Lancaster Court Residential Care Home

Lancaster Court is a residential care home that provides accommodation and personal care for up to 30 people some of whom were living with dementia. At the time of our inspection, there were 27 people using the service.

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

People received care and support from the right amount of suitably skilled and qualified staff. People told us there were enough staff to assist them and that they felt safe with staff and trusted them. The recruitment of new staff was safe. Applicants suitability and fitness was thoroughly checked before they were offered a job.

Risk assessments were completed, and measures put in place to minimise the risk of harm to people and others. Regular safety checks were carried out on the environment and equipment. People told us staff provided them with safe care and support.

There were processes for protecting people from the risk of abuse. The registered manager and staff knew the signs and indicators of abuse and the procedures for reporting allegations of abuse to other agencies.

Safe infection prevention and control practices were followed to minimise the spread of infection, including those related to COVID-19.

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; the policies and systems in the service supported this practice.

The culture of the service was positive and inclusive. People received person-centred care and experienced good outcomes.

People, family members and staff were complementary about the way the service was managed, they described the registered manager as supportive and approachable and felt involved and listened to.

The systems used to assess, monitor and improve the quality and safety of the service were effective.

There was good partnership working with others to make sure people received joined up care.

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 good (published 27 October 2017).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

We undertook a focused inspection to only review the key questions of Safe and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has stayed the same based on the finding from this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

• Staff were wearing the required personal protective equipment (PPE). They were aware of the correct process for the use and safe disposal of PPE in accordance with the relevant national guidance. Staff uniforms were laundered on the premises.

• A testing programme was in place to frequently test staff and people living at the home.

• The environment was clean and hygienic. Cleaning schedules were in place and touch-point cleaning was carried out frequently throughout the day. An environmental audit was undertaken three times a day and a more detailed audit each week.

• Family and friends were tested when they arrived for their pre-booked visit to their loved one. They were provided with PPE and the visiting guidance. A dedicated visiting room was located close to the front door and it was cleaned after each visit.

• In the absence of chiropody, the staff provided people with foot massages. In addition, one of the care staff with hairdressing experience had taken on the role of hairdresser as this was a need identified for people living at the home.

Situated in Birkdale, Southport, Lancaster Court is a residential care home that offers accommodation and support for up to 30 people. The home is spread across three floors including a basement. Car parking is available at the front of the building and there is a garden to the rear of the building. At the time of our inspection, there were 25 people using the service.

At the last inspection on the 25 January 2017, we found that the provider was no longer in breach of regulations identified on the 2 September 2016 and improvements had been made. However, we rated the service as 'requires improvement' because we needed to see a longer track record of sustainability before the rating could be improved.

During this inspection, we found that these improvements had been maintained.

We saw that fire procedures in the event of an evacuation were clearly marked out, and regular mock fire drills were completed. However, we found that people’s personal emergency evacuation plans were not sufficiently detailed. We have made a recommendation regarding this.

We looked at records which showed that staff assessed risk to people and information was updated regularly. We suggested that the provider introduce a new analysis chart to capture trends in relation to accidents and falls. Following our inspection visit, we received confirmation that this had been done.

Staff had received training in ‘Safeguarding’ to enable them to take action if they felt anyone was at risk of harm or abuse and understood the reporting procedures.

We saw that medicines were given to people on time by staff that had been appropriately trained and people told us they were happy with their medicine management.

Our observations showed people were supported by sufficient numbers of staff. This was confirmed by people we spoke with. The registered manager had systems and processes in place to ensure that staff who worked at the service were recruited safely.

Staff were assisted in their role through induction, supervisions and an annual appraisal and staff told us they felt well supported. The registered manager provided us with a staff training plan and this showed staff received training to ensure they had the skills and knowledge to support people living at Lancaster Court.

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

The service operated within the principles of the Mental Capacity Act 2005 (MCA). We found that consent was sought before providing care. Staff completed mental capacity assessments and Deprivation of Liberty authorisations were applied for appropriately.

The food served at Lancaster Court was of a high standard. Staff knew, and catered to, people’s individual dietary needs and preferences.

People we spoke with were complimentary about the staff and the service in general. We observed interactions between staff and people living in the home to be warm and familiar. Staff supported people in a kind and compassionate manner.

Staff knew people’s likes, dislikes and social histories. Care plans contained good information regarding people's preferences, likes and dislikes.

