Laywell House Limited, Brixham.Laywell House Limited in Brixham is a Residential home specialising in the provision of services relating to accommodation for persons who require nursing or personal care, caring for adults over 65 yrs and physical disabilities. The last inspection date here was 31st July 2019 Contact Details:
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9th November 2017 - During a routine inspection
Laywell House Limited is registered to provide personal care and support for up to 30 older people who may have a physical disability. At the time of the inspection there were 27 people living at the home. Laywell House is an 18th century detached building located within its own gardens in a residential area of Brixham. There was a registered manager employed at the home at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.' At the last inspection, the home was rated Good. At this inspection, we found the home remained Good. Why the home is rated good: People received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm; protect people from any type of discrimination and ensure people's rights were protected. Risks had been appropriately assessed and staff had been provided with clear guidance on the management of identified risks. There were enough staff to provide care safely and to support people. Checks were carried out on staff before they started work to assess their suitability to support people who use care services. People were protected from the risks associated with unsafe medicine administration because medicines were managed safely. The home was clean, well maintained, and people were protected from the risk of cross contamination and the spread of infection as staff had access to personal protective equipment (PPE) and received training in infection control. The home was effective in meeting people's needs. People’s health and wellbeing were promoted and protected as the home recognised the importance of seeking advice from community health and social care professionals. People were supported to eat a healthy diet which promoted their health and well-being, taking into account their nutritional requirements and personal preferences. Staff received the supervision and training needed to meet people's needs. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the home support this practice. We have made a recommendation in relation to the recording of best interests decisions. People received a service that was caring. People were cared for and supported by staff who knew them well. Staffs were kind, caring and treated people with dignity and respect. People were involved in the planning of their care and were offered choices in how they wished their needs to be met. The home was responsive to people's needs. People received person centred care and support which promoted their health and wellbeing and enhanced their quality of life. People were aware of how to make a complaint and felt able to raise concerns if something was not right .The provider and registered manager welcomed comments and complaints and saw them as an opportunity to improve the care provided. People benefitted from a home that was well led. The vision, values and culture of the home were clearly communicated to and understood by staff. A comprehensive quality assurance system was in place. This meant the quality of service people received was monitored on a regular basis and where shortfalls were identified, they were acted upon. There was an open culture where people and staff were encouraged to provide feedback. Staff felt they received a good level of support and could contribute to the running of the home. Further information is in the detailed findings below.
17th September 2015 - During a routine inspection
Laywell House Limited is registered to provide personal care and support to 30 people who may have a physical disability.
The home had a registered manager. At the time of this inspection, the registered manager was in the process of applying to cancel their registration. The manager who was the person in charge on the day of our inspection told us they were in the process of applying to become the registered manager. 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.
This inspection took place on 17 September 2015 and was unannounced. There were 28 people living in the home at the time of the inspection. People had a range of needs. Some people were independent, others needed support with personal care, one person was being cared for in bed, and five people were living with dementia.
The service was last inspected in October 2014. At that time, we found the service was not meeting the regulations in relation to care and welfare, safeguarding people, consent, staffing, risk assessment, medicines management, complaints, records, and quality assurance. The provider sent us an action plan telling us what they were going to do to meet the regulations. On this visit we checked and found improvements had been made.
The service had a new management team in place. People spoke highly of the manager and confirmed they were approachable. Comments included “I can talk to the manager at any time. They are caring and listen” and “The new manager is great”. Staff spoke about the changes that had taken place since the previous inspection. Their comments included “It’s really coming together” and “There’s been a marked improvement”. A visiting healthcare professional said the service was improving under the new management, who knew where improvements needed to be made.
People spoke very highly of the care they received. Comments included “I’m very lucky to be here”; “They make you feel wanted” and “The staff are lovely, we have a laugh. They’re wonderful, very kind”. A number of the staff had worked at the home for a long time and staff knew people really well. Staff spoke passionately about the person they supported and wanted to achieve the best outcomes for them. People told us if they needed help, staff always came. Comments included “Just ring the bell and they’re there” and “Staff pop in and check on me”. People told us they enjoyed the food at the home. Comments included “The food is very good.” and “I enjoy my meals”.
Staff knew people’s preferences and how to deliver care to ensure their needs were met. The manager showed us the new care plan format they had introduced. This was to make further improvements to ensure information was clear and easily accessible. People’s care plans were updated when their needs changed. For example, one person’s mobility needs had changed. The person chose to spend their time in bed as they were more comfortable. The moving and handling care plan had been updated. Staff knew how to support this person with moving and handling and pressure area care. People confirmed staff knew how to meet their needs. Comments included “I just say how I would like it, and they do it” and “They let me do what I can, and then help if I need it”.
