Archived: Lancaster Lodge

This unannounced inspection took place on 10 and 11 May 2016 in response to a serious incident that happened at the home and to check if people using the service were safe. The report should be read in conjunction with the report we produced after our unannounced inspection of March 2016.

Lancaster Lodge is a care home for up to 11 adults with mental health needs.

The home did not have a registered manager. The previous manager left on 18 January 2016. 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 and associated Regulations about how the service is run.

The provider did not have effective systems to manage risks and where risks were identified, comprehensive plans were not in place to ensure risks were managed appropriately and in a consistent manner.

The provider did not have proper arrangements to ensure people received their medicines as prescribed so they received the treatment prescribed by their doctor.

Some risks in relation to the safety of the premises, more specifically about the storage of cleaning products and other chemicals, were not managed appropriately to fully ensure the safety of people who use the service.

There were conflicting records meaning people were not protected from known risks. These included records associated with nutrition and hydration as staff were given conflicting directions to follow in relation to keeping people using the service safe.

The provider did not ensure appropriate skilled and experienced staff were deployed at the home to meet the various needs of people who used the service.

We found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider in combination with the findings of our inspection in March 2016 in accordance with our enforcement policy. We shall report on this when our action is completed.

Two people said that currently they felt safe living at the home and had now got used to the new staff and felt better supported by them.

Staff said they had received appropriate support with their work including support to come to terms with a serious incident which occurred at the service.

The overall rating for this service continues to be ‘Inadequate’ and the service is still in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Lancaster Lodge is a care home for up to 11 adults with mental health needs.

The home did not have a registered manager. The previous manager left on 18 January 2016. 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 and associated Regulations about how the service is run.

In September 2015, our inspection found that the service met the regulations we inspected against, received an overall good rating and a good rating for each of the five key questions.

A number of changes to the service had taken place between the last inspection and this inspection. This included a change to the way therapeutic support was delivered. The longstanding manager and experienced staff had also left the service. People told us staff tried hard to provide a supportive service. This was often not achieved as many of the staff was new and therefore relationships and trust had not been built up.

People said that since the previous manager and some more experienced staff had left this made it more difficult to have their needs met and support provided in the way they wished. They told us this problem was made worse as more experienced staff had also been on leave or on training away from the home. This was at a crucial time when many changes were being made to the way that support was being delivered.

People told us that they were not given the opportunity to choose the way that their individual and group activities would be delivered. Rather they were presented with a new method of service delivery that concentrated on therapy being delivered in-house, by staff rather than by external psychotherapists whom they had built up bonds and relationships with. This set back their development of the life skills required to live independently, further their education and gain employment. They said that staff no longer provided the support they required in a way that suited people using the service.

Key documents were missing and records not kept up to date. The support plans for people using the service were missing, incomplete or did not contain up to date and regularly reviewed information. This meant staff were not able to perform their duties efficiently.

The new staff were not knowledgeable about the people they worked with. They had inappropriate experience and qualifications. In spite of their best efforts and hard work to provide care in a supportive and friendly way, they did not have appropriate experience and qualifications to. This was not successful beyond meeting daily basic needs. Staff had received induction training that did not provide them with the skills and knowledge to deal with the complex needs of people using the service and were reliant on shadowing more experienced staff who were often not available. As part of their induction training, staff had not received training in behaviour that may challenge, de-escalation techniques or mental health. This meant that they were not appropriately skilled to deal with potentially challenging and stressful situations for people as well as themselves.

As support plans and risks assessments were not up to date potentially people were not protected from taking unacceptable risks, including those associated with nutrition and hydration. More experienced staff, who knew people well were able to support and advise them regarding healthy and balanced diet options.

