Leahyrst Care Home

Leahyrst Care Home is a residential care home providing accommodation and personal care to up to 41 people. The service provides support to older people and people with sensory impairments. At the time of our inspection there were 36 people using the service.

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

Quality assurance processes were not always effective in identifying concerns and areas for improvement. People's care plans were not always reflective of people's current care needs and risks and care plan audits had not identified areas that required improvement. Environmental risks and some checks had not been regularly documented.

Medicines were safely stored. People received support with their medicines from staff members who had been trained and assessed as competent.

People were supported by enough staff who were available to assist them in a timely way. 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.

The provider had assessed the risks associated with people's personal care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm. However, some records contained conflicting information.

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 referred to additional healthcare services if needed and staff were knowledgeable about any recommendations or treatments.

People were supported by staff members who were aware of their individual protected characteristics like age, religion, gender and disability.

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 5 February 2021). The service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 remained requires improvement based on the findings of 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.

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 monitor the service and will take further action if needed.

We have identified a continued breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Leahyrst Care Home is a residential care home providing personal and nursing care for up to 41 people aged 65 and over, some of whom are living with dementia. At the time of inspection 33 people were living at the home.

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

Risks to people’s care were not always managed safely, however, systems to assess and manage risks had improved since the last inspection. Infection prevention and control measures were in place but were not being followed. The manager took immediate action to address concerns on the day. This was followed up by the provider. People told us they felt safe and relatives told us they thought their relations were safe in the home. Medicines were managed safely. Accident and incidents were analysed to check for themes and reduce the risk of reoccurrence.

The provider had taken steps to address issues raised at the last inspection to ensure people’s nutritional needs were met. 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. Staff were aware of people's individual communication needs and respected their wishes and preferences. People's mental capacity and decisions made in their best interests were mostly well recorded. Training was mostly up to date and staff felt well supported.

Staff were kind, patient and caring with the people they supported. However, some of the staff approaches were not always person centred. People were treated with respect and their independence was encouraged. Staff knew the people they supported and how they liked to be cared for. Feedback from relatives about staff's caring manner and approach was very positive.

There was a new enthusiastic activities coordinator in place who planned activities for people specific to people’s interests. Work was in progress to ensure care records were fully reflective of people's needs. There had been no complaints since the last inspection. People's relatives were confident the manager and the provider would deal with any matters of concern without delay.

Systems and processes with which to monitor the quality of the provision were beginning to be established and embedded however, we found concerns in relation to governance. Changes had been made to the management of the service since the last inspection. The manager was developing the culture and communication in the home through the involvement and development of staff. Staff were positive about the manager and changes that had taken place. Improvements had taken place in some key areas, such as redecoration and the replacement of floor coverings.

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 inadequate (published 13 March 2020) and there were multiple breaches of regulation across all domains. The service has been in special measures since March 2020. 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, however the provider was still in breach of the regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

This was a planned inspection based on the previous rating. We looked at infection prevention and control measures under the Safe key question. We look at this in all care homes even if no concerns of risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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 in relation to the safety of the care delivered to people.

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Leahyrst Care Home is a residential care home providing personal and nursing care for up to 41 people aged 65 and over, some of whom are living with dementia. On the first day of our inspection there were 35 people living at the home and on the second day of our inspection there were 33 people. The home has three floors.

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

People did not always receive safe care. During this inspection, we identified and reported several safeguarding concerns. People’s medication was not administered safely, and people did not always have medication available to meet their needs. Risks to people’s care were not managed safely. During this inspection, we could not be sure the equipment used to support people was always safe. The environment was not always clean and free of odours. Staff were not recruited safely.

The provider failed to ensure people's nutritional needs were always met. People were not always supported to eat in a caring or considerate way. Several people living at the home had lost weight and appropriate action had not always been taken in a timely way. People living at the service told us the food was not always appetising or varied.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. We found blanket restrictions for people living at the home. Some people required a deprivation of liberty safeguards, their order had conditions but the provider was not complying with them.

Staff had not been supported to have the appropriate knowledge and skills to deliver safe and effective care. We found training was not kept up to date and staff were not offered regular supervision or appraisal meetings. We found concerns about the staffing levels, in particular during the night period.

