns. But they did say if they had any concerns they would approach the manager or deputy.

People told us before they received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People experienced care, treatment and support that met their needs and protected their rights.

People were provided with a choice of suitable and nutritious food and drink. Everyone we spoke with said the food was good.

We found that appropriate arrangements were in place in relation to obtaining, recording and the disposal of medicines.

There were effective recruitment and selection processes in place and appropriate checks had been undertaken before staff began work in the home.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Everyone we spoke with said they knew how to complain.