27 April 2023
During a routine inspection
People’s experience of using this service and what we found
The recruitment of staff was not always safe as previous employment history was not always recorded and references were not always obtained from the most appropriate referees. Advocacy support had not been considered for one person when decisions were being made about their care and support.
The management of medicines was safe but further work was completed following the inspection to ensure medicines administered covertly were clearly recorded. Records in relation to fluid intake were not always accurately recorded. Quality monitoring processes had not highlighted the concerns found at this inspection.
People felt safe living at the home and told us staff were kind and caring. Internal and external health and safety monitoring of the home was regularly completed. Risks to people were identified and strategies implemented to reduce each risk. Infection control was well managed.
People received regular reviews from health and social care professionals. Relatives were regularly updated with information about their relations health. People received a healthy and nutritious diet. A programme of refurbishment was planned for the home. The home was fully accessible.
Staff promoted independence and we saw dignified interactions with people living at Marion Lauder House. Staffing levels were sufficient from our observations; however, we made a recommendation to review the staffing dependency tool to ensure it was suitable for the home. Staff received an induction, training and supervision. Staff felt supported by the manager.
There was a programme of activities in place, however, people from the nursing unit did not always take part. We made a recommendation; the provider reviewed the activity provision for people on the nursing unit. Care plans were in place and staff were aware of people’s needs. We made a recommendation; the provider ensures people, and their representatives are involved in reviewing their care records and advocacy support should be considered where people don't have any representation.
People and their relatives felt confident to raise any concerns they had with the manager or staff. Staff were aware of safeguarding processes. Relatives felt the manager was responsive. There had been a change in directors since the last inspection and an action plan was in place to highlight the improvements they wish to make and by when. We received positive feedback from professionals about the management and staff at the home.
People were mostly 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 28 August 2021).
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
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.
Enforcement and Recommendations
We have identified a breach in relation to good governance.
We have made recommendations the provider should review the dependency tool used to calculate staffing levels, provision for activities for people in receipt of nursing care and for people’s representatives to be involved in reviews of care and advocacy support should be considered where people don't have any representation.
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.