CQC report explained · a residential care home
What the CQC found at Livingstone House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found weaknesses in safeguarding risk controls, incident recording, medicines management and staffing levels. Infection control was mostly satisfactory, although staff were sometimes seen without masks.
- Effective?
- Requires improvement
- Staff induction, training and supervision were incomplete, and some healthcare referrals were delayed. The home did follow the principles of the Mental Capacity Act and people appeared to enjoy the food.
- Caring?
- Requires improvement
- Staff were kind and caring at some times, but did not always engage people or support their independence. During lunch, staff took a break together while people were left without staff support.
- Responsive?
- Requires improvement
- People did not have regular meaningful, individual activities and there were no written activity schedules. Care plans were detailed but not always reviewed or easy for staff to access.
- Well-led?
- Inadequate
- Quality checks did not identify or resolve a range of problems, including staffing, medicines, activities and record keeping. There was no registered manager in post and the provider had not maintained effective oversight.
What inspectors found, January 2023
Rated Requires Improvement, with an Inadequate well-led rating; inspectors found risks in staffing, medicines, care and oversight.
Inspectors made an unannounced visit over 17 and 18 October 2022. They spoke with people, five family members and five staff. They observed care and reviewed care plans, medicines records, staff files and management records.
The home was not always safe or effective. Staffing was often below the home's own assessed need. Medicines records and storage checks were not reliable. Some healthcare referrals were delayed, and staff training, induction and supervision were incomplete.
People did not always receive enough individual activities, support to build independence or active engagement from staff. Care plans were not always up to date. The home had weak quality checks, no registered manager at the time of the inspection and an Inadequate rating for being well-led.
The overall rating fell from Good at the previous inspection, published on 17 November 2021. The provider gave later assurances about extra staff, medicines training, audits and care plan reviews, but CQC said it would continue monitoring the home.
Respectful support
Staff usually asked for consent and understood that people should be able to make choices within safe limits. Inspectors also saw private conversations about personal care handled discreetly.
“I will always ask the person before I help them with care.” from the report
Some kind care
Inspectors saw staff show kindness, especially when people were upset. Some people actively sought staff out to joke with them.
“However, at other times, we saw staff had a kind and caring attitude towards people, particularly when they were demonstrating levels of upset or unhappiness.” from the report
Communication with families
Family communication had improved in recent months under the temporary manager. Families described receiving more regular telephone and email updates.
“One good point is that there is now regular contact with family members by telephone and I get emails with updates.” from the report
Complaints were investigated
The five complaints received since the previous inspection were investigated. The report says outcomes and apologies were shared with complainants.
“The provider received five complaints since the last inspection, all of which were investigated.” from the report
Safeguarding risk controls
seriousControls put in place after one alleged abuse incident were not adequate, and a second incident occurred. The report says measures had since been put in place, while the incident remained subject to further CQC investigation.
“The control measures put in place following the first incident were not adequate, which subsequently meant a second incident occurred.” from the report
Medicines management
seriousRecords were missing or handwritten, medicines were not always given at the prescribed time, and storage temperatures were not regularly recorded. This made it difficult to confirm that medicines were given and stored safely.
“The provider failed to ensure that prescribed medicines were safely and effectively managed.” from the report
Staffing levels
seriousRotas often showed fewer staff than the home's own dependency assessment said were needed. Families and staff reported frequent shortages, particularly at weekends.
“The provider failed to deploy sufficient numbers of suitable, skilled and experienced staff.” from the report
Training and supervision
needs fixingSome staff did not have the induction, training or supervision required by the provider's policy. Completion rates for several training subjects were low.
“There was almost no training recorded for two members of staff who were regularly rostered to work.” from the report
Activities and independence
needs fixingPeople had few meaningful activities and most recorded activities were group activities. Low staffing meant some individual outings and interests could not go ahead.
“People did not have regular access to meaningful activities, despite most people's care plans referencing the importance of activities.” from the report
Weak management checks
seriousAudits and action plans did not reliably identify or resolve problems. The provider had no written record of monthly management walk-throughs, so improvements could not be tracked.
“The provider failed to ensure there were robust management oversight of the service.” from the report
- 01What staffing levels are now provided on weekdays, weekends and nights, and how are staff shortages covered?
