Archived: Lee Beck Mount

We found the following examples of good practice.

Staff and people at the home were part of a testing and immunisation programme for COVID-19. Staff had been trained in the use of personal protective equipment (PPE) and were observed to be using it appropriately during the inspection. Hand sanitiser was readily available on the premises and additional dispensers had been put on walls throughout the building at key points.

There was a plentiful supply of PPE for staff to use and stock was regularly monitored. There was a poster up on the wall with people in their face masks to make it more fun and to remind people they needed to wear masks when going out of the home. The manager explained that it was very difficult for people to socially distance but with support and advice people were supported to remain safe

There had been no new admissions to the home for a number of years and people were settled, and happy in a homely environment. The home was in the process of being sold, and there were plans in place to completely renovate and move towards an independent living service. With this in mind the decision had been made not to take on any new people so the transition would be the least disruptive to people’s lives.

The provider had a policy in place to support visits in line with government guidance in place at the time. All visits were pre-booked, and a system was in place to carry out risk assessments and testing of visitors prior to the arranged appointment to reduce the risk of transmission of COVID-19. There was a designated outdoor building for visitors to meet with people. Visits out had just commenced and there was a process in place to ensure these were conducted as safely as possible.

People were supported to maintain relationships and contact with others through electronic devices where this had been possible. The registered manager advised us the local GP surgery had gone above and beyond with their support during the pandemic.

The service was on the whole, clean throughout, and there were procedures to ensure infection control risks were minimised. The home was due to undergo a full refurbishment once sold so there were areas that needed updating, painting and some furniture required replacing to make it easier to clean.

The home was observed to be clean without losing its homely atmosphere. Additional cleaning schedules had been introduced since the beginning of the COVID-19 pandemic but recording of frequently touched areas, such as door handles and light switches was not taking place. There were no dedicated domestic staff, and this was done in and amongst other duties. People were involved in cleaning their own rooms and staff encouraged them to do this to remain as independent as possible.

Lee Beck Mount is situated in the Lofthouse area, near Wakefield and provides care and support for up to 13 people with learning disabilities. Local shops and community facilities are a short distance away. Accommodation is provided over two floors and with single occupancy rooms.

The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. Eleven people were using the service at the time of our inspection. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure people who used the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Medication management was safe and people received their medication as prescribed. Although, some minor issues with some people’s medication records were noted and addressed by the registered manager on day one of our inspection. People were supported safely and protected from harm. There were systems in place to reduce the risk of abuse. Risks to people's health, safety and welfare were assessed and mitigated. There were sufficient numbers of staff deployed to meet people’s care and support needs. Staff recruitment policies and procedures in place and were followed.

People were supported in a safe, tidy and clean environment. The home was well maintained, and people’s bedrooms and communal areas were homely. There was access to a large safe outside space.

Staff received appropriate training and induction to enable them to deliver effective care and support. Staff had received an annual appraisal. Although, a formal supervision had not been completed, staff were able to speak with the registered manager at any time.

People and relatives said staff were kind and caring and treated people with dignity and respect.

Staff were very knowledgeable about people’s needs, care and support was person-centred and inclusive. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Policies and systems in the home supported this practice. People received appropriate social stimulation and accessed the community.

Care plans were person-centred and contained sufficient information for people’s care and support needs to be met. Healthcare professionals supported people's health needs, when required. People received support with eating and drinking, when needed and were involved with weekly menu planning and shopping. The service was not supporting anyone who was at the end of their life.

People were listened to and complaints were appropriately dealt with and resolved. Accidents and incidents were monitored, however, an analysis of these had not been documented. The registered manager addressed this during our inspection.

The service was well managed. Staff said the registered manager was approachable and available to provide support and guidance. Quality monitoring was carried out using various audits. The service promoted an open, inclusive and positive culture. The registered manager worked in partnership with other services to support people’s care and quality of life.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (report published 11 October 2018) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Thematic review

The Secretary of State has asked CQC to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism.

Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

Lee Beck Mount is a ‘care home’. People in care 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.

At the time of registration, the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. However, the service is now working towards developing the provision in line with these principles. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Lee Beck Mount is situated in the Lofthouse area, near Wakefield and provides care and support for up to 13 people with learning disabilities. Local shops and community facilities are a short distance away. Accommodation is provided over two floors and with single occupancy rooms. There were 11 people living at the home on a permanent basis at the time of our inspection.

