Care service description

We inspected the service on 15 and 16 May 2018. The inspection was unannounced. Lukestone Nursing Home is a ‘nursing home’. People in nursing homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lukestone Nursing Home is registered to provide accommodation, personal and nursing care for up to 44 people, and there were 37 people living at the service at the time of the inspection.

The service had 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 2008 and associated Regulations about how the service is run.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service remains good.

People were protected from harm by staff who were trained to identify signs of abuse. Where risks to people of the environment were identified, staff took action to minimise them. There were enough staff to meet people’s needs, and staff were recruited safely. Medicines were stored, given to people as prescribed and disposed of safely. People were protected by the prevention and control of infection. Lessons were learned when things went wrong.

People’s needs were assessed before they moved into the service. These needs were met by staff who had the skills and knowledge to deliver effective support. People were supported to eat and drink enough to have a balanced diet, including those with complex health needs. People were supported to have healthier lives by having timely access to healthcare services. People lived in an environment which was suitable for people living with dementia. People were 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 service support this practice.

People received a service which was caring. People were treated with dignity and respect by staff who were compassionate and caring. Staff treated people’s private information confidentially. People were able to make decisions about how their care was provided, and were involved in reviews of their care along with people who mattered to them.

People received care that was personalised to their individual preferences. Staff knew people’s needs and personal histories well. When people or their families had complaints or concerns they were encouraged to raise them. Management saw complaints to be an opportunity to improve the service. People were supported at the end of their life to have a dignified and comfortable death.

The registered provider’s vision and values were embedded into the service, staff and culture. Governance systems were effective in ensuring shortfalls in service delivery were identified and rectified. Management encouraged honesty and transparency in the service. . People and their families were encouraged to be involved and engaged with the service. The registered manager had developed links with the local community.

Further information is in the detailed findings below

This inspection took place on 15 and 16 March 2016 and was unannounced.

Lukestone Dementia Nursing Home provides accommodation for up to 44 people who need nursing and personal care. Communal areas, such as the lounge and dining room are on the ground floor. Bedrooms are found over three floors accessed by stairs and a passenger lift. There is a garden to the rear of the building. At the time of our visit, there were 40 people who lived in the home. People had a variety of complex needs including 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 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.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to

manage these safely.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.

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. Training records showed that staff had completed training in a range of areas that reflected their job role. Staff told us that they had received supervision and appraisals were on-going.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the home to be meeting the requirements of Deprivation of Liberty Safeguards.

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

People were involved in their care planning, and that staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

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’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

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.

There were effective systems in place to monitor and improve the quality

At our last visit in August 2013 we found that although there were enough staff on duty, some staff lacked skills and confidence. This meant that they did not know how to support people in accordance with their needs.

At this visit we checked how the management of the home had addressed this and found improvements had been made.

People using the service had dementia. This meant they were not always able to tell us their experiences. We observed how people interacted with the staff and management of the home both during and after the lunch time meal. We spoke with five staff, the manager and looked at records.

We found that staff had a good understanding of the different people who lived in the home. Staff who we spoke with told us how they supported people and what people did and didn’t like. One member of staff said, “It is so important to talk to people, they need conversation and company”. Another member of staff explained how they were promoting, “Meaningful interactions” with people and described the use of ‘memory boxes’ that contained items that were important to the person.

All the staff we spoke with knew how to support people when they displayed challenging behaviours.

We observed that staff were kind and patient with people. They listened to what people had to say and answered their questions with patience and understanding.

Staff had received updated training and guidance to support them in their roles.

Peopple who used the service had dementia. This meant they were not always able to tell us their experiences. We observed how people interacted with the staff and management of the service. We spoke with three relatives, the manager and staff.

Visitors we spoke with told us that they were happy with the care provided to their relatives. They told us, “This is a very nice home and I am well pleased with the care and support given". “Everyone is very respectful and they never get agitated with people". "Staff are very patient and kind”.

We found that people or their representatives had been involved in decision making and giving their consent for care and treatment.

People were provided with appropriate care and support, although some staff were unable to manage challenging situations and unsure of how to interact with someone who was aggressive.

People received the medication they needed at the time they needed it.

There were enough staff on duty to meet the needs of the people who lived in the home.

There was an effective system to regularly assess and monitor the quality of service that people received.

We conducted an inspection of this service on 2 February 2012. The provider sent us an action plan following that visit telling us what they were going to do to achieve compliance where we had found shortfalls in the service. During this visit we found that improvements had been made. People’s care and welfare needs were met and they were protected from risk of harm or abuse. The premises were clean and provided a pleasant environment for the people who lived there. This meant that people were comfortable and protected from risk of infection. People could be confident that staff were supervised and suitably trained to provide them with appropriate care and support.

We have highlighted areas in the report which the provider may find it useful to note to make sure compliance is sustained.

People who lived at the home were experiencing dementia and were not always able to tell us about their experiences. We used a number of different methods to help us understand the experiences of people using the service. We observed how people interacted with staff and the management of the service. We saw the atmosphere in the home was calm and relaxed.

People we spoke with said, “Care is genuine here, staff take time to sit and talk to people”. “It is excellent care here, they always listen if I have any concerns and all the staff are very kind.” People told us they felt safe in the home. We saw that people enjoyed their meals and the activities on offer during our visit.

Not everyone using the service was able to tell us about their experiences. We spend time observing how people were treated.

People who were able, told us how they made day to day choices about their lives and described how staff supported them to do this.

Most people using the service, that spoke with us, said they enjoyed the activities provided by the home, although one person told us they were bored. “I do singing”. “I like watching TV a lot”. “There are no trips out for patients”.

One person told us that their friends and family visited regularly.

People we spoke with described how staff supported them with their needs.

People said that they liked living in the home and enjoyed having their own room.

People told us the staff were kind and caring and were always there if they needed to talk to someone, although one person told us they did not always have a lot of time. “Staff are alright. There is no bullying”.