CQC report explained · a nursing home
What the CQC found at Lower Farm Care Home with Nursing
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some medicines were not given as prescribed, records had gaps and risks linked to tube feeding, weight loss, bed rails and call bells were not always managed safely. Staffing was adequate on the inspection day, but people and relatives gave mixed views about staffing levels.
- Effective?
- Requires improvement
- Staff received training and people had access to healthcare, but training was not always reflected in practice. Records about nutrition and follow-up care were not always complete, and some people could not sit properly at dining tables.
- Caring?
- Requires improvement
- Most people and relatives described staff as kind and respectful, and inspectors saw staff offering reassurance. However, two people who were unwell and in pain did not receive pain relief as prescribed.
- Responsive?
- Good
- Care records were detailed and held in one place, and people said staff responded to their needs and choices. The home had increased activities and provided information in formats people could understand.
- Well-led?
- Requires improvement
- The new manager and providers were making improvements and were open with inspectors. However, governance systems were not robust enough to identify medicines problems, poor dining arrangements and failures to follow care plans.
What inspectors found, July 2019
Rated Requires Improvement; the home had made progress and left special measures, but medicines, risk management and oversight were still unsafe or inconsistent.
Inspectors made an unannounced visit on 12 June 2019. They spoke with people living in the home, relatives, staff, managers and health professionals. They reviewed care records, medicines records, training information and quality checks.
The home had improved since earlier inspections. Care planning, activities, the environment and involvement of people and relatives had improved. People were generally positive about staff, privacy and dignity. However, inspectors found medicines were not always given as prescribed, some risks were not managed properly and quality checks had failed to identify important problems.
The overall rating was Requires Improvement. Safe, Effective, Caring and Well-led were also Requires Improvement. Responsive was Good. The home had previously been rated Inadequate and had been in Special Measures since August 2018. It was no longer in Special Measures, but it was still breaking regulations and needed further improvement.
Improved care planning
Care records had improved and were kept in one place. They gave staff clearer information about people's individual needs.
“Care records were detailed and described the support people needed to meet their individual needs.” from the report
Activities and social life
The home had increased activities and social opportunities. People were encouraged to take part in interests inside the home and in the community.
“Since our last inspection further work had taken place to ensure people were supported and encouraged to have active lifestyles and access a range of activities both within the home and in the community.” from the report
Privacy and dignity
People generally felt respected during personal care. Staff used practical steps to protect privacy and encouraged independence.
“Staff were respectful of people's privacy.” from the report
Healthcare support
People were supported to access healthcare when needed. Records showed contact with health professionals and referrals for people who had lost weight.
“People received support to keep them healthy.” from the report
Medicines not always safe
seriousSome medicine records had gaps and medicines were not always given according to the prescriber's instructions. This included strong pain relief, with one person receiving it on only five occasions in 16 days when it was intended before regular movement.
“Medicines were not always administered in accordance to the prescriber's instructions.” from the report
Risks were not consistently managed
seriousPeople receiving tube feeding were seen lying flat, increasing the risk of aspiration. Other concerns included undated syringes, missing bed-rail protection, lack of call bells and incomplete action records for weight loss.
“People who were receiving a specialist kind of tube feeding were seen by members of the inspection team lying flat in their bed whilst receiving their feed.” from the report
Quality checks missed problems
seriousThe home's audits did not identify important shortfalls in medicines, dining arrangements and following care plans. The provider was still in breach of the governance regulation.
“These governance systems were not robust and did not provide the leadership team with effective oversight of the service.” from the report
Staffing needed monitoring
needs fixingPeople and relatives gave mixed views about whether staffing was always sufficient and whether call bells were answered quickly. CQC recommended continued close monitoring of staffing levels.
“We recommend that the provider continues closely monitoring and reviewing staffing levels using an effective tool and through communication with people using the service and staff to ensure people's needs continue to be met in a timely manner.” from the report
Dining arrangements
needs fixingSome people using wheelchairs or specialist seating could not sit level with the dining table. Some people also experienced a significant delay between their main course and dessert.
“Several people could not sit level to a dining table as the table to eat their meal was too low to accommodate their wheelchair or other specialist seating.” from the report
- 01What has been changed to make sure every medicine is given at the prescribed time and recorded correctly?