People were supported to share their views about Lancaster Court through the use of ‘resident meetings’. People had access to a complaints procedure which provided relevant contact details should people wish to make a complaint.

People told us they took part in a range of activities, some of which were organised social events in the community. The service supported people to pursue their own interests such as attending the opera and the theatre.

Arrangements were in place to seek the opinions of people who lived at the home, so they could provide feedback about the home. Annual surveys and staff questionnaires were issued to capture people’s views regarding the service.

The service had a registered manager in post. We received positive feedback about the registered manager from staff, people who lived at the home and their relatives. People described the registered manager as “lovely”, “approachable” and “supportive”.

The registered manager had put in place a series of audits (checks) to monitor the quality of the service and improve practice. The registered manager was a visible and active presence at Lancaster Court and maintained oversight of the service.

The registered manager took on board feedback and responded promptly to suggestions made in order to improve the service.

Further information is in the detailed findings below.

Lancaster Court is a residential care home in Birkdale, Southport. The service offers accommodation and support for up to 30 people. The home is spread across three floors including a basement. Car parking is available at the front of the building and there is a garden to the rear of the building.

The service was last inspected in July 2016 and at that time was found in breach of four regulations: Regulations 15,13, 11 and 17 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safe management of the premises and equipment at the home, consent, safeguarding and the governance arrangements in the home [how the home was being managed]. We served a warning notice regarding premises and equipment.

This inspection was ‘focussed’ in that we only looked at the four breaches of regulations to see if the home had improved and the breaches were now met. This report only covers our findings in relation to these specific areas / breaches of regulations. They cover only three of the domains we normally inspect; whether the service is 'Safe' ‘Effective’ and ' Well led'. The domains ‘Caring’ and ‘Responsive’ were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Lancaster Court Residential Care Home' on our website at www.cqc.org.uk.

On this inspection we found improvements had been made and the home had taken action to address the issues identified with regards to the environment. In addition, the provider had reassessed people to establish whether they required a DoLS application and this process was much clearer. We saw that people who may be subject to DoLS had the applications in place. For people who could not consent to decisions about their care and treatment, we saw that the registered manager had followed the process to make decisions in people’s ‘best interest’. Quality assurance systems in place to monitor and improve standards in the home had also been improved. These breaches of regulation and the warning notice were now met.

There was 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.

We spent time looking around the home to check if the areas identified in our last report had been improved. During our last inspection we were concerned regarding the premises and equipment in the home. We felt people were at risk and served a warning notice to the provider to make the required changes within a specified timeframe. We checked this as part of this inspection. We saw there were systems in place to monitor the environment and any required repairs and maintenance was completed, this included a full refurbishment of the sluice room. Carpets had been replaced with flooring across the home, and new window restrictors had been fitted to windows. The registered manager had taken on a laundry assistant to take responsibility for the task of cleaning people’s clothes so there was a minimal chance of cross contamination. The warning notice had been met. We have revised the rating for the safe domain from 'Inadequate' to 'Requires Improvement' as the provider was able to evidence these changes were sustainable.

During our last inspection we found that some people who may require DoLS to be in place did not have them, which meant that people were unlawfully being restricted of their liberty. We found the provider in breach of this regulation. The provider sent us an action plan detailing what action they were going to take and we checked this as part of this inspection. We saw that all people who lived at the home had been re-assessed individually and appropriate applications to the Local Authority had been made. The provider had followed the principles of the MCA with regards to this and this was clearly documented in people’s care plans. The provider was no longer in breach of this regulation.

During our last inspection we found that some people were not protected from improper use of restraint. This was because best interest processes had not been followed for people who were unable to give consent due to a lack of capacity. We found the provider was in breach of this regulation and told the provider to take action. The provider sent us an action plan detailing what action they were going to take, and we checked this as part of this inspection. We found during this inspection that for people who lacked capacity appropriate legal processes had been followed and decisions had been made their ‘best interests.’ The provider was no longer in breach of this regulation.

During our last inspection we found that the quality assurance procedures were not robust as they had failed to identify the areas highlighted by us during our inspection process. We found the provider was in breach of this regulation and told the provider to take action. The provider sent us an action plan detailing what action they were going to take, and we checked this as part of this inspection. During this inspection we saw that the provider was able to evidence a series of quality assurance processes and audits carried out internally by the registered manager. We found these had been developed to meet the needs of the service. The provider was no longer in breach of this regulation.

