Archived: Lebrun House

Lebrun House is a residential care home that was providing personal care for up to 20 older people, some living with dementia. At the time of the inspection, 17 people were using the service. One of these people was staying at the service on a short-term basis, otherwise known as respite.

Lebrun House is situated over three floors, with several large communal areas for people to use. This included a lounge, dining-room and conservatory. There was also a garden that we saw people enjoying throughout the inspection. Some bathrooms had been adapted to support people with mobility needs.

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

People told us that staff made them feel safe. A relative told us, “The place is secure but it's discreet. You don't feel that people are locked away. They are supported to go out all the time. And staff really know what they’re doing.” There were enough staff and if people’s needs changed, more staff were provided. Risks to people were identified, regularly reviewed and well documented so that staff knew what was expected of them to keep people safe. The building was maintained with a number of health and safety checks from safe and external professionals. People received their medicines safely from trained and competent staff.

Since the previous inspection, significant improvements had been made to staff training and the environment. Staff received training that was specific to people’s needs, such as dementia, diabetes and epilepsy. A relative said, “My loved one is well looked after, and their needs met thoroughly and with love.” Improvements had been made to the environment to ensure that it was dementia friendly. This included clear signage so that people could move around the building without getting confused. People were complimentary about the food at Lebrun House and their nutritional needs were met. When people were unwell, they were supported to see a variety of health and social care professionals.

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, their loved ones and professionals described staff as “Kind”, “Caring” and “Friendly.” One professional said, “Staff are wonderful, and people very well looked after.” A relative said, “I am very pleased with staff. They are so lovely and work so hard.” The atmosphere in the home was warm, friendly and homely. Staff were mindful of always respecting people’s dignity and privacy. They listened to people’s views and respected their choices about their care. Independence was continually promoted and encouraged by staff.

Significant improvements had been made to activities since the previous inspection. These were tailor-made to people’s preferences and interests and encouraged people to be involved with the community. People told us they enjoyed going out and the various external activity professionals that visited. Staff knew people’s communication needs well and supported them with a variety of person-centred tools. People knew how to complain if they needed to and were given a variety of ways to do so. When people were at the end of their life, staff supported them in a kind and caring way.

Improvements had been made to quality audit processes to ensure good oversight of the service. People, their relatives, professionals and staff felt the service was well-led. They described the registered manager and deputy manager as “Bubbly”, “Very nice”, “Enthusiastic” and, “Welcoming.” Staff told us they had worked hard as a team to overcome difficulties and felt proud of the service it had become. Management were passionate about people’s experiences and sought feedback to improve.

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 requires improvement with one breach of regulation. (Published August 2018). 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 and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Lebrun House provides accommodation and personal care for up to 20 older people, living with dementia. At the time of inspection, 18 people were living at the service.

Bedrooms are located over three floors and can be accessed via stairs or a lift. Communal bathrooms and toilet facilities are available throughout. There are several communal areas; a dining room with adjoining lounge and another lounge area which connects to a conservatory with seating area. There was some garden space, which two people spent time sitting in during the inspection.

At our last inspection in September 2017, the service was rated as Requires Improvement with breaches in Regulation 11 (Need for consent) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated activities). There was a lack of specific mental capacity assessments that did not include the views of people or relevant others. There was also a lack of adequate quality assurance systems and care plans that did not hold person centred information about people. The provider was issued with two warning notices and required to be compliant by February 2018. At this inspection, improvements had been made and Regulations 11 and 17 were no longer in breach. However, we still found some areas for improvement. This is therefore the fifth time that Lebrun House has been rated Requires Improvement overall.

The service had 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.’

The environment, training and activities were not specific for people living with dementia. Although all people living at Lebrun house had dementia related support needs, staff had either not had training or it had not been reviewed since 2015. We found there was a lack of signage around the building to support people to remember where they were. Previous signs used to familiarise and reassure people had been removed. People’s care plans contained detailed information about people’s histories and their preferences, however activities offered to them were not person centred to these. People, relatives and staff told us that they felt activities could be improved and that they wanted opportunities to go out, yet this was not currently happening.