- 02How do you now keep people safe during tube feeding, including their position, syringe storage and infection control?
- 03How do you monitor people who lose weight, and how do you record the action taken when they refuse food?
- 04How quickly are call bells answered, and how do you check that staffing levels are enough at busy times?
- 05What new checks now identify problems with medicines, care plans and mealtimes before people are affected?
This was a planned, unannounced inspection covering all five key questions; the home had previously had a focused inspection of Safe and Well-led only. This explanation was written from the published report of 30 July 2019 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, April 2019
Rated Inadequate; inspectors found people were still at risk from unsafe care, medicines problems and weak management.
This was an unannounced, focused inspection on 9 January 2019. Inspectors checked whether earlier problems with safe care and management had been fixed. They spoke with people, a relative and staff, and reviewed care plans, medicine records, staff files and other records.
Some improvements had been made, including locks and alarms on external doors after the visit. However, inspectors found that risks were still not recorded and managed reliably. Medicine supplies and timings were not always safe, and records about people's care were confusing or contradictory.
The home was rated Inadequate for Safe and Well-led. This means inspectors found serious shortfalls in keeping people safe and in the systems used to manage and improve the service. The home was already rated Inadequate at the previous comprehensive inspection.
Safeguarding systems
Staff understood how to recognise and report possible abuse. The provider generally reported safeguarding concerns to the local authority and CQC without delay.
“The provider had systems in place to protect people from the risk of abuse.” from the report
Clean environment
Inspectors found the home clean. Staff used suitable infection control practices and protective equipment was available.
“The service was clean. Staff received training relating to infection control and appropriate stocks of protective equipment such as gloves and aprons were available to staff.” from the report
People could raise concerns
Residents and relatives had regular meetings and an annual survey to share their views about the service.
“There were monthly resident committee meetings and monthly resident meetings as well as a quarterly relatives meeting.” from the report
Safe recruitment
The provider carried out the required recruitment checks for staff.
“The provider recruited new staff safely and carried out all appropriate checks designed to ensure people were safe to work in this setting.” from the report
Risks were not reliably recorded
seriousRecords about repositioning, fluids and pressure care were incomplete or stored in different places. Inspectors could not be sure that some people's risks were being managed properly.
“This meant that staff and the provider could not be assured that risks relating to pressure care and nutrition were being clearly recorded and well managed.” from the report
Medicine problems
seriousSome medicines were given late and some were not in stock. This could make medicines less effective or increase the risk of harm.
“Medicines were not always in stock for people to take.” from the report
Environmental dangers
seriousThe upstairs kitchen was unlocked and contained potentially harmful items. The pond gate and access to the nearby main road had also not been made fully safe until after the inspection.
“An upstairs kitchen was not locked and contained items which could harm people.” from the report
Confusing care plans
seriousImportant information was kept in different places, and some care plans were out of date or contradicted other instructions. This made it harder for staff to know what care people needed.
“Some records were not fit for purpose because they presented a potential risk of staff being unclear about the care required.” from the report
Weak management oversight
seriousAudits did not identify or correct important problems. Inspectors also found poor working relationships between senior managers and weaknesses in oversight of nursing care.
“There were widespread and significant shortfalls in service leadership.” from the report
- 01How do you now make sure medicines are always in stock and given at the prescribed time?
- 02How are repositioning, eating, drinking, fluid output and pressure mattress checks recorded now?
- 03What changes have been made to night staffing and response times to call bells?
- 04How do you ensure care plans are up to date, consistent and easy for all staff to find?
- 05What action has been taken in response to the Regulation 12 and Regulation 17 requirement notices?
This was a focused inspection of Safe and Well-led only; the other three questions were not rated in this report. This explanation was written from the published report of 30 April 2019 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 Lower Farm Care Home with Nursing
4 rated inspections over 2 years: the service has held its Requires improvement rating throughout.
- July 2019Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Lower Farm Care Home with Nursing →
- April 2019Inadequatestayed InadequateSafe: InadequateWell-led: Inadequate
Read what inspectors found at Lower Farm Care Home with Nursing →
- November 2018Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- January 2018Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2017
Registered with the Care Quality Commission on 28 April 2017.
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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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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