Archived: Lambourne House

Lambourne House is a care home for nine adults with a learning disability and or autistic spectrum disorders. At the time of our inspection there were nine people living at the service. The service was provided from a domestic style nine-bedroom house over two floors. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered person’s'. 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Relatives told us they felt their family members were safe living at Lambourne House. Staff described procedures that were in place to safeguard the people they supported. They fully understood the safeguarding policies and procedures and felt confident to raise a concern and thought they would be listened to. Risks to people's safety had been assessed and care records contained risk assessments to manage identified risks.

Recruitment systems at the home continued to be safe and robust. There were sufficient trained and competent staff to meet people's individual assessed needs. The staff were supported by the management team through on-going supervision and team meetings.

People received their medicines as prescribed and staff knew how to manage medicines safely.

The design and layout of the building was hazard free and met the needs of people who lived there. All areas of the home were clean and in a good state of repair with equipment maintained.

People received care that was personalised and responsive to their needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were involved in the planning of meals and menus. They received appropriate nutrition and hydration support to maintain their health and wellbeing.

We observed kind and caring interactions between people and staff. People living in the home praised the caring nature of the care staff and registered manager. People were involved in planning their care and supported to engage in meaningful activities of their choice.

The registered provider had a clear complaints policy and procedure that people and their relatives were familiar with and felt confident any concerns would be listened to.

The registered manager was accessible, supportive and had good leadership skills. Staff were aware of the values of the provider and understood their roles and responsibilities. Morale was good within the workforce.

The service had a quality assurance system and shortfalls were identified and addressed. There was a culture of listening to people and positively learning from events so similar incidents were not repeated. As a result, the quality of the service continued to develop.

Further information is in the detailed findings below.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

People felt safe with the home’s staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm. Risks to people’s safety had been assessed and care records contained risk assessments to manage identified risks.

People were supported to take their medicines as directed by their GP. Records showed that there were appropriate arrangements for obtaining, storing and disposing of medicines.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained at a level to meet people’s needs safely. Relatives and staff told us there were enough staff on duty and observations also confirmed this.

Food at the home was good. There was a four week rolling menu displayed in the kitchen. People had regular meetings where they had an opportunity to discuss and plan menus. Staff provided support to people to help ensure meals were balanced and encouraged healthy choices

Staff were aware of people’s health needs and knew how to respond if they observed a change in their well-being. Staff were kept up to date about people in their care by attending regular handover meetings at the beginning of each shift. The home was well supported by a range of health professionals.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one. The provider had suitable arrangements in place to establish, and act in accordance with the Mental Capacity Act 2005 (MCA). Staff had an understanding of the Mental Capacity Act (MCA) 2005

Each person had a care plan which informed staff of the support people needed. Staff received training to help them meet people’s needs. Staff received an induction and regular supervision including monitoring of their performance. Staff were supported to develop their skills by training such as the National Vocational Qualification (NVQ) or care diplomas. These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard. All staff completed an induction before working unsupervised. People said they were well supported and relatives said staff were knowledgeable about their family member’s care needs.

People’s privacy and dignity was respected. Staff had a caring attitude towards people. We observed staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

The registered manager operated an ‘open door’ policy and welcomed feedback on any aspect of the service. There was a stable staff team who said communication in the home was good and they always felt able to make suggestions. They confirmed management were open and approachable.

There was a clear complaints policy and people knew how to make a complaint if necessary.

The provider had a policy and procedure for quality assurance. The registered manager and her deputy worked alongside staff and this enabled them to monitor staff performance. A locality manager employed by the provider visited the home regularly to carry out quality audits.

Weekly and monthly checks were carried out to monitor the quality of the service provided. There were regular staff meetings and feedback was sought on the quality of the service provided. People and staff were able to influence the running of the service and make comments and suggestions about any changes. Regular one to one meetings with staff and people took place. These meetings enabled the registered manager and provider to monitor if people’s needs were being met.

