East Lothian care home criticised by watchdog for second time as medication issues remain

Lammermuir House fell short on medication management, nutrition and personal care.

An East Lothian care home is still failing to meet standards following a damning inspection report.

Lammermuir House in Dunbar has become the subject of yet another scathing review by the Care Inspectorate after it was slammed for uncleanliness and poor medication management last year. Following another visit in January, the watchdog acknowledged the quality of staff had improved but insisted the service had a way to go on nutrition, medication and personal care.

With regard to several points on which the home was ordered to improve, inspectors concluded insufficient progress had been made. On was the frequency of bathing, hair washing, maintenance of bed sheets, nail and oral care, with a lack of recording 'compromising people's wellbeing'.

Lammermuir House continues to fall short

Medication to treat residents' skin was not being properly managed, creating a risk of skin breakdown and infection. Although the dining room experience had improved for some residents, inspectors still raised concerns about the risk of malnutrition and staff's lack of knowledge on food fortification.

Commenting on mismanagement of medication in general, the latest report reads: "The arrangements for managing people's medication were, at times, poor and compromised people's health and well being. Even where there was access to healthcare professionals, people's healthcare needs were sometimes not reliably followed through.

"This may result in people experiencing disjointed or reactive care and support impacting on their health outcomes. People may not always receive the right medication at the right time with the potential to affect their physical and emotional well being. There were examples of 'as required' medication which was not clearly laid out."

Acknowledging staffing improvements, it continues: "Staff were warm, kind and responsive to peoples needs. At the last inspection staffing was inadequate and we made a requirement.

"At this inspection the needs of people living in the home were calculated, using a tool which helped the provider calculate the required staffing hours. This took account of the layout of the building and deployment of staff to cover the home. During the mealtimes, the deployment and availability of staff had improved and this meant people experienced better care.

"The home still had a high reliance on agency nurses and carers to staff the home which affects continuity and consistency of care. The manager tried to use agency staff who were familiar with the home to try to improve communication and care for the residents.

"Cleaning staff arrangements had been strengthened by the appointment of a new housekeeper. Recently implemented changes to the numbers and deployment of domestic staff were starting to make an impact and should help keep the home clean whilst the refurbishment programme is completed."

But despite a refurbishment programme being underway with the aim of overcoming cleanliness problems, not enough progress had been made at the time of the watchdog's last visit. Care plans compiled for residents were also considered sub-standard.

The document goes on: "Where people were subject of guardianship or powers of attorney, care plans did not fully recognise what this meant. Views of families and friends were not fully heard resulting in a limited understanding of their expectations.

"There remained a number of reviews of care to be completed. These are important to ensure that people are heard, receive the care that is right for them and takes account of their choices and preferences.

"Most care plan evaluations were not meaningful and did not make it clear whether the current care was working. For example, whether prescribed pain medicine was working.

"Overall, care plans needed to be more outcome-focused and take into account peoples needs, wishes and choices. Better evaluation of care would lead to more responsive and timely action helping residents to get the right care at the right time."

A spokeswoman for the home's owners, the Four Seasons Health Care Group, said: “We regret that Lammermuir House Care Home has fallen below the standards that we and the Care Inspectorate expect. We have implemented a comprehensive improvement plan to address the areas noted in the report.

"Since the inspection in January, a new manager has been appointed who is working closely with the Care Inspectorate to make improvements throughout the home. This has included a review of resident care and medication processes and a programme of refurbishment, to ensure the needs of residents are better met.

"We are pleased that inspectors recognised improvements to the dining experience and staffing, noting ‘staff were warm, kind and responsive to people’s needs.’ The safety and wellbeing of residents and colleagues in our homes remain our first priority."