Staff had received a wide variety of training and people and their relatives were confident that staff had the right skills and knowledge to support people effectively. However, staff had not received more specific training required to meet the needs of some people, for example in epilepsy management. We have made a recommendation about this.

We found that consideration had not been made to whether other types of communication would be beneficial to people, such as pictures added to documentation. We have made a recommendation about this.

Although there had been significant improvements to people’s care plans, only half had been transferred to new paperwork and so more time was needed to embed positive changes. There was improvement to the amount of quality audits completed by the registered manager and other external sources. However, there were some issues we found that had not been recognised by the registered manager.

People, their relatives and professionals told us they felt people were safe. Staff demonstrated a good knowledge of how to safeguard people and there were suitable numbers of staff to meet people's support needs. People received their medicines safely. The building was kept safe with a variety of health and safety checks completed by the registered manager and we observed good practise in infection control.

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 procedures in the service supported this practise. People's nutritional needs were met. People told us that they enjoyed the food and any risks that were identified for eating and drinking were highlighted in care plans and also displayed in the kitchen. The provider sought guidance from health professionals where additional support needs were identified. Professionals felt the service were responsive to people's changing needs.

Staff treated people with kindness, compassion and respect and promoted people's independence and right to privacy. People, their relatives and professionals were positive about the staff team who demonstrated their understanding of people's preferences, dislikes and support needs. These were reflected in detailed, support plans for people.

Staff and the relatives were knowledgeable of the complaints procedure and confident they could talk to the registered manager about anything that was worrying them. People’s choices and wishes were respected when planning for end of life care.

People, staff and relatives were positive about the management team and felt they were responsive to any concerns. The registered manager sought feedback from people and their relatives to continually improve the quality of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was no registered manager for the home, however, there was an interim manager in post who was supported by the provider and consultant. Following our inspection the manager informed us she had applied to become the registered manager and was awaiting her interview with CQC. 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 carried out an inspection at Lebrun House in July 2014 where we found the provider had not met the regulations in relation to the safe management of medicines and records. A further unannounced inspection took place on in February 2015 where we found improvements were still required in relation to medicines and records. We also found improvements were required in relation to consent, quality assurance and notifying the commission of the absence of a registered manager. The provider sent us an action plan and told us they would address these issues by June 2015.

We undertook another inspection in April 2016 where we found some improvements in relation to medicines, notifications and consent had been made. However not all legal requirements had been met in relation to records and quality assurance and the provider and registered manager did not have oversight of the service. We found further breaches in relation to risks, care was not always person centred, and there had been no assessment of staff competencies. We met with the provider and registered manager to discuss our concerns and issued them a warning notice in relation to records and quality assurance. A warning notice is part of our enforcement powers. It informs the provider that we may take further action if they do not comply with the notice. It also gives the provider a timescale within which they must comply. For the remaining breaches the provider sent us an action plan and told us they would address these issues by September 2016.

We carried out a further unannounced inspection in December 2016 where we found improvements had been made, however, not all legal requirements had been met in relation to people’s records and mental capacity. The provider sent us an action plan and told us they would address these issues by 10 February 2017.

At this inspection we found there were still shortfalls. People’s care plans did not reflect the person-centred care people required and received. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and applications for Deprivation of Liberty Safeguards (DoLS) had been submitted when required. However, there was no information about how people who lacked capacity were able to make decisions or how restrictions may affect them.

People were supported by staff who were kind and caring. They knew people really well. The understood people as individuals and were able to provide detailed information about the care and support people received. There was a range of activities taking place throughout the day. These included group and one to one activities designed to suit each individual person. People were able to make individual and everyday choices and staff supported them to do this.

Risk assessments were in place and staff had a good understanding of the risks associated with the people they looked after. Medicines were stored, administered and disposed of safely by staff who had received appropriate training. Staff had a clear understanding of the procedures in place to safeguard people from abuse.