While improvements had been made and we have revised the rating for the 'safe' domain from 'Inadequate' to 'Requires Improvement' we have not revised the overall quality rating for the home. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review the quality rating at the next comprehensive inspection

Lancaster Court is a residential care home in Birkdale, Southport. The service offers accommodation and support for up to 30 people. At the time of the inspection there were 26 people living at the home. The home is spread across three floors, including a basement. People living at the home have access to a large rear garden and paved areas.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since April 2012. A registered manager is a person who has registered with the CQC 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 said they felt safe living at the home and said the staff treated them well. Staff had received training with regard to safeguarding issues and demonstrated an understanding of potential abuse. They told us they would report any concerns to the registered manager. We found a number of issues with the premises and equipment at the home. Some windows did not have restrictors or devices that met with current Health and Safety Executive guidance for care homes. No risk assessments were in place. Small electrical items had not been recently checked to ensure they were safe to use and fire extinguishers were immediately due checks.

Some areas of the home were not clean. Bathrooms and toilets required cleaning and some rooms had unpleasant odours. Some commodes used at the home were rusted and could not be cleaned effectively. A sluice area at the home was in need of cleaning and updating and had been left unlocked, meaning there was public access and a risk of infection. Clean clothes were left to dry in the laundry area or near the kitchen facility.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people at the home. People said they did not have to wait long for support. However, the manager did not carry out an assessment of people’s dependency meaning we could not be sure the right levels of staff were always available. Medicines were handled safely and effectively and stored securely.

Most people told us they were happy with the standard and range of food and drink provided at the home and could request alternative dishes, if they wished. Kitchen staff had knowledge of specialist dietary requirements. Soft or pureed diets were not always served in a manner that supported people’s dignity.

People and relatives told us they felt the staff had the right skills to look after them. Staff confirmed they had access to a range of training. Staff told us, and records confirmed that regular supervision took place and they received annual appraisals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The manager told us no one at the home was subject to a DoLS. However, no formal assessment had taken place to ensure people did not meet the criteria for a DoLS application. It was not always clear from records that decisions about people’s care had always been taken in line with the MCA and best interests guidance.

People’s health and wellbeing was monitored, with regular access to general practitioners and other specialist health or social care staff.

People told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff demonstrated an understanding of people’s particular needs. People said they were treated with respect and their dignity maintained during the provision of personal care.

Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care. A range of activities were offered for people to participate in including; entertainers visiting the home and group events. People could also spend time pursuing their own interests if they so wished. People and relatives told us they had not made any recent formal complaints and would speak to the registered manager if they had any concerns.

The registered manager told us she carried out regular checks on people’s care and the environment of the home. These audits and checks had not identified the short falls highlighted at the inspection. Staff were positive about the manager and the homely nature of the service. They said management were approachable and supportive. People told us there were regular meetings at which they could express their views or make suggestions to improve their care. A quality audit of people’s views was overwhelmingly positive about the home. Records were well maintained and up to date.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Safe care and treatment, Safeguarding, Need for consent and Good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, spending time with people who lived at the home, talking with their relatives, staff providing support, talking with health and social care professionals and looking at records.

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

Is the service safe?

Effective arrangements were in place to ensure the people living at the home were protected against the risks of receiving care and support that was inappropriate or unsafe.

Sufficient numbers of staff were on duty at all times to keep people safe and meet their needs.

Arrangements were established to ensure the building was clean and that people were protected from the spread of infections.

Is the service effective?

People living at the home were supported to maintain good health and had access to a range of healthcare services when they needed it.

Staff were recruited in a way that ensured they had the knowledge and skills to care for people in a safe and individualised way.

Is the service caring?

During the inspection we observed staff supporting people with their individual needs in a dignified and respectful way. People told us they liked living there and that the staff were friendly and kind. One person said to us, 'It is like staying in a good hotel where they [staff] bring me tea whenever I want one. They arrange for my GP to call here and they are friendly and responsive.'

Is the service responsive?

The care records we looked at were personalised to take account of each person's individual needs and preferences. We observed staff providing personalised care to people during the inspection.

A complaints procedure was in place and we observed that a copy of the procedure was located in each person's bedroom.

Is the service well-led?

Processes were in place for people living at the home to express their views about the quality of the service. These included meetings for people living at the home and an annual feedback questionnaire.