People who use the service had complex needs and learning disabilities and were unable to tell us about their experience of the care and treatment they received. In order to understand people's experience we reviewed three people's care plans, we spoke to the registered manager and three care staff, observed people with staff and spoke with three people's relatives. We reviewed records related to the management of the home, including staffing and quality assurance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives, and staff told us, what we observed and the records we looked at.

Is the service safe?

People's relatives told us their family members were cared for safely. People's care plans detailed areas of risk and these were assessed and managed to promote people's safety and wellbeing. Staff had a good understanding of people's needs and risks; records showed staff were trained and supported to meet people's individual needs safely.

The provider carried out the relevant checks to ensure staff were of good character with the skills and experience needed to support people living in the home. One relative said, "Staff are very attentive and well trained, they can spot whether there is anything amiss with my relative and they call whoever is needed. They are very proactive."

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. At the time of our inspection applications had been submitted to review whether the arrangements for people's care and treatment in the home amounted to a deprivation of their liberty. This was in response to a recent Supreme Court judgment and the provider was taking appropriate action to ensure the human rights of people using the service were protected.

Staff were trained in safeguarding vulnerable adults and the appropriate procedures were followed when concerns arose.

Is the service effective?

It was clear from our observations and from speaking with staff that they understood people's care and support needs and knew them well. Staff were able to describe people's communication needs and how they used a variety of methods to support people's understanding. One staff member said, "I pay attention to how people respond to me and I try and put myself in their shoes to understand how they are feeling". A relative said, "They (staff) always discuss with residents what they want to do and make sure they live life to the full, I couldn't have wished for a better place."

When people did not have the mental capacity to make some decisions the provider followed the appropriate procedures under the Mental Capacity Act (2005). People were supported by their relatives, staff, other professionals and independent advocates to make decisions in their best interests.

Care plans were personalised and reflected people's individual needs, preferences and goals. Care and treatment was reviewed and monitored for its effectiveness and we saw people were supported to achieve their goals.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff treated people with dignity and respect and showed patience and encouragement when supporting people. One relative said, "Staff are very caring and proactive, nothing is too much trouble. I find the residents are very content and relaxed there." Another relative said, "They try to do the best they can for the residents. I have confidence in them."

Is the service responsive?

Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People were supported to participate in a range of activities within the community and people were supported to maintain relationships with their friends and relatives. We saw evidence people were supported by a range of providers. For example; people were supported by a range of healthcare professionals to meet their physical and mental healthcare needs.

Is the service well led?

Quality assurance processes were in place. This helped to ensure the provider could identify where improvements were required to deliver a good quality service. Records showed people and their relatives were asked for their feedback on the service and their comments were acted on. One relative said, "I like the way the home is run it is very well thought out." Another relative said "I get a questionnaire twice a year but you can call and voice your opinions at any time. If you have a problem you can talk about it and we have regular review meetings."

Staff told us they were supported by their managers. One staff member said, "I am very well supported. The manager and seniors do shifts with you they are not just office based they work alongside the team and we all communicate well with each other." Records showed effective communication systems were in places to ensure staff were updated on important information about people and the service.

We spoke with a relative who told us that they were very happy with the service provided to their family members. They said, "As a family we feel so lucky to have found this place. We would recommend it to anyone looking for a home. It has brilliant staff and is welcoming and friendly".

We spoke with two staff members during this inspection. Both demonstrated an in-depth knowledge of the needs of the people they supported. The staff we spoke with told us that they had a good level of training, including an induction and they were encouraged to develop their skills. They also told us that they felt supported in their work and had regular supervision.

We found that the provider had addressed the concerns raised at the last inspection of this service. Consultation had taken place concerning the locked doors in the home with outcomes documented in people's care plans. We found that people were supported to access all areas of the home during our inspection.

We found that people were not always involved in decisions about their care and treatment. We saw that restrictions were in place which meant people could not access many areas of their home. Records showed that most people had not been asked about this.

We found that people had care plans and risk assessments in place which met their individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

The provider employed sufficient staff to meet the current needs of people at the home. Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.