The Care Quality Commission
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  • Care home

Archived: Lane End House

Overall: Inadequate read more about inspection ratings

Lane End Drive, Emsworth, Hampshire, PO10 7JH (01243) 373046

Provided and run by:
Caromar Care Limited

All Inspections

22 June 2015

During a routine inspection

This inspection was unannounced and took place on the 22 June 2015. Lane End House can accommodate up to 22 older people with a variety of long term conditions, including those living with dementia and physical disabilities. On the day of our inspection 13 people were living at the home.

The home has a 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. In this home the registered manager is also the nominated individual of the registered provider.

There has been a history of non-compliance with the requirements of the law at this service since February 2014. At this time we issued three warning notices relating to care and welfare, infection control and quality assurance. In May and June 2014 inspections found non compliance remained with care and welfare. In November 2014 we inspected the service again and found non compliance was continuing, because we found risk assessments were not in place to prevent and protect people from injury, pain and harm. Care plans were not detailed enough to guide staff on how to meet individual needs. Medicine practices were not safe. The principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests had not been applied. People’s independence had not always been promoted and people had not been involved in decisions regarding their care. Effective systems were not in place to ensure the quality of the service provided was good and incidents were learnt from. Staffing levels were not always planned to ensure they were adequate to meet the needs of people. As a result we issued the provider with a formal notice which prevented them from being able to admit any new person to the home. The provider sent us regular action plans detailing what action they were/had taken to reach compliance. The last action plan was received on 10 April 2015.

At this inspection 13 people were being accommodated. We found staffing levels had not been arranged to ensure the needs of people could be met at all times. We found not all areas of the home were clean. Staff were not competent regarding medicines administration practices. Appropriate checks had been carried out on staff before they worked in the home. Safeguarding policies and procedures were available and staff understood these.

We found staff had received training but the provider was not reviewing the training to ensure staff were putting their learning into effect. Staff did not demonstrate a basic understanding of the Mental Capacity Act. However, the provider had reviewed care plans and ensured the principles of the Act had been applied to people’s records.

We found staff were not always caring or respectful when supporting people. Where people needed support with their meals this was not always offered in a respectful and dignified manner. People’s privacy and dignity was not always promoted.

Care plans were person centred and had been developed with people and their relatives. Activities were offered but these tended to be larger group activities.

Quality assurance procedures in the home were not effective. It was not possible to establish an open culture existed within the home. The provider had failed to clearly display their previous rating given from the most recent inspection.

The overall rating for this provider is ‘Inadequate’. This means that the service is therefore in special measures. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

17 November 2014

During a routine inspection

This inspection was unannounced and took place on the 17 November 2014. Lane End House can accommodate up to 22 older people with a variety of long term conditions, including those living with dementia and physical disabilities. On the day of our inspection 18 people were living at the home.

The home has a 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. In this home the registered manager is also the registered person.

The home was previously inspected on 10 February 2014 where we found non-compliance. At this time three warning notices were served for outcomes which related to care and welfare, infection control and quality assurance. Compliance actions were also made in relation to outcomes relating to safety and suitability of premises and staffing.

On 8 May 2014 we carried out an inspection to check if the provider was compliant with the warning notice regarding infection control. We found the provider was compliant with the warning notice.

On 17 June 2014 we conducted a further inspection to check if the provider was compliant with the two warning notices and two compliance actions. We found the provider was compliant with the two warning notices and one compliance action. The outcome relating to care and welfare remained non compliant and we deemed this had a moderate impact on people. We received an action plan from the provider stating they would be compliant by 14 July 2014.

When we inspected on 17 November 2014, we found that risk assessments were not in place to prevent and protect people from injury and harm. The storage of medication was safe but risk assessments were not in place to ensure people received their medication when they needed it, including pain relief.

We found care plans did not have sufficient detail to ensure staff had enough information to know and meet people’s needs. Activities were provided but these were not based on people’s choices. People made little comment about the meals. Records maintained made it difficult to establish how much a person had eaten and drank.

Where people lacked the mental capacity to make decisions the home was not guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. People’s independence was not always promoted and people were not involved in decisions regarding their care.

Staff understood the homes policies on safeguarding. The local authority confirmed the manager worked in co-operation with them when investigating safeguarding concerns. We found the provider did not have effective systems in place to ensure the quality of the service provided was good and incidents were learnt from. The premises were clean and tidy but had not been adapted to meet the needs of older people with cognitive impairments.

Appropriate recruitment checks had been undertaken on staff. We have made a recommendation that the registered manager records staff member’s qualifications.

The home has a small staff team with some staff consistently working long hours. Staffing levels were not always adequate to meet the needs of people. Staff received a range of training which they found useful.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Due to the level of concerns we served a notice of proposal to vary a condition of the provider’s registration and restrict admissions to the service. The provider did not submit representations and we served a notice of decision, which the provider did not appeal against. The notice of decision came into effect on 24 March 2015.

17 June 2014

During an inspection looking at part of the service

At the time of our visit there were 18 people living at the home. We looked at the care records for four people and spoke with six people. We spoke with three staff including the manager and cleaner. We also spoke with two visiting relatives.

This inspection was carried out by two inspectors. The focus of the inspection was to answer our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

Is the service safe?

