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Lester Hall Apartments Requires improvement

Reports


Inspection carried out on 3 September 2019

During a routine inspection

About the service

Lester Hall Apartments is a residential care home providing accommodation and personal care to 24 people who were primarily living with mental health needs at the time of the inspection. The service can support up to 33 people in individual apartments within an adapted building.

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

People's care plans included detailed guidance and information about measures required to reduce risks. People’s safety was not always promoted by staff as some staff had not followed guidance or understood how they should reduce potential risk. People were supported to take their medicines. Medicine records were not always completed correctly or accurately.

Systems to monitor the quality of the service were in place but these were not always effective in identifying where improvements were required. The provider was in the process of implementing more robust systems and processes at the time of our inspection. These had yet to be embedded into working practices to demonstrate they could support sustainable improvements.

People were supported by sufficient numbers of staff who had undergone a robust recruitment process. Staff had knowledge and understanding of reporting potential safeguarding concerns and following infection control procedures.

People’s needs and expectations of care were assessed and used to develop a care and support plan. Staff were supported through ongoing training to enable them to meet people's needs. Staff promoted people’s health by supporting them to attend routine and specialist appointments and by liaising with health care professionals when required.

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

People were positive about the staff and care provided. They spoke of the caring and respectful nature of staff and how staff considered their privacy, dignity and independence.

Care plans were in the process of being revised and updated to support staff to provide personalised care. People were encouraged to take part in activities and interests of their choice, including going out into the local community. There was a complaints procedure in place and systems in place to deal with complaints effectively. The service provided appropriate end of life care to people.

The management team were aware of their role and responsibilities in meeting their legal obligations. The provider worked with key stakeholders to facilitate improvements, develop the service, and keep up to date with good practice.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lester Hall Apartments on our website at www.cqc.org.uk.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 21 August 2018) and there were two breaches 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.

Inspection carried out on 28 June 2018

During a routine inspection

This inspection visit was carried out on 28 June 2018 and was unannounced.

At the last comprehensive inspection in February 2017 the service was rated as Good.

Lester Hall Apartments is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service cares for people with mental health needs. At the time of our inspection there were 30 people using the service.

There were two registered managers in post who job shared. 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.

Systems and processes did not ensure the safe management of medicines and people could not be confident they were supported to take their medicines as prescribed.

There was a lack of systems to monitor the quality of the service and identify where improvements were needed to ensure people received safe, good care as a minimum.

Procedures for controlling the risk of infection were not embedded in staff working practices and were not effective in supporting the prevention of infection for people.

Where people were at risk of poor nutrition or dehydration, records were not completed accurately or correctly to show people had received nutrition and fluids in line with their assessed needs. People were positive about the quality and choice of meals provided.

Records did not reflect that all potential risks to people had been assessed appropriate, and did not include the detail and guidance regarding the measures staff needed to take to reduce risks. Staff demonstrated a good understanding of actions they needed to take to keep people safe.

Care plans were not always updated in a timely manner and records did not consistently provide the detail and information staff needed to meet people's needs. The registered manager was in the process of reviewing and updating care plans and records.

People were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. There were enough staff available to meet people's needs as assessed in their care plans.

Staff had completed a range of training to provide them with the knowledge and skills they needed to meet people's needs. Training records were not maintained accurately or fully completed to support the effective analysis and monitoring of staff training.

People were supported to access a range of health professionals to maintain their health and well being. The service worked in partnership with other agencies to ensure people received the care and treatment they needed.

People's needs were assessed prior to them using the service. People were supported to make choices and decisions about their care. Staff understood the principles of the Mental Capacity Act 2005, sought consent before providing care and respected people's right to decline care and support.

People were treated with kindness, respect and compassion and were given emotional support when needed. Staff supported people to achieve as much independence as possible and protected people's right to privacy and dignity.

People and their relatives were involved in planning their care and were able to make changes to how their care was provided.

People had access to a range of varied activities and were supported to be involved in their local community. People maintained contact with their friends and family and were therefore not isolated from those people closest to them.

People understood how to raise concerns and complaints and were confident these would be listened to and acted on.

The registered manager and the registered prov

Inspection carried out on 21 February 2017

During a routine inspection

This inspection visit was carried out on 21 February 2017 and was unannounced.

We last inspected Lester Hall Apartments in July 2014 and found the service was meeting the requirements of the regulations.

Lester Hall Apartments provide care for up to 33 people with a range of needs which include mental health needs, physical disabilities, dementia and drug and alcohol dependency. The service is based in a large residential property that has been converted to provide apartments and spacious communal areas. It is situated close to the village of Wigston in Leicester. At the time of our inspection visit there were 28 people using the service.

The service 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.

People were kept safe from the risk of harm. Staff knew how to recognise signs of abuse and who to raise concerns with. Risks to people's safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessments and promoted people's safety, although some risk assessment records required further development to provide the detail staff needed to keep people safe.

There were enough staff to provide safe and effective care. Staff were skilled in meeting the needs of people using the service including how to respond when people became distressed or agitated.

People's medicines were managed in a way that kept them safe. People received the medicines they needed when they needed them.