People enjoyed spending time with each other, were comfortable in each other’s company and chatted together. People also spent time knitting, reading, listening to music, sitting in the garden, and receiving visitors. Staff told people about the forthcoming cake party in support of charity and people talked excitedly about this. Activities took place every afternoon for those who wished to take part. People enjoyed a memory quiz on the day of our inspection. There was lots of excitement and laughter as people and staff discussed their childhood, first date, holidays, and talents.
People were protected by staff who knew how to recognise signs of possible abuse. One staff member said “We are encouraged to raise any concerns and they do act immediately”. There were sufficient staff to meet people’s needs. Staff responded to people’s needs and requests in good time. Staffing levels had been increased and one staff member commented “We have more time now”. Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be a risk to vulnerable people. Staff told us they were happy with the training they had received and felt skilled to meet the needs of the people in their care. Comments included “We’re open to knowledge and training – it’s happening now” and “We’ve had a whole bunch of training”.
Most people had capacity to consent to care and treatment. Staff told us if people were not able to make decisions for themselves they spoke with relatives and appropriate professionals to make sure people received care that met their needs and was deemed to be in their best interests. People were not being deprived of their liberty. The manager monitored this and knew to make an application to the local authority’s Deprivation of Liberty Safeguarding team if there were any changes.
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Risk had been assessed for each person. For example, one person had a history of falls. Staff knew how to support this person and carried out regular checks to make sure they were safe. The service had also sought advice from an occupational therapist. Premises and equipment were maintained to ensure people were kept safe and there were arrangements in place to deal with foreseeable emergencies.
People were confident if they made a complaint this would be dealt with. When we asked one person could anything be better. They said “I’d have a job to find something”. The manager kept a complaints log and any issues were dealt with quickly. For example, some people had said the meat was tough. The manager tried the meat themselves and then arranged for a new butcher to supply the service. As the manager was new to the home, they had audited records, policies, environment, and staffing. They had written a service improvement plan and we could see that a number of actions had been signed off as completed.
12th April 2013 - During a routine inspection
When we last visited the service in November 2012 we had some concerns over the ways in which people with memory loss were being supported to make decisions. The provider told us that they had put this right and on this visit we checked to see what they had done. We found they were now compliant and that people were being supported to make decisions and have their wishes acted upon. Where people did not have capacity, decisions were being made within a legal framework that supported their rights. We saw that people were being supported to eat and drink well and actions were being taken if people were losing weight or needed additional support. People told us "We get very good food here – fish and chips is my favourite” and “They look in on us at night and ask if we want anything. I wouldn’t give you tuppence for a cup of tea at night I like a hot milky drink to help me sleep”. We heard that they were given this. We saw that the provider had made arrangements to protect people from abuse and that systems were in place to manage any money held for safekeeping. We saw that staff were employed following a full recruitment process that helped ensure they were suitable to be working with potentially vulnerable people. We found that the provider had management systems to assess and manage the quality of the service that people experienced. People said “We’re very lucky here – the way we get cared for. The staff are all wonderful and treat us just like their Mums”.
28th November 2012 - During a routine inspection
On our visit we spoke with people living at the home, staff, a visiting relative and district nurse. We found that people were involved in making decisions about their care. However where they potentially lacked capacity this was not always being assessed or best interests decision making recorded. People we spoke with told us their wishes were respected. Some care plans were in development to include better risk assessments. We spoke with six people receiving care at the home. They told us that the care was good and met their needs. A visiting relative told us "I would recommend it to anybody. The staff are all local girls and very caring. My (relative) is very happy here." We found that activities were provided that suited people's interests and wishes. We spoke with a visiting district nurse who told us the home called them in early if they had any concerns. They also confirmed they had good infection control practices in place and that the staff were always interested to observe and learn from them. We found that medication was being administered and stored safely. We saw staff interacting well with people living at the home. The staff told us, and we saw evidence that, they received training and support to carry out their role, although some of this was still being developed. The complaints procedure was not up to date, but people we spoke with said they would be happy to raise any concerns and be confident the home would act on them.