Systems were in place for regularly monitoring the quality of the service. They included a daytime check, evening check and night check. Each check was comprehensive and covered areas, such as health and safety, fridge temperature checks, medication checks, care records and communication.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

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

Is the service safe?

People told us they felt safe. There was refresher training organised for staff in relation to safeguarding and staff understood their role in safeguarding the people they supported.

There was no system in place to make sure that the manager and staff learned from events such as incidents, concerns and investigations. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety.

There were two people with infections and all people living at the home were isolated in their rooms. We found examples of how infection could have been spread by staff not adhering to advice regarding the wearing of gloves and aprons. This was putting people at risk of harm.

We were unable to look at the recruitment of new staff. This was because the manager was on leave and all staff files were locked away and no responsibility had been delegated to the assistant manager. We were unable to confirm that recruitment checks into qualifications and experience were being followed and could not determine if this put people at risk of being supported by staff without the appropriate skills.

Staff we spoke with demonstrated good understanding of the importance of respecting human rights and involved the people who used the service in decision making about their care and treatment. Staff we spoke with confirmed they had received no specific training to date in relation to the Mental Capacity Act (2005) or Deprivation of Liberties (DoLS).

DoLS Safeguards are part of the Mental Capacity Care Act 2005.They aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom.

Of the twenty five people living at the home there were five people who lacked capacity to make their own decisions. The assistant manager told us there were policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although was unsure if any applications had needed to be submitted as this information was held by the manager. This means we were not able to confirm that people will be safeguarded as required.

The assistant manager was able to explain what measures were in place for the five people who lacked capacity e.g. one person had a solicitor appointed with power of attorney and they were invited to all meetings and informed of any changes. Whilst other people's family members acted in their best interests and this was documented.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events, infection control and recruiting new staff.

Is the service effective?

People's health and care needs were assessed but they were not always involved in writing or reviewing their care plans. Some people were not aware of what was in their care plans. Specialist dietary needs were not always re-assessed. Some of the assessments and objectives in the care plans had not been reviewed regularly and certain information was held separately by the manager. Agency care workers were not encouraged to read care plans. Care plans were therefore not able to support staff consistently to meet people's needs.

People's mobility and other needs were taken into account in relation to building adaptation, enabling people to move around freely and safely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers gave encouragement when supporting people. People commented, 'I think they're wonderful they've got great patience, they look after you, treat you as an individual with care and attention'.

People using the service completed an annual satisfaction survey to give them a Prestige Quality Rating (PQR). They achieved 5 stars which was the highest rating achievable. The registered manager was on annual leave and we were unable to tell if they had been given recommendations to take any actions.

People's preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people's wishes.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care and ensuring care plans are up to date and all information is included and accessible to all staff.

Is the service responsive?

We looked at the care plans and whilst an assessment was undertaken prior to admission by the registered manager which provided baseline information, personal objectives and risk assessments (for example in relation to diet and nutrition) were not reviewed in line with any changes to care. This meant that changes were not communicated to staff and they were not fully informed about the person's needs.

We have asked the provider to tell us what improvements that will make in relation to reviewing individual risk assessments and objectives.

Is the service well-led?

The registered manager was on annual leave and had not delegated responsibility to the assistant manager. The assistant manager was not able to access policies, procedures, certain aspects of the care plans or any staff files or any information stored electronically.

There were no formal staff meetings, and whilst the staff assured us they felt supported and the registered manager operated an open door policy we were not assured that any shortfalls identified had been addressed. The system in place did not systematically ensure that staff were able to provide feedback to their managers, so their knowledge and experience was not being properly taken into account.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

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

We asked the people we spoke with about how the service managed their health care needs. Both people said the service managed their health needs very well. We were also told they were always treated with dignity and respect by the staff.

We found improvements had been made since our last inspection in November 2012 when we had concerns over a lack of information for staff to report safeguarding concerns and that records were not held securely. Staff now had all the information they needed to respond appropriately to safeguarding concerns and had received adult safeguarding refresher training. We found records were now all held securely.

People said they were usually treated with dignity and respect. One person said, 'If you need to ring the bell for assistance they [the staff] always come quickly.' People told us they enjoyed the food and there was always a choice available. One person said 'The food is excellent. You get lots of choice and it is all home made.'

People told us there was a good range of things to do including exercise classes, visiting entertainers and quizzes. Residents meetings were also held, which people said they valued.