Leabrook Lodge Limited

Leabrook Lodge Limited is an extra care housing scheme that provides personal care and support to people living in their own bungalows in a large community. The office base was on site and staff were on hand 24 hours a day to respond if required.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection 1 person was receiving personal care.

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

People were not safe as the provider failed to identify and assess the risks associated with their care and support. The care and support plan failed to provide staff members with the information needed to ensure people received safe care which met their needs.

People could not be assured they received their medicines safely. The provider failed to complete protocols identifying the specific medicines people took including the provision of ‘as required’ medicines.

The provider did not have effective systems in place to review incidents, accidents or significant events to see if something could be done differently.

The provider did not have effective systems in place to identify improvements and drive good care. People were not asked about their experiences of care or effectively engaged with developing the service they received.

People were protected from the risks of ill-treatment and abuse as staff had been trained to recognise potential signs of abuse and understood what to do if they suspected harm or abuse. However, the provider needed to provide people, relatives and visitors with information on how to raise any concerns they had.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests; the application of the policies and systems supported good practice.

People were supported by staff who arrived when expected and stayed for the agreed amount of time. The provider followed safe recruitment checks when employing staff.

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

Rating at last inspection.

The last rating for the service under the previous provider was good, published on 28 August 2019.

Why we inspected

The inspection was prompted in part due to concerns received about the overall management of the service. A decision was made for us to inspect and examine those risks.

This report only covers our findings in relation to the key questions safe and well led.

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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

You can see what action we have asked the provider to take at the end of this report.

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

Enforcement and Recommendations

We have identified breaches in relation to keeping people safe and with the overall management of the care provision.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection nine people were receiving personal care.

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

People received care that was responsive to their needs and were supported by kind and caring staff that knew them well.

People and a relative felt staff were kind, compassionate and respectful towards them. They described how they trusted and felt safe with the staff.

Staff received the training and support they needed to carry out their role and provided flexible care and support in line with a person's needs and wishes. The staff team was consistent, many of whom had worked at the service a long time.

Staff were aware of people's interests and kept them informed of activities and trips out they may be interested in.

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.

People's needs had been assessed and planned for. Risks which compromised people’s health and well-being were appropriately assessed, reviewed when needed and care plans contained detailed information. People told us they received their medicines on time and that staff supported them to access healthcare support when needed.

People and staff felt listened to and that the service was managed well.

Everyone we spoke with was complimentary about the service.

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 good (published 24 September 2016).

Why we inspected

This was a planned inspection based on our inspection programme.

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.

Leabrook Lodge is a domiciliary care agency that provides personal care and support to people living in their own homes based at Meadowbrook Court. Meadowbrook Court is a complex of 60 privately owned bungalows on one site. The service operates a 24hour on call system with a minimum of two staff on duty throughout the day and night. At the time of our visit the agency was providing the regulated service of personal care to 17 people. The frequency of visits and duration across the service varied dependent on individual needs and circumstances.

There was a registered manager in post who was present during the inspection. 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 supported to remain safe in their own homes. Staff were knowledgeable about the different signs of abuse and who to report concerns to. Staff were aware of the risks associated with people’s needs and how to reduce these without restricting their independence. The provider ensured that potential new staff were suitable to work with people before they started working with them. There were enough staff to meet people’s needs in a timely manner.

People received support to take their medicines as prescribed and accurate records were maintained. Only staff who had received training in the safe administration of medicine could support people to take them. Staff knew what action to take if they found people to be unwell when they visited and would arrange health care as required.

People were confident in staff knowledge and ability to meet their needs. Staff received the appropriate training and guidance to meet people’s individual needs. Staff felt valued and listened to.

Staff sought people’s consent before supporting them. Staff explained things to people in a way they could understand to allow them to make decisions for themselves.

Staff were aware of people’s dietary needs and ensured they ate and drank enough to meet their nutritional needs. Staff prepared and served meals and drinks as required.

People were supported by staff who were caring and kind. Staff had formed positive working relationships with people. Staff talked with and about people with respect. People were given choices and involved in decisions about their care. Staff treated people with dignity and promoted their independence.

People received personalised supported from staff who knew them well. Staff provided individualised care that respected people’s needs and wishes. People received a flexible service which was responsive to changes in their needs or circumstances.

People had not had cause to complain but felt able to report any concerns to the registered manager and were confident they would take appropriate action. The provider had a complaints process and were able to demonstrate they would take appropriate action in the event of a complaint.

People knew the registered manager well and found them approachable. There was a positive working culture where staff and management worked together to meet people’s needs and wishes. The registered manager sought the views of people and staff to develop the service. The registered manager had checks in place to monitor and improve the quality of care.

At our August 2013 inspection progress had been made with regard to an improved recruitment process and the development of regular audit systems to monitor the quality of the service. Records we sampled were accurate and regular reviews of people's care planning documentation had been undertaken.

We visited to see if the service had addressed the issues identified at the last inspection in August 2012. We found little or no progress had been made despite an action plan telling us they had been completed by December 2012.

People were satisfied with the way that care was delivered. They were very positive about the staff that cared for them. Relatives were very satisfied with the agency. One person said they were, "Absolutely delighted with the service". They said staff and the manager were, "Fantastic", and always helpful.

Care plans detailed people's needs and how staff should deliver support. Staff knew what care people needed. Care plans and risk assessments were not always updated when people's circumstances changed.

People had prompt and appropriate access to healthcare professionals when necessary.

Staff files were now kept in the office but there had been no progress in making sure that effective recruitment systems were in place. People spoke highly about the staff and they were described as a, "Very good team, who do anything for me".

The service did not have any quality assurance or audit tools in place to enable the manager to monitor and assess the quality of the service. This meant that there were no systems to evaluate the agency's records or identify measures to reduce potential risk.

People were treated as individuals. Staff were aware of some equality and diversity issues and took them into account when planning people's care.

Detailed care plans guided staff on people's preferences, equipment and how staff should deliver support.

People had access to health and medical care whenever necessary and systems were in place to share information with other services when people had to go into hospital or care homes.

People were confident about raising any concerns with the agency. The manager and staff were clear on procedures to keep people safe. People said that they felt safe with staff, however insufficient evidence was provided to demonstrate that appropriate recruitment checks were in place before staff started work.

There were no quality assurance systems in place so that the agency could find out what people who use the service think about it. There were no audit systems in place to evaluate the agency's records or identify measures to reduce potential risks.

Some but not all records about people were kept securely in the office and people had a copy of their own plan. However, care plans and risk assessments were not always updated when circumstances changed to keep people safe and well.