There were enough suitably qualified and experienced staff to meet people's needs. Recruitment records demonstrated there were systems in place to ensure staff were suitable to work at the home.

People were given choices about what they wanted to eat and drink. They were supported to eat and drink a variety of food that met their individual needs and preferences. People were supported to maintain good health and had access to external healthcare professionals when they needed it.

We found two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. 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.

We inspected again on 18 and 20 April 2016 where we found some improvements in relation to medicines, notifications and consent had been made. However not all legal requirements had been met in relation to records and quality assurance and the provider and registered manager did not have oversight of the service. We found further breaches; risks associated with supporting people had not always been identified. Accidents and incidents had been documented with the immediate actions taken. However there was a lack of information about follow up actions. Staff had received training but there had been no assessment of competencies to ensure they had understood the principles of what they had learnt. People did not receive person-centred care and there was a lack of stimulation for people throughout the day. We met with the provider and registered manager to discuss our concerns and issued a Warning Notice in relation to records and quality assurance. A Warning Notice is part of our enforcement powers. It informs the provider that we may take further action if they do not comply with the notice. It also gives the provider a timescale within which they must comply. For the remaining breaches of regulation the provider sent us an action plan and told us they would address these issues by 30 September 2016.

We carried out this unannounced inspection on 12 and 13 December 2016. We found some significant improvements had been made, however other areas still needed to be addressed and changes embedded into practice. The provider had engaged the services of an external consultant to support them to make the necessary improvements at the home. There had been a number of changes at the service and the provider and consultant had kept us informed of what was happening before our most recent inspection.

Lebrun House is a care home that provides accommodation for up to 20 older people who require a range of care and support related to living with dementia and behaviours that may challenge. At the time of the inspection 16 people lived there. There was a registered manager for the home however they were not currently working there. There was an interim manager in post who was supported by the provider and consultant. 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 found significant improvements had taken place since our last inspection. There was an audit system, however this had not identified all the shortfalls we found and people’s records did not reflect the care they required and received. However, this did not impact on people because staff had a good understanding of their needs and were able to tell us about the care people needed and received.

There had been improvements in the way risks were managed and risk assessments were in place. However, we found occasions where further improvements were needed to ensure these changes were fully embedded into practice and all risks were managed safely.

There were systems to help ensure staff were suitable to work at the home. However, these had not always been followed. We discussed this with the provider who was aware of what was required and assured us recruitment procedures for future employees would be followed.

Systems were in place to ensure medicines were stored, administered and disposed of safely. However, there were no protocols in place to ensure ‘as required’ PRN medicines were given to people in a consistent way.

There was no information about how people who lacked capacity were able to make decisions or how restrictions may affect them. However staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) had been submitted when required.

Staff had a clear understanding of the procedures to safeguard people from abuse. They told us what steps they would take if they believed people were at risk. There were enough staff to meet the needs of people.

There was a warm and friendly atmosphere at the home. The pace of life was gentle and relaxed. Staff were kind, caring and patient. They supported people to work at their own pace. Staff knew people well and this helped to ensure people received good person-centred care. There was enough for people to do throughout the day and they were supported to make their own decisions and choices.

There was a training and supervision programme in place. This included observations of staff in practice and assessment of their competencies.

Mealtimes were a relaxed and social occasion. People were supported to eat and drink a variety of food that met their individual needs and preferences.

People were supported to have access to healthcare services this included the GP, district nurse and chiropodist.

There was an open and positive culture at the home. Staff felt valued and supported. Both the management team and all other staff were striving to improve and develop the service.

We found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulation 2010. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we found some improvements had been made however not all legal requirements had been met.

Lebrun House is a care home that provides accommodation for up to 20 older people who require a range of care and support related to living with a dementia type illness and behaviours that may challenge. On the day of the inspection 20 people lived there. There is a registered manager at the home. 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.

Staff knew people well and had a good understanding of their individual needs and choices. However, risks were not always safely managed and care plans did not reflect the care and support people. We found that people with behaviours that may challenge others or themselves did not have sufficient guidance in place for staff to deliver the support they needed. Not everyone who required them had risk assessments in place that guided staff to promote people’s comfort, nutrition, and the prevention of pressure damage.