People were treated kindly and with dignity and respect by staff. People and their relatives told us about their satisfaction with the home and told us they felt safe.

There was a system in place for monitoring incidents and accidents. Whilst we saw an example of where learning had taken place we could not be assured that a consistent approach was undertaken as the records were not always clear.

We looked at the staffing levels and skill mix within the home. Suitable numbers of staff were on shift throughout the day and night and staff had received a variety of training.

CQC monitors the operation of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) which applies to care homes. We did not look at this on this inspection, however we did not observe anything that gave us cause for concerns. People were able to come and go as they pleased and where they required support, plans were in place for this.

Is the service effective?

People's health and care needs were assessed and care plans were developed. Care plans were basic in content and whilst they identified a need they did not provide sufficient guidance about exactly how the support should be delivered. Staff were knowledgeable about people's needs, however the lack of detail in the records may mean that new staff, or any agency staff may not have appropriate information to support the person in the correct way.

Is the service caring?

People were supported by staff who were kind and patient in their approach. We saw care workers taking time to sit and chat with people. They responded promptly to people's requests and demonstrated a good understanding of people's needs. People described their satisfaction with the home. One person told us, "I love it here, everyone is friendly and caring. They really help'. A second person told us, 'If I need anything I just ask and staff will help me'.

Is the service responsive?

People knew how to raise concerns if they needed to. Relatives knew how to make a complaint. Where there were identified risks for people, risk assessments were not always clear and not all staff were able to tell us how these would be monitored and managed.

Is the service well-led?

All of the staff and people we spoke with said they felt supported. We saw the provider had implemented a number of systems to monitor and assess the quality of the service including audits and meetings. These had been recently implemented and therefore need time to become embedded within the service and to ensure they were effective.

8 May 2014

During an inspection looking at part of the service

We visited this service following us finding non- compliance with this outcome at our last inspection visit on 8 February 2014. At that time we deemed the impact of the non-compliance had a major impact on people and we served a warning notice. This visit was to see if the provider had made the necessary improvements to ensure compliance with this outcome. We found that the necessary improvements had been made and the provider was now compliant with this outcome.

During this inspection 16 people were being accommodated. We looked in 15 of the occupied bedrooms and in all the communal areas. One person was asleep in their bedroom so we did not disturb them. We spoke with three members of care staff, the manager/provider and the deputy manager. We looked at infection control policies and procedures and related records. When asked if the home was clean, one person told us, 'It is and should be they (staff) are always cleaning'.

10 February 2014

During a themed inspection looking at Dementia Services

Lane End House can accommodate up to 22 people. On the day of our inspection 18 people were accommodated. The registered manager told us most of these people had a diagnosis of dementia.

During this inspection we spoke with fourteen people, and four staff members including the registered manager. One nursing professional was spoken with on the day, who told us they had been made welcome and the person they had come to see was being well cared for. We received 15 comment cards, which all made positive comments. All felt that people were treated with respect and dignity. Comments included, "The home provides good care" and "People are treated with care and understanding".

People spoken with gave us a mixed picture of the care they received. One person who was reasonably more independent told us they felt able to exercise choices about their care and how they spent their days. They told us they had a good relationship with the staff and the registered manager. Another person told us they 'Scared to say anything' to the manager. They discussed several aspects of their care where they were not happy. These related to their mobility and being 'Forced to walk' and not being allowed to use a wheel chair. They told us staff worked hard but were too busy to listen. They told us someone near to their bedroom had been shouting in the night. They reported they had not heard staff respond to this person.

People were supported to access a range of services but some services were not accessed to ensure their overall needs were met.

We found that the environment of the home was not clean. The layout of the home made accessing all points difficult for some people. The home had not been changed or adapted to make it friendlier for people who had dementia.

We found that the staffing levels and skills of staff did not meet the need of people living in the home.

The manager had did not have an effective way of monitoring and assessing the service provided to people.

23 January 2013

During a routine inspection

People living at Lane End House told us they were very happy with the care and environment of their home. People told us they were able to discuss their care and treatment with the manager and staff members. They told us their choices and opinions were listened to and respected.

People said all their care needs were met by a staff team who they knew their needs. We saw that people had up to date care plans with appropriate risk assessments to maintain their independence. People were treated as individuals and their care was planned accordingly. Relatives told us they were happy with the care their relative received and were kept in touch with any changes to their relatives care.

We found that the home had appropriate information on safeguarding people. Staff spoken to were aware of this information and knew the procedures they would need to take if they had any concerns over the safety of any of the people living in the home. We saw records showing staff had received training in this area. People told us they felt safe.

We were shown recruitment records demonstrating appropriate checks had been made on staff to ensure the safety of people.

The home had a clear complaints policy and procedure, which was displayed in the home. People and relatives all told us if they had any concerns they would discuss with the manager. All people spoken with told us they had every confidence the manager would be able to sort out any complaint they had.

9 February 2012

During a routine inspection

People told us that they liked the home and they felt respected as individuals.

Staff told us that they felt that they were supported and trained to carry out their roles and meet the needs of people who use the service.

Relatives that we spoke with told us that the home provides a high level of support to their family members. The were very happy with the home and the staff team.