24 June 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This was an unannounced focused inspection and took place on 10 and 11 May 2016. It was in response to a serious incident, on going concerns that we have about the quality of care people received at the service and to assess whether the provider was doing all that was practicable to keep people safe.
This inspection was carried out by one inspector and an inspection manager.
Before the inspection, we considered notifications made to us by the provider, whistle-blowing concerns raised and information we held on our database about the service and provider.
During our visit we observed care and support provided, was shown around the home and checked records, policies and procedures. These included the staff recruitment, training and supervision systems and the home’s maintenance and quality assurance systems. We also spoke with two people using the service, four staff and the nominated individual.
We looked at the personal care and support plans, risk assessments, daily notes and medicine administration notes (MAR) for two people using the service and one person who had recently used the service.
24 June 2016
Our last inspection of the service took place on 1, 2, 3 and 8 March 2016 and was unannounced. During that inspection we found seven breaches of regulations as a result of which we rated the service as inadequate. These were in relation to person centred care, safe care and treatment of people, safeguarding adults from the risk of abuse, dealing with complaints, good governance, staffing and sending notifications about significant events to CQC as all providers are required to do. We are taking actions against the provider for the above breaches of regulations and will report on these when our actions are complete.
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.