On occasions people were not treated with respect and language within care plans was not always respectful. Despite this we observed staff were kind and caring and enjoyed looking after people who lived at the home.

There was not enough for people to do throughout the day. We saw one group activity during the inspection but for those who chose not to or were unable to take part there were no one to one activities or stimulation.

Staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards however; there was no information about how people were able to make choices or decisions. Staff had a good understanding of abuse and how to protect people from the risks associated with abuse.

People were given choice about what they wanted to eat and drink and received food that they enjoyed. However, mealtimes were sometimes disorganised and people did not always receive support in a timely way.

Staff received regular training and supervision. However, there was a lack of competency assessments and supervision. This had not ensured good practice was embedded into care delivery.

The audit systems had not ensured that actions identified at the last inspection had been addressed. The systems to assess the quality of the service provided were not always effective and had not identified the shortfalls we found.

Staffing levels had impacted on people receiving the support required to ensure their social needs were met. Recruitment checks took place to ensure as far as possible staff were suitable to work at the home. However, criminal record checks were not always completed before staff commenced work.

Staff had a clear understanding of the procedures in place to safeguard people from abuse.

There were systems in place to ensure medicines were stored, administered and disposed of safely.

People were supported to maintain good health and had access to on-going healthcare support.

There were a number of breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with all of the people who lived at the home. Most of the people were unable to tell us their experiences of living at Lebrun House because of their complex needs. People who spoke with us said, "I like my room'. 'The food is very good' and, 'I like to sit and relax in the afternoon'.

We spoke with two visitors, five care staff, a volunteer, the deputy manager and the manager during the inspection. We reviewed ten care plans; we looked at the management of medication, relevant policies and procedures, and the systems in place to assess and monitor the services provided.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

Visitors we spoke with told us they felt people who lived at the home were safe. We saw that people lived in a safe environment, the home was clean and people were able to move around the home with the support of staff, if required, to ensure their safety.

Is the service effective?

Our observations told us that staff had a good understanding of people's needs. People's health and social care needs had been assessed and care plans had been produced. However, some of these had not all been reviewed regularly and some of the information was not up to date.

Is the service caring?

We saw that people were supported by kind, patient staff, who encouraged people to make decisions about how they spent their time.

Is the service responsive?

Staff were attentive, and we saw evidence that when people's needs had changed appropriate referrals were made to outside agencies.

Is the service well led?

Staff we spoke with were clear about their roles and responsibilities. They had an understanding of the needs of people who lived at the home, and they said they felt supported by the management.

One person told us, "I can't really fault it". We spoke with a visitor who told us, "The home is spotlessly clean," and "I am always made very welcome." We saw that staffing levels were appropriate across both day and night shifts to provide support to people living at the home. We saw from staff files that proper checks were carried prior to staff working unsupervised at the home. There was an organised schedule of regular training in place to ensure that staff were able to carry out their duties efficiently and keep people safe.

Staff we spoke with told us they felt listened to and supported by the management. One staff member told us, "It's a good team," another said, "I wouldn't change anything."

The premises were well laid out, decorated and maintained to a good standard and felt comfortable and homely.

There were effective systems in place at the home to assess their performance and ensure improving standards of care were maintained. This included gaining feedback from people at the home, relatives and visiting professionals.

During our visit we spoke with five people who lived at the home and three members of staff. We saw records that showed that all staff were trained in all mandatory subjects. Staff we spoke with told us they were encouraged to undertake extra training in other areas. They also told us that they felt their job was not only to provide care for the people in the home but to promote their independence. Staff were friendly and respectful when dealing with people. We observed them knocking and waiting for an invitation in before entering rooms and seeking people's permission before doing anything for them.

The home was clean, safe and homely and records we examined showed that there were audits in place to maintain standards of hygiene and personal care. We saw records of surveys and meetings at regular intervals to seek and act upon the views of people living at the home, relatives, visitors and staff.