Archived: Leeming Garth

Leeming Garth care home is a residential care home providing accommodation and personal care to 33 older people at the time of our inspection. The service can support up to 45 people in one adapted building.

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

We received positive feedback from people, who told us they were happy living at Leeming Garth. People received personalised care and staff knew people well. The care plans covered all aspects of people’s care and included their preferences.

There were systems in place for communicating with people, their relatives and staff to ensure they were fully involved. This included one to one meetings, handovers and team meetings. The environment was clean, safe and maintained to a good standard. It was also adapted to meet people’s needs.

Medicines were managed well, safely administered and recorded accurately. Individualised risk assessments were in place. Staff were confident about how to raise concerns to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.

All essential visitors had to wear appropriate personal protective equipment (PPE). In addition, complete NHS Track and Trace information. Additional cleaning of all areas and frequent touch surfaces was in place and being carried out and recorded regularly by staff. Training included putting on and taking off PPE, hand hygiene and other COVID-19 related training.

Additional competency checks and spot checks were carried out by the manager with all staff regarding safe use of PPE as well as practice checks.

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.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published on 7 November 2019). 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 and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. 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.

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.

We found the following examples of good practice:

• All staff and visitors had to wear appropriate personal protective equipment (PPE), complete a health declaration form, NHS Track and Trace information and had their temperature checked prior to entering the home.

• Staff supported people’s social and emotional wellbeing. The service had used different methods including information technology to assist communication with staff wearing face masks. The provider and staff kept family members up to date about the latest guidance and their relative’s health via regular telephone calls, letters and other technology.

•The manager explained the quality systems they had in place to check the service was providing safe care. There was a robust communication system to ensure staff received consistent updates in relation to infection control policy and practice.

Further information is in the detailed findings below.

•Additional cleaning of all areas and frequent touch surfaces was in place and being carried out but not always recorded by housekeeping staff. This was addressed by the manager following our inspection.

•Additional cleaning of the bedrooms of people who were isolating was not always carried out. We raised concerns about this. These issues were addressed during our inspection.

•All staff, including catering and housekeeping staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training. We recommended that staff take up additional IPC training from the local NHS IPC team.

Leeming Garth is a residential care home providing personal and nursing care to up to 55 people older people, younger adults and people with physical disabilities and over at the time of the inspection. 43 people were living at the service at the time of our inspection. The provider had made changes to the service and was no-longer providing nursing care and had de-commissioned bedrooms, reducing the number of people it was able to accommodate. We asked the provider to notify us of these changes.

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

People were at risk of avoidable harm as care records were not complete and up to date. The provider did not have effective systems in place to check safety and quality across the service.

People, relatives and staff told us there were not always sufficient numbers of staff in the service to provide high quality care. This meant they could not always have the care they would like and staff may be less patient with them. We asked the provider to review this and received evidence to show this was addressed.

We made a recommendation about staffing.

People were at risk of avoidable harm as information about risks to people was not always recorded accurately or consistently to guide staff in how to keep them safe.

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 did support this practice. Records were not always in place to evidence policy had been followed.

We made a recommendation about the Mental Capacity Act 2005.

People’s dietary requirements, including diabetic and vegetarian diets were not always catered for. Referrals were made to healthcare professionals. It was not always clear that this advice was followed

People responded positively towards staff, laughing and joking with them. Care was provided in considerate, kind ways, ensuring people were comfortable. People had opportunities to be independent, including with their mobility.

Information about people’s likes, dislikes and histories was known. This helped staff provide person-centred care. People were able to access a varied activities programme, which was being reviewed and developed.

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 27 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to the governance of the service at this inspection.

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

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.

The service was last inspected in September 2015 and at that time required improvement in the safe domain due to concerns around the administration of medicines and in the caring domain due to negative feedback about a small minority of staff. A further inspection took place in June 2016 by a Care Quality Commission (CQC) pharmacy inspector. At the June 2016 inspection we found that further improvements needed to be made around medicines to be taken when required, being missing for some medicines, incomplete records for topical medicines, medicines not having a carried forward figure, (mainly dietary supplements) and although a stock balance record was in place, where counts were out this was not always notified to the registered manager so that they could investigate.

Following our last inspection the registered provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the home.