Staff told us they felt supported in their roles and the registered manager and provider gave clear guidance and leadership. Staff had completed the training and qualifications they needed and we saw they used this knowledge to provide people with safe and effective care.

Staff were knowledgeable of and acted in line with the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing care and support and respected people's right to decline care. Care plans required further development to include the support people required to make specific decisions, for example in relation to their healthcare. This is important to ensure people have the support they need to make their own decisions.

People had their health and social needs assessed and care plans were put in place to meet their needs to guide staff on how best to meet these. People were supported to have sufficient to eat and drink and access a range of external health professionals. This meant that people were supported to remain as healthy as possible.

We saw positive relationships between people and staff who were caring and attentive in their approach in meeting people's needs. Staff demonstrated that they knew people well and took time to chat with them and provide reassurance. Staff promoted and upheld people's privacy and dignity and respected people as individuals.

Care plans included information about people's needs, preferences, life history and how they preferred their care to be provided. Staff used the information they had about people's interests and preferences to tailor their care and support. Care plans were regularly reviewed and updated to reflect changes in people's needs. This meant that people received personalised care that reflected their preferences and met their needs.

People were supported to take part in a range of activities to meet their social needs. People had been asked what was important to them and how they liked to spend their time. Staff used information to plan the activities provided. This meant people were able to spend their time in the way they preferred.

People and relatives were provided with opportunities to be

Inspection carried out on 7 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was unannounced which meant the provider was not aware we were visiting. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Lester Hall Apartments is a care home that provides accommodation for up to 20 people with a range of needs which include old age, physical and mental health and alcohol and drug dependency. Each person has their own apartment. There were 20 people using the service at the time of our inspection.  

The service had a registered manager.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe at the home and that they were well cared for. Staff knew how to recognise and report signs of abuse. Staff understood the risks associated with people’s care and protected them from harm. Staffing levels were based on people’s and enough staff were on duty to meet the needs of people who used the service. The provider’s recruitment procedures ensured as far as possible that only people suited to work at the service were recruited.

Staff had received appropriate and relevant training to be able to meet the needs of people who used the service. Staff had a good understanding of people’s needs and they had supported people in line with their care plans. Senior staff understood the relevance of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).  This is legislation that protects people who lack mental capacity to make decisions and who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. DoLS had been authorised for two people who used the service.

All of the people we spoke with told us that they enjoyed the food at the service. People with special dietary needs had those needs met. 

The provider worked closely and effectively with health and social care professionals to ensure that people’s health needs were met. 

Staff treated people with kindness and consideration. People and their relatives were able to express their views about their care and support to the management team and staff. People had been supported to access advocacy services. People’s privacy and dignity had been respected. Staff respected people’s cultural backgrounds and supported them appropriately. Staff understood the individual needs of people they supported. People’s views, and their relative’s views, had been sought and acted upon. That had been through regular surveys, resident’s meetings and daily interaction with people.

The provider promoted a culture that put people’s needs at the centre of decision making. Staff knew how they could raise any concerns about the service. The registered manager understood their responsibilities and had ensured that staff understood what the aims of the service were. The provider had effective procedures for monitoring and assessing the quality of service.

    

Inspection carried out on 8 August 2013

During a routine inspection

People we spoke with in many instances had lived at Lester Hall Apartments for many years. All told us that in the main they were happy with the care and support they received from staff and felt they had good access to health care professionals. People told us they were happy with the accommodation and for some having their personal space was very important to them. People told us they were happy with the meals provided.

People gave conflicting information as to their awareness of their care plan. People in some instances said they had a keyworker who was supportive whilst others said they didn�t think a keyworker was necessary to them. Others said they would like to have a keyworker. People�s understanding and awareness of advocacy services and raising concerns and complaints was mixed.

People in some instances told us they preferred their own company and chose to remain in their room, whilst others told us they enjoyed taking part in the activities at the service. On the day of our visit we saw a number of people taking part in a game of pool, dominoes, cards and bingo. We also saw people going out in the community either by themselves or accompanied by staff or friends and relatives. People in some instances told us that at times they felt isolated and would benefit from being encouraged to take part in activities.

We looked a range of records which included a number of people�s care plans around consent to care and treatment and nutritional and hydration needs. Care plans were in place and had been regularly reviewed. Records recording staff training were up to date.

Inspection carried out on 2 October 2012

During a routine inspection

We spoke with six people who use the services of Lester Hall Apartments. They spoke to us about their experiences and views of the service. People�s comments were positive and included - �with (provider�s name) and the carers it�s like a family firm and they take ever such good care of you.� And �I am very comfortable here; I have my own apartment and can come and go as I please.� People told us how they spent their day. One person told us �I play scrabble with the social skills lady on Tuesdays and Thursday, we play �themed� scrabble. They also take me to the local shops.� A second person told us: - �I like to spend time in my apartment watching television I also go out to the shops with the social skills lady; I recently went to the supermarket to buy some essentials things

Records showed that the service supported people to access a range of health care professionals who work with the staff of the home to monitor and promote people�s health. Monitoring of people�s health included regular reviews with a range of health care professionals. People's diversity, values and human rights were respected. The service supported people to access advocacy services and had used legislation which included the Mental Capacity Act to promote people�s safety and welfare where people were unable to make an informed decision for themselves.