22nd February 2012 - During a routine inspection
People told us they were able to make choices as part of their daily lives and staff respected their wishes. Relatives told us that they were involved and kept well informed. We saw that staff offered choices to people throughout our visit to the home. We saw good interactions between staff and people who live in the home. We observed that staff were kind and respectful. People and their relatives told us they were happy with the care and support they received at the home. Their comments included “I can not speak highly enough of the care”; “it’s like living in a hotel. You only have to ask and it’s done”; “nothing is too much trouble”; and “we’re a group of friends here”. We observed people who live in the home appeared well looked after and were dressed nicely. Whenever a person asked for help, staff were always available to support them. We spoke with two people who had been to the home’s hairdressing salon in the morning. They were pleased with the service and told us they enjoyed being pampered. During the afternoon, we observed that a large group of people were taking part in the bingo activity. One person sitting in the lounge was knitting; another person was enjoying the daily newspaper that had been delivered for them. One person was sitting with a relative looking at old photographs. Staff came in to the lounges regularly and we observed that people enjoyed chatting to them. One staff member was sitting in the lounge and reminiscing with people. One person was going out to sit in the garden; the staff told them they would get them a blanket so they kept warm. Another person told us that a volunteer came in regularly to play chess with them. We spoke with two healthcare professionals who had involvement with the home. One person told us that the manager and staff were very good at giving them the information they need. If they were visiting a person for the first time, the staff introduced them to the person and stayed with them to ensure they felt comfortable with the assessment. The other person told us that the manager was very accommodating and very helpful. They told us that the manager and staff were very good with people who live in the home. They felt that the staff sometimes found it more difficult when dealing with people who were a bit more challenging and had complex or increased care needs. We saw lunch being served. The tables in the dining room were laid nicely with tablecloths and flowers. People were given the choice of where they would like to eat their meal. There was a choice of cottage pie or lasagne for lunch and people told us they had enjoyed their meal. The registered manager told us that the food was homemade, wherever possible. People told us they enjoyed the food at the home. One person said, “Tea sounds nice, I’m looking forward to that”. Another person told us the cakes were beautifully made. The staff were aware of people's food preferences. People we spoke to told us they felt safe and felt able to speak to the manager or staff if they were unhappy about something. They were confident that the staff would deal with any matters to their satisfaction. We asked people about the staff. People told us “the staff support me well, they know what I need”; “I only have to ring the bell during the night and staff are there quick as a flash”; “the staff helped to motivate my relative” and “the care staff are wonderful”. We observed that staff had time to chat with people, and were available when people needed them. The staff had a good knowledge of people' s individual needs and appeared kind and respectful. People who live in the home and the staff told us the manager was approachable. People told us their comments were listened to and acted upon. Staff told us that they were able to make suggestions at staff meetings, and as a result improvements had been made.
1st January 1970 - During a routine inspection
Laywell House Limited provides accommodation and personal care for up to 30 older people who may also be living with dementia. There were 29 people living in the home at the time of our inspection.
This was an unannounced inspection carried out on 14 and 15 October 2014. We previously inspected the home on the 12 April 2013 and found no concerns.
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 and associated Regulations about how the service is run.
Although people told us they felt safe in the home, the registered manager had not followed local safeguarding adults policies and practices by ensuring concerns were investigated externally. They had not told us when these events were known. Proper recruitment processes were not always followed to ensure that new staff were suitable to work with vulnerable adults.
There were not sufficient staff in the home which meant people’s needs were not always met in a timely manner. We observed staff were task focussed and activities were usually planned as a group activity, as staff did not have time to respond to people’s needs individually.
Training had lapsed in some areas so staff were not up to date in certain subjects, for example, manual handling techniques. Staff had not received training in areas associated with people’s needs, for example, in supporting people living with dementia and care planning was not in place to meet people’s changing needs. As a result people’s needs were not being properly met as staff did not understand how people were affected by their condition and were making judgements which were inappropriate.
Staff had limited information available to them to know how people wanted their needs met as the care planning and associated risk assessments were not adequate or did not exist. There was insufficient information on specific conditions, for example diabetes, and in respect of specific medicines, to ensure staff knew how to support people. Other risk assessments were not completed fully and staff lacked the knowledge to understand what they meant.
People were at risk of receiving incorrect dosages of medicines due to the unsafe administering of medicines. Staff gave people their medicines, signed documentation to say the medicines had been administered, but did not check that people had actually taken them. Medicines given in variable doses were not being recorded so it was not clear how much of that particular medicine people had taken. People who administered their own medicines did not have risk assessments completed to determine whether they could do this safely. There was no system in place to ensure people’s creams were being administered as required. People were having creams used on them which had not been prescribed for them. Therefore their GP, or prescriber of other medicines and creams, would not be aware of any reactions the person may have in relation to other medicines.
There was no formal way the staff were ensuring people were consenting to their care. People were not being assessed in line with the Mental Capacity Act 2005 to ensure they were able to consent to their care. People were not being assessed in line with the Deprivation of Liberty Safeguards to ensure they were not having their freedom restricted unduly.
People were provided with an adequate diet. People were at risk of not receiving the support they needed to eat and drink as staff were not recording when people needed that support. The records of people whose weight was causing a concern were not detailed enough to ensure this was monitored, followed up, and action taken. Food supplements that people needed were not being recorded so it was not possible to ensure these were being given as required.
The home was led by a registered manager and a management committee. They had recently started to look at how this could work better and meet current expectations on them. They were not ensuring the auditing of quality of care in the home was maintained. The audits and arrangements in place for quality monitoring were not robust enough to identify the concerns raised during this inspection.
People told us they felt well cared for. They spoke highly of the staff and the registered manager. We were told the home had a waiting list due to its good name and many people wanted to live there. The home was kept in a good standard of repair and decoration. People’s rooms were personalised and they could choose how to have them decorated. People told us they saw a doctor when required and felt comfortable talking about their health with staff and felt their needs were met.
We found a number of Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.
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