At this inspection we found that medicines were now administered safely. Medicines to be taken when required guidance was now in place and a daily count system of all medicines was taking place. However due to this count there was a potential risk of dropping bottled medicines. We recommended theservice obtain a tablet counter from the pharmacy to prevent this potential risk. The concerns raised about a minority of staff had been investigated and these staff members no longer worked at Leeming Garth.

Leeming Garth provides general nursing and residential care for up to 55 people. The home is situated in the village of Leeming Bar with easy access to the A1 motorway. It is spread over two floors, with lift access to each floor. There are parking and garden areas. At the time of inspection the service was no longer providing general nursing care.

There was a registered manager in place who had been registered with the Care Quality Commission since 2015. 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 to people arising from their health and support needs or the premises were assessed, and plans were in place to minimise them. Risk assessments were regularly reviewed to ensure they met people’s current needs. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

On the day of inspection there were enough staff to meet people's needs. However, existing staff and relatives were concerned there were not usually enough staff. We discussed this with the registered manager who explained due to two staff members being on maternity leave it was difficult getting their shifts covered. Both staff members were returning in March 2017 which would ease the workload. They were also in the process of recruiting another member of staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff were given effective supervision and a yearly appraisal.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. Staff had received Mental Capacity Act (MCA) (2005) and the Deprivation of Liberty Safeguards (DoLS) training and clearly understood the requirements of the Act. This meant they were working within the law to support people who may have lacked capacity to make their own decisions. The registered manager understood their responsibilities in relation to DoLS.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, district nurses and other professionals.

The service also had access to a system called Immedicare. Immedicare is a digital health hub system which operates on a 24 hours a day, seven days a week, 365 days a year basis. The digital health hub enables clinicians and others involved in healthcare provision to respond to and assist patients remotely in real-time, via the use of video-based teleconsultation technologies. This meant that staff had access to a nurse at all times, staff could see the nurse and the nurse could see the staff or if needed a person who used the service.

We found the interactions between people and staff were cheerful and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. People and their relatives spoke highly of the care they received. People had access to a wide range of activities, which they told us they enjoyed.

Procedures were in place to support people to access advocacy services should the need arise. The service had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any issues they had.

Care was planned and delivered in way that responded to people’s assessed needs. Plans contained detailed information on people’s personal preferences, and people and their relatives said care reflected those preferences.

The registered manager was a visible presence at the service, and was actively involved in monitoring standards and promoting good practice. Feedback was sought from people, relatives, external professionals and staff to do assist in this. The service had quality assurance systems in place.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at: www.cqc.org.uk

We carried out this focused inspection on 18 May 2016. This was an unannounced inspection visit and was completed by a specialist pharmacist inspector.

Leeming Garth provides residential and nursing care for up to 55 people, with the service user bands older people, physical disability and younger adults. The registered provider is HC-One Limited. The home is situated in a rural location on the outskirts of the village of Leeming Bar and consists of an old listed building with modern extensions. The accommodation is arranged over two floors with lift access. There are private car parking facilities, gardens and grounds.

The service had a registered manager who was on duty during 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.

We observed medication being administered to people safely. Safe storage arrangements for medicines were also in place.

Improvements had been made to ensure that medicines were administered in a timely way, with medicine rounds being completed to allow safe time periods between medicine administration.

Systems for the management of end of life medicines and oxygen had also been improved, in response to safeguarding investigation findings.

Arrangements were in place for recording the administration of oral medicines, but some improvements were needed in the records relating to medicine stock, medicines prescribed 'as required' or with a choice of doses, and for topical medicines.

We looked at how medicines were monitored and checked by management to make sure they were being handled properly and that systems were safe. We found that the provider had completed a monthly medication audit which identified similar issues to those we found relating to recording. Staff also completed daily checks of medicine records. However, these checks had not always been effective. For example, because staff had not always notified the registered manager when discrepancies had been identified.

We found a breach of regulation, relating to records and governance. You can see what action we told the provider to take at the back of the full version of the report.

On the day of the inspection we talked with people who lived in the home and spent time in the communal areas of the building observing the interactions with staff and people who lived in the service. Some people who lived in the service had dementia type illnesses and found it difficult to discuss their experience of care. We talked with four people about their experience of care and we spoke with five relatives and friends. We talked with six staff and the Quality Manager who had responsibility for quality assurance at homes managed by the provider. We looked at records. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents.