The home 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.

In August 2016 the home was rated as requires improvement. We found the provider did not ensure people’s nutritional and hydration needs were met, medicines were not always safely managed and they did not have effective systems in place to monitor the quality of the service. We told the provider they needed to take action; we received an action plan telling us what they were going to do to ensure they were meeting the regulations. At this inspection we found the provider was still in breach of regulations for the management of medicines and good governance. We also found additional areas of concern.

Some areas of medicines were not always well managed. Quality management audits were in place but were not always effective. The audits did not identify the concerns found during this inspection, which included, areas of the care plans were not always accurate and staff had not received annual appraisals during 2017/2018. Accidents and incidents were not analysed in a way which enabled trends to be identified.

Regular safety checks took place, although, prior to our inspection the gas safety certificate had expired and the home did not have a fire risk assessment in place. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies.

Staffing levels were sufficient, although, at times one person did not receive their allocated one to one hours and an increase in staffing numbers was not put in place to cover some recent planned absence. Staff were recruited safely and completed an induction when they started work. A range of training courses had been completed by staff but, it was not always clear how often these should be renewed. Staff received regular supervision during 2018 but annual appraisals were not conducted in line with the registered provider’s policy.

The registered provider had a safeguarding policy in place and staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Risks to people had been assessed. Advocacy services were available if people, so wished.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We found the home was clean, tidy and well maintained. Bedrooms had been personalised and communal areas were comfortably furnished. The home was small with ramp access and wide door areas. People were familiar with the layout of the building.

Throughout our inspection people were treated with kindness and staff had a good rapport with people. Staff clearly knew people well and worked together as a team to provide appropriate support. People’s dignity and privacy was respected and they were encouraged to maintain their independence and relationships with people who were important to them. We saw people spent time and stayed with family members both during the week and at weekends. People had access to a range of activities, both within the home and in the local community such as, going to day centres, excursions and nights out. The registered manager told us they had strong links with the local community. They said people visited the local pubs and café next to the home.

People received appropriate support for their nutrition and hydration needs to be met. People’s physical, mental health and social needs had been recorded in care plans and the registered manager told us they worked with local healthcare professionals such as, doctors and consultant psychiatrists to make sure people healthcare needs were met. They told us they attended local authority forums to share good practice to provide direction for staff to ensure care was provided in line with current guidance.

Overall, care plans contained person-centred information, although, some information was difficult to find and some required updating. We saw ‘My personal plan’ was in pictorial format and some sections had been signed by the person. We saw relevant information was shared between the staff team which, helped to ensure people received continuity of care.

There were lots of pictorial information for people to see and use and care plans we looked at recorded if people required specific communication needs. There had been no recent complaints but there was a system in place for handling complaints.

The registered provider had not ensured their rating from our last inspection was on display on their website. We dealt with this outside the inspection process.

We made a recommendation in relation to how staffing numbers were determined and the support people received and found a repeat breach of the regulation relating to good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Lee Beck Mount provides care for up to 13 people who have a learning disability. The service had 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.

People told us they felt safe, and talked about how they were involved in health and safety procedures, which helped keep them informed about staying safe. Staff understood safeguarding procedures and their responsibility to report any concerns relating to abuse or allegations of abuse. People were not protected against the risks associated with the unsafe management of medicines.

There was enough staff deployed to keep people safe. However, some people received additional funding for one to one staffing support but it was not clear from the rotas or care records these were being allocated appropriately. Staff were skilled and experienced to meet people’s needs because they received appropriate training and support.

People told us they were happy in the home and said they were well cared for. We observed staff providing support and it was evident they knew people well. We saw examples where care was person centred and independence was promoted, which included people making decisions about where to spend their time and when to make a drink. We also observed practices that did not promote individuality and independence such as meal everyone carrying their dinner on a tray from the serving hatch and eating their dinner from the tray, which replicated a ‘canteen’ type of setting rather than a ‘home’ setting.

People’s care records were personalised and provided information so staff understood their history and what was important to them. People’s needs were assessed and support plans described what staff needed to do to meet people’s needs. However, some information was not up to date so these were not always accurate. A range of other professionals were involved to help make sure people stayed healthy.

People who used the service and staff provided positive feedback about the management team who worked alongside everyone overseeing the care given and providing support and guidance where needed. The provider encouraged everyone to share their views and ideas about the service to help drive improvement.