People and their relatives said that they did not feel listened to or find the management team at the home or within the organisation, approachable or responsive. Neither did they feel encouraged to provide feedback. There was little recorded evidence of the service being monitored or quality assessments taking place.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This was in relation to medicine being incorrectly administered and not being accurately recorded. There were insufficient numbers of suitably qualified, competent, skilled and experienced persons deployed. People were not safeguarded from abuse and improper treatment. Risks to the health and safety of people were not assessed. Reasonable steps were not taken to mitigate risks. Staff had not received appropriate training, support or supervision. Peoples' care and treatment did not enable and support relevant people to understand the care or treatment choices or to discuss them with a competent health care professional. This included the balance of risks and benefits involved in any particular course of treatment. The care and treatment did not meet peoples' nutritional and hydration needs, regarding their well-being. People did not have their needs met and their preferences were not considered. The home failed to operate a quality assurance system. The management team did not have suitable qualifications or experience of working directly with this client group. Required notifications were not made to the Care Quality Commission. We are taking action against the provider for their failures to meet regulations, according to our enforcement procedures. We will report on this when our action is completed. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

Is the service safe?

During our visit we saw that staff treated people with dignity and respect. People told us that they felt safe using the service. The service safeguarding procedures were robust, staff were trained in how to use them and understood how to safeguard people individually and as a group. Details of areas or circumstances of concern specific to individual people were also recorded in the sample of three support plans we looked at.

There were systems that enabled the manager and staff to learn from events such as accidents, incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped service improvement.

The home had policies and procedures that worked in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Training was provided for relevant staff to understand when an application should be made and how to submit one. There were no current applications submitted. This meant that people were safeguarded.

The service was safe, clean and hygienic with well maintained equipment that was regularly serviced. This meant people were not put at unnecessary risk.

People's care needs were taken into account within the staff rotas when making decisions regarding the required staff numbers, qualifications, skills and experience. This ensured that people's needs were met.

No staff were currently subject to disciplinary action and policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People had access to an advocacy service if they required it. This meant that people could access additional support.

The home assessed people's support needs with them and those that wished to contributed to their support plans. Any individual specialist input was identified in the support plans as required. The three support plans we saw contained evidence that people had contributed to them and they confirmed this when we spoke with them. People told us "I have regular reviews" and "I have a review tomorrow with a person from the placing authority".

The layout of the service enabled people to move around freely and safely.

The visiting policy and visitors' book demonstrated that people were able to see their visitors in private and that visiting times were flexible.

Is the service caring?

We saw that people were supported by professional, kind, knowledgeable and attentive staff. The staff were patient and gave encouragement when supporting people. People commented, "Staff are really supportive'. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with this information.

People and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People regularly completed a range of activities in and outside the home. During our visit people were coming from and going to a number of different activities individually. We were told that they also attended group activities. People's support plans identified that they were enabled to be involved in activities within their local community and further afield.

People knew how to make a complaint if they were unhappy. We looked at how complaints were investigated and saw that they were investigated properly and action was taken as necessary.

Is the service well-led?

We saw that the manager and staff listened to people's needs, opinions and acted upon them. The service worked well with other agencies and services to make sure people received their care and support in a joined up way. This was demonstrated by the relationship the home had with the local authority Rehabilitation Placement and other teams and community based health services.

Appropriate notifications to the Care Quality Commission were made.

We saw and they told us that staff treated them with dignity and respect.

People were supported and encouraged to make their own decisions and choices, including activities they wanted to do and those that helped improve their life skills if they wished.

They lived in generally well kept surroundings that they liked and enjoyed "I like living here".

People said there were enough staff to meet their needs and they thought the staff were "Excellent and couldn't fault them".

They said and we saw that staff were friendly, caring and supportive.

People liked the way staff spoke and interacted with them and everyone spent a lot of time laughing, joking and smiling.

One person told us they knew how to complain and who to.

We saw that there was a comprehensive admissions system that ensured people's needs could be met at the home before moving in.

There were enough staff to meet people's needs during our visit.

The building was generally well maintained.

There was a complaints policy and procedure that was readily available and easy for people using the service to follow.

Comments about the service from the people who used it included 'very good, the best one yet', 'I've grown to like it' and 'it's good - I like this place'. Other feedback included 'the support in general has been marvellous' and 'respectful and very supportive'.

People spoken to said that there were enough staff on duty to meet their needs and told us that 'the staff are ok', 'there is always someone around ' evenings and weekends' and 'very good'.

Staff members spoken to were positive about the service being provided and felt well supported by the organisation. One staff member described the improvements over the past year as 'a revolution'.