People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual support plans in relation to activities of daily living. Staffing on the day of the inspection were agreed as appropriate for the levels of dependency in the home. Staff we spoke with told us that they believed there were not always enough staff on duty and they were concerned that they sometimes had to rush people who lived in the service when providing care. We saw that there had been staff recently recruited but there were still some vacant posts. The quality manager told us that staffing levels were reviewed and adjusted to address any changing needs.

Is the service effective?

People we spoke with told us that they were happy with the care they received. From our observation and from speaking with staff that they understood people's care and support needs and they knew them well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and where it was possible for them to do so, people were involved in developing their plans of care. Relatives we spoke with were able to describe specific benefits to the health and wellbeing of their relatives and the impact that this had had on their daily life. One relative told us. "I can't praise this place enough, they treat people with respect 100%."

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were supported to be as independent as possible.

Is the service responsive?

People were involved in a range of activities inside and outside the service. The home supported people to take part in activities within the local community which included visiting local places of interest. People knew how to make a complaint if they were unhappy and two people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. Records seen by us showed that complaints were investigated appropriately. People who lived in the service, staff and relatives were asked for their views. People who used the service were invited to complete an annual survey. This had recently been circulated and so we were not able to see the outcome of this. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. Any identified shortfalls were addressed promptly and as a result the service was constantly improving. Staff told us that they felt they could talk with the manager if they had concerns.

At our last inspection we identified that peoples' weights were not being monitored appropriately. At this inspection we saw improved systems were in place to manage and monitor peoples' weights. We also identified at our last inspection that people were not always being repositioned and checked in bed at the required time as indicated in their care records. We found in the majority of cases at this inspection that improvements had been made and people were now being checked and repositioned appropriately. During our inspection we observed a calm environment with call bells being responded to in a timely way. People living at the home were clean, well dressed and appeared relaxed in their surroundings with positive interactions observed between people living at the home and staff.

The majority of people we spoke with were positive about the care they received. We saw that people were clean and appeared well cared for and were supported by staff in a person centred and dignified way. We also found that health care professionals were contacted as people's needs changed and regular visits were made by health professionals. We spoke with a visiting professional on the day of our visit. They told us that they had been called in promptly to visit two people who staff were concerned about. This helped to ensure that advice was being sought to help maintain people's health and wellbeing. Despite this, we found that not all people's care and treatment was planned and delivered in line with their individual care plan. We have asked the provider to address these issues.

The provider should note that whilst there was no evidence that Leeming Garth was not meeting the regulation relating to staffing; there needs to be a review of the deployment of staff during the morning period to ensure that a coherent and systematic arrangement is in place for ensuring that people's needs are met in line with their care plan. There needs to be clear leadership and direction in place for staff to follow. We have discussed these issues with the provider and will continue to monitor this area of compliance.

People said they were generally well looked after, with comments including 'Oh yes, I'm very happy and get looked after very well', 'The food is nice and I have a choice' and 'My relative is happy here and I don't worry about them.' Care plans reflected people's needs and had been reviewed regularly. People were given special diets where needed and people were monitored for weight loss.

However, negative feedback regarding dissatisfaction with staffing levels was received from the people we spoke with. Comments included 'I'm concerned that a lot of the experienced staff have left', 'People keep ringing in sick and nobody will cover because everybody's tired' and 'You just rush all the time.' However, there was also less negative feedback, including 'The basics of care are there', 'It's busy but I don't see any lack of care' and 'I have to wait sometimes to go to the toilet or when we're taken to the dining room, but it's generally ok.'

The home manager said they were currently recruiting and awaiting start dates for new staff. Following feedback the home supplied information to show they had increased staffing levels in the mornings on a permanent basis. The home had systems in place to monitor the quality of the service.

People told us that they liked the food. Special dietary requirements were being catered for and people were monitored for weight loss. People's comments included 'I've had a lovely meal, the food was good.' However, we found that fluid and food intake monitoring could be improved.

People who use the service and staff told us that staff were very busy and that sometimes people had to wait for their needs to be met. Our observations supported this and we saw occasions when staff were not available when people needed them. Comments made to us included 'the staff are really, really busy, and look miserable' and 'we are struggling, I'm worried that care is suffering because we rush all the time.'

Staff knew how to report any concerns they had and systems were in place to monitor the quality of the service. This included seeking the views of people who used the service.