The provider was not carrying out appropriate audits and checks so did not have effective systems in place to monitor the quality of the service. Information to show how the service was well led was not always accessible. Concerns or complaints were responded to and resolved where possible to the satisfaction of the person.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

As part of this inspection we spoke with seven people who use the service, the registered managers and two care staff. We also reviewed records relating to the management of the home which included, three care plans, daily care records, health care plans, staffing records, questionnaires and health and safety records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you wish to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was well maintained bright and clean. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

We saw people had completed annual health check and there were records of contacts with other professionals. One person in the home now self-medicates. Everyone living in the home has their money and medication locked within their own rooms.

We saw the managers had in place regular health and safety checks and any repairs required were recorded and dealt with in a timely manner.

Is the service effective?

We spoke with seven people who used the service and they told us they could make

decisions about their day to day lives, such as choosing what to wear, when to go to bed and what to do during the day. We saw one of the people likes to have their nails done and they have been able to do this regularly. People's comments included:

'I like it here it's my home'

'I have made good friends'

Is the service caring?

People who lived in the home spoke very positively about the staff and we observed good relationships amongst staff and people who lived in the home. We saw staff encouraging people to make their own choices and to engage in activities they enjoyed. Staff were kind and attentive and it was clear they knew and had a good rapport with the people they were supporting.

Is the service responsive?

We looked at three peoples care records and saw there were now clear descriptions of how people like to spend their day and how they wished to be supported. They were all personal to the person and it was evident people had been involved in creating their care plans with the goals they wished to achieve.

We noted when someone had refused food it was not clear, from the records, what action had been taken and how this person nutrition was being monitored. Other people's weight was fluctuating and although records had been kept they had not been reviewed and action taken noted. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service well led?

People told us they were involved in aspects of the home. One person told us they did the fire checks with a staff member each week.

We saw the easy read questionnaires which had been given to everyone in the home in March this year. The feedback from people was positive. We saw there were regular meetings for people who live in the home.

You can see our judgements on the front page of this report.

Our previous visit showed three areas which needed action: People did not have person centred care plans. People were not always protected from unsafe equipment because the provider had not ensured the equipment used in the service was serviced and maintained. Although people told us the service provided safe and effective care we found the provider had not monitored some important aspects of the service.

Following the July inspection the provider sent us an action plan telling us what they would do to achieve compliance. During this inspection we checked if improvements had been made.

We spoke with five people who lived in the home. All were very happy living at Lee Beck Mount and spoke positively of the staff who supported them. Some of their comments included:

'I love it here. I wouldn't change it.'

'I like all the staff.'

We saw people were relaxed and related well with the staff. We observed staff treated people kindly and with respect. (GAP)We looked at five people's care records and saw they had a care passport which described the person, what support they needed and how they wished to be supported. We saw evidence that person centred care plans were being developed for each person.

We spoke with the two managers and a new member of staff who told us how they were encouraging people to become more involved in their care.

We saw the home was maintained and there was a system to record any maintenance issues. However, we saw that this system was not always updated.

The provider had monitored important aspects of the service and checks had been carried out as required.

We found that not all records were available and not all those seen were up to date.

We observed staff assisting people who used the service. People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff were friendly and treated people they supported in a respectful way. They knew the people they were supporting very well. Staff told us people were given opportunities to make choices and decisions throughout the day and those decisions were respected.

Although people told us they were happy with the care, we found sometimes the care was not individualised or planned to enable people to care for themselves. Service provision for people with learning disabilities should be helping people to live as independently as they can. People were not always given opportunity to access community services.

The provider had not monitored some important aspects of the service and checks were not always carried out. They had policies and procedures which identified systems what they should do to ensure effective and safe care is delivered but these were not always followed.

'I like the food, the staff and going to the day centre.'

'The staff look after me very well.'

'I love this home.'

'The staff spoil me, I love it.'

We observed care practices and people who used the service were treated with respect and dignity. We looked at three care plans and found that they were up to date, provided good information about how people's care and support needs were assessed. People said they were happy and felt safe living at the home. We saw evidence that demonstrated the provider had taken appropriate steps to ensure that staff were suitably skilled and experienced to carry out their roles. People told us that they were aware of the complaints process, knew who to speak to and felt confident that complaints would be investigated and responded to.

All bedrooms were spacious, provided en-suite facilities and decorated to people's own personal tastes. There was a large communal lounge area, a dining room, a kitchen area and a covered patio area outside.