People did not always receive person centred and dignified care. Some people's care plans were inaccurate and lacked information about people's needs which meant staff were not provided with clear guidance to support and care for people. People's end of life wishes were not always documented appropriately. Although people and relatives told us staff were kind, our findings did not indicate the home was consistently providing a caring service that always respected people’s needs.

The provider did not have effective processes in place to handle complaints. People were not offered regular opportunities to interact and we found there were no structured activities happening during our inspection visits.

Quality assurance processes were not effective in identifying the issues found at this inspection and in driving improvements. Records were not always accurate, complete or kept safe.

We found widespread shortfalls in the way the service was managed, in particular a lack of management oversight and accountability. There was a risk of people receiving inappropriate care. There was no registered manager. A new home manager had recently been appointed and was in post on the second day of our inspection. The nominated individual did not have good oversight of the day to day running of 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 6 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safety of the care delivered to people, safeguarding people from abuse and neglect, lack of person-centred care, poor support with nutrition and hydration, failure in ensuring adequate and appropriately trained staff and lack of appropriate management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a manager at the service who was registered with Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

Our last inspection at Leahyrst took place on 20 May 2016. Whilst no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found, the service required improvement in some areas. At this inspection we found improvements had been made.

This inspection took place on 19 June 2017 and was unannounced. This meant the people who lived at Leahyrst and the staff who worked there did not know we were coming. On the day of our inspection there were 37 people living at Leahyrst.

People living at the home and their relatives spoke very positive about their experience of living at Leahyrst. They told us they, or their family member, felt safe, were happy and felt respected.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

Staff recruitment procedures ensured people’s safety was promoted.

Sufficient numbers of staff were provided to meet people’s needs.

Staff were provided with relevant training so they had the skills they needed to undertake their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

A programme of activities was in place so people were provided with a range of leisure opportunities.

People said they could speak with staff if they had any worries or concerns and they would be listened to.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

At the last inspection on 12 and 16 November 2015 we found breaches of legal requirements in relation to staffing levels, staff training and supervision. We also found medicines were not managed safely and the systems in place to monitor the service were not effective. We asked the provider to take action to make improvements and this action had been completed.

Leahyrst Care Home is a 41 bed residential care home providing care and support to older people with a range of support needs, including dementia. It is located in a residential area close to Sheffield city centre. On the day of the inspection there were 32 people living in the home.

The service requires 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. On the day of the inspection the registered manager was not working at the service and there was an acting manager in place.

People who used the service told us they felt safe living in the home. Their relatives spoke positively about the standard of care and support their family member received.

Staff knew people well and were aware of their personal needs and preferences.

People who required support with their medicines were given this in a caring and attentive way.

During the day staffing numbers were sufficient to meet people’s needs. Additional staff had been employed to work during the night, but had not started as they were awaiting final recruitment checks to be completed.

Staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

Staff were receiving regular training and supervision so they were skilled and competent to carry out their role.

People said they enjoyed the meals provided to them and that their was plenty of choice. People could chose to eat their meals either in the dining room or their own room. At lunchtime staff were busy taking meals to people which meant some people had to wait to be assisted to eat.

People and their families were involved in making decisions about their care. A range of healthcare professionals visited the home to offer support and advice to staff about people’s varying needs.

Staff and people who used the service were mutually respectful. People were seen enjoying the company of staff and staff spoke with people in a polite and caring way.

Work had started to re-write all care plans. This was to ensure people’s needs were recorded and understood by everyone.

The majority of social activities had stopped being provided as no activity worker was in place. A new activity worker was due to start work imminently.

There was a new manager in place who was working in partnership with other professionals to improve the quality of the service. New audit systems were in place which needed to be maintained so that improvements were sustained.

People, relatives and healthcare professionals had confidence in the managers ability to lead the service.

We saw that people had a care plan in place which considered their mental state and cognition. This gave details on whether the person had insight and the capacity to make decisions. It was regularly evaluated to ensure it remained accurate.

The provider had taken steps to provide care in an environment that is suitably designed and adequately maintained. We checked the property and found that it was well maintained and decorated.

We saw through our observations that staff were skilled and knowledgeable, although steps needed to be taken to embed formal staff supervision within the home.

We checked people's records and care plans, and checked staff files. We found that records were not accurate or fit for purpose.