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Inspection report

Date of Inspection: 30 April 2014
Date of Publication: 17 July 2014
Inspection Report published 17 July 2014 PDF


Inspection carried out on 30 April 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to follow up on compliance actions issued at our last inspection in January 2014, to look at additional outcomes and to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had not needed to make any applications but there were policies and procedures in place and the manager had been trained to understand when an application should be made and, how to submit one. We were told that arrangements would be made for the staff team to receive training on this subject. There were shortfalls in record keeping in relation to the management of some medicines.

A number of staff personnel files did not contain all required pre-employment checks. This meant that the provider could not demonstrate that staff employed to work at the home were suitable. There was no system in place to demonstrate that all staff received regular supervision. A number of records were misplaced, some were found over the course of the day and others could not be located. This meant that the home was unable to demonstrate that they were meeting the standards in these areas.

Is the service effective?

People told us they were happy living at Lucerne House and that their needs had been met. Staff had a good understanding of people�s needs and it was evident that they knew people well. If people had complex needs, specialist advice and support had been sought to assist staff. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were treated with respect and staff were courteous. They explained to people what they were doing and offered them a choice of a variety of activities. We saw that staff supported people to achieve their wishes. For example, one person in supported living told us, �I swapped my bedroom and lounge around so that I have a bigger bedroom and a smaller lounge. We don�t use the lounge much and I needed more space so we had a meeting and agreed to do it. We like the way it is now.�

Is the service responsive?

Records confirmed that people�s preferences, interests and diverse needs had been recorded and that care and support had been provided that met their wishes. People had access to activities that were important to them. For example, some people had work placements; some went to college and some, day centres. People were supported to attend religious services, to go to clubs and a disco. They visited friends and invited their friends to visit them.

Is the service well led?

The organisation had arranged for a consultant to support them with addressing shortfalls identified at the last inspection. It was evident that progress had been made in some areas and that systems needed time to be embedded fully. However, there was still no effective system in place to regularly assess and monitor all areas of the home.