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Lester Hall Apartments Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 4 November 2021

About the service

Lester Hall Apartments is a residential care home, providing personal or nursing care to up to 33 people with mental health support needs. At the time of inspection, 23 people were living at the service.

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

The service was not always sufficiently cleaned. We found areas within the home that had not been cleaned for some time, including a person’s bedroom, and communal areas.

The service was dated and in need of repair and refurbishment. Areas of flooring were uneven and damaged, causing dirt to get trapped and a trip hazard.

Audits and checks were not in place to ensure cleaning was completed to an acceptable standard across the whole service.

A new provider and management team were in place, who had identified the areas within the service which required attention, however no timescales had been set to take action. Some improvements had been made since our last inspection.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

Medicines were administered and stored safely.

People had risk assessments and care plans which reflected their current needs.

People and staff told us that the new provider and manager were doing a good job, and the service had improved in several areas.

Meetings were held for staff and people to feedback their thoughts to the management team.

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

Rating at last inspection

The last rating for this service was requires improvement (published 17 October 2020) and there was a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Two targeted inspections took place afterwards in response to concerns received by CQC about infection prevention controls (IPC), and staffing at the service. We looked at the IPC measures the provider had in place and there was a breach of regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. (Report published 5 February 2021). Targeted inspections do not change the ratings of services and the rating remained Requires Improvement.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections. At this inspection enough improvement had not been made/sustained and the provider was still in breach of regulations.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well Led sections of this full report.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of regulation in relation to cleanliness and lack of oversight within the service. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection areas

Safe

Requires improvement

Updated 4 November 2021

The service was not always safe.

Details are in our safe findings below.

Effective

Good

Updated 4 November 2021

Caring

Good

Updated 4 November 2021

Responsive

Good

Updated 4 November 2021

Well-led

Requires improvement

Updated 4 November 2021

The service was not always well-led.

Details are in our well-Led findings below.