- 02How do you check that every person's medicines are given at the correct time, recorded properly and stored at the right temperature?
- 03Which staff have completed training for autism, epilepsy, positive behaviour support and the Care Certificate, and how is their competence checked?
- 04What individual activity schedule is in place for my relative, including community activities, volunteering, employment or independence goals?
- 05Who is currently responsible for management oversight, and what written audits show that the problems found by CQC have been fixed and kept fixed?
This was an unannounced inspection covering all five key questions, including infection control and the premises; it was prompted partly by an abuse allegation, but inspectors did not examine the circumstances of that incident. This explanation was written from the published report of 20 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2021
Rated Good; inspectors found safe, kind and personalised care, with a medicines record mismatch to monitor.
This was an unannounced comprehensive inspection on 27 October 2021. One inspector spoke with people, staff, a family member and health and social care professionals. They also reviewed care records, medicines records, recruitment files and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were protected from avoidable harm, supported by trained staff and treated with kindness and respect.
Care plans were personalised. Staff supported people to make choices, communicate in ways that suited them, access activities and use local services. The home worked with families and professionals and used reviews of incidents and other checks to improve care.
There was one medicines recording mismatch. The stock level in one medicines administration record did not match a separate stock book, although inspectors found the medicine had been given as prescribed and no doses had been missed. The home also had many stairs and some superficial damage that was awaiting redecoration.
Personalised support
Care plans gave staff detailed information about people's needs, choices and preferred ways of receiving support. A positive behaviour support team helped staff use a person-centred approach.
“People's support plans were person-centred and comprehensive providing information and guidance about people's health and care needs, their choices and how they wished to be supported.” from the report
Kind relationships
Inspectors saw positive relationships between people and staff. Relatives and professionals also spoke positively about the support provided.
“We observed a kind and caring culture at Livingstone House.” from the report
Choice and independence
People were encouraged to make day-to-day choices and use local shops and amenities. Staff supported independence and respected people's privacy and dignity.
“Staff enabled people to make choices about how they wished to communicate and how to be supported in any given activity.” from the report
Staff training and support
Staff received training, supervision and team support. New staff had a structured induction and shadowed experienced staff before being assessed as competent.
“New staff shadowed a senior team leader for a minimum of four days until they were deemed competent and felt confident to support people.” from the report
Learning from incidents
Accidents and incidents were reviewed for patterns, with learning shared with staff. Managers also held debriefs and identified further training where needed.
“Accidents and incidents were reviewed each month in order to identify any developing trends.” from the report
Medicines records
needs fixingThe stock recorded in one person's medicines administration record did not match the stock recorded in a separate book. Inspectors found the medicines had been given correctly, but the records should be checked carefully.
“The stock levels on one person's medicines administration record (MAR) did not correspond to stock levels recorded in a separate book kept in the clinic room.” from the report
Stairs and building condition
minorThe home had many stairs and no lift, so it was not suitable for someone with a significant physical disability. Some areas had superficial damage and were waiting to be redecorated.
“There were many stairs in the home and no lift, which made it unsuitable for people with a significant physical disability.” from the report
Activities after the pandemic
minorThe pandemic had reduced access to outside activities. Activities were beginning to reopen, but families may want to check what is currently available and how often.
“COVID has had a huge impact on activities …..I do believe LH have moved forward in recent months to increase their efforts.” from the report
- 01What checks now make sure the medicines administration record and the separate stock record always agree?
- 02What is the current plan for redecorating the areas with superficial damage, and has this work been completed?
- 03How would you assess whether the home's stairs are suitable for my relative's mobility and physical needs?
- 04Which activities can residents currently take part in, and how often do they access local shops, amenities and community activities?
- 05How will my relative and our family be involved in reviewing their personalised care and positive behaviour support plans?
This was a planned comprehensive inspection covering all five key questions and included checks of infection prevention and control; an earlier targeted inspection in August 2020 looked only at Safe and Well-led and did not provide ratings. This explanation was written from the published report of 17 November 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Livingstone House
2 rated inspections over a year: the service has slipped, from Good to Requires improvement.
- January 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- November 2021GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2021Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- September 2019
Registered with the Care Quality Commission on 6 September 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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