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Archived: Lancaster House Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 25 November 2017

We carried out an inspection of Lancaster House on 13, 20 and 27 September 2017. The first day of the inspection was unannounced.

Lancaster House is a care home providing personal care and accommodation for up to 13 adults with a mental health need. The home is a large semi-detached house situated on the main bus routes close to a busy slip road leading off Eccles Old Road onto the A6. The driveway and back garden are shared with the house next door, Cairn House, which is also a care home owned by the same provider. At the time of inspection 10 people were using the service.

The home was last inspected on 25 and 27 January 2017, when we rated the service as ‘Inadequate’ overall. We also identified 10 breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including continuing breaches with premises and equipment, staffing and good governance, along with additional breaches with safe care and treatment, management of medicines, safeguarding people from abuse or improper practice, person-centred care and receiving and acting on complaints.

We took enforcement action and issued the provider and registered manager with warning notices in regards to premises and equipment and good governance, to formally request action be taken to address the overall standard or the premises and ensure quality assurance and auditing systems were in place and being utilised. We also asked the provider to take action to ensure people were actively involved in their care, ensure staff received the necessary support and professional development to enable them to carry out their roles effectively, assess the risk of and control the spread of infections, ensure the proper and safe management of medicines, ensure they acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and ensure they had an system for the identifying, receiving, recording and handling of complaints.

At this inspection we identified eight continuing breaches in four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including breaches relating to, staffing, safe care and treatment, management of medicines, person-centred care and good governance and one breach of the Care Quality Commission (Registration) Regulations 2009, due to a failure to inform the commission of notifiable incidents. We also made a recommendation in relation to following best practice in relation to the MCA and DoLS. We are considering our enforcement actions in relation to these regulatory breaches.

At the time of the inspection the home 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.

We found remedial action had been taken to address previously identified issues with the overall décor and maintenance of the property. A schedule of works had been produced which the provider and registered manager had overseen. Bedrooms and bathrooms had been re-decorated, damaged or broken fixtures and fittings had been replaced and attempts to de-clutter communal areas had taken place. We noted work was ongoing and the hall, stairs and landing along with replacement of carpets had purposefully been left until last, to ensure all building and painting tasks had been completed.

We saw staff continued to be responsible for cleaning tasks, with checklists in place detailing what tasks needed to be completed in each room. We found the home to be reasonably clean; however some fixtures, fittings and ornaments required dusting. Cleaning equipment was stored safely and securely and Control of Substances Hazardous to Health (COSHH) forms were in place for the cleaning prod

Inspection areas

Safe

Inadequate

Updated 25 November 2017

The service was not safe.

Positive action had been taken to improve the overall décor and standard of the premises, with a detailed action plan in place.

Whilst some improvements had been made, hand hygiene practices and equipment did not adhere to Department of Health or NICE guidelines.

Medicines were not always managed safely. One person had been given medicines contrary to prescription guidance and we found gaps in recordings on MAR charts.

Fire safety checks were not being completed as per required timescales and we found no record of smoke detector checks being carried out.

Effective

Requires improvement

Updated 25 November 2017

Not all aspects of the service were effective.

Supervision meetings were being held but not as frequently as the provider had reported on their action plan.

Training had been provided in a number of areas over the last six months, however we found new employees were not provided with a thorough induction training programme.

People enjoyed the meals provided and reported getting enough to eat and drink.

People were supported to stay well through involvement of a multidisciplinary team and attendance at GP surgery as necessary.

Caring

Good

Updated 25 November 2017

The service was caring.

People using the service were positive about the care and support provided, telling us that staff were kind and treated them with dignity.

Throughout the inspection we observed a positive atmosphere within the home and appropriate interactions between staff and people using the service.

Meetings were being held with people who used the service, who had input into what was discussed.

Responsive

Requires improvement

Updated 25 November 2017

Not all aspects of the service were responsive.

Limited updates to care files had been completed since the previous inspection. We found a number of gaps and omissions of important information.

Mental health care plans and risk assessments had been drawn up, but not yet implemented, which meant staff did not have the information they needed to provide person centred care.

Care plans and other documentation were not completed fully or consistently, meaning that contemporaneous records were not being kept.

The service had an effective system for managing complaints; people had been reminded on the process during both individual and resident meetings.

Well-led

Inadequate

Updated 25 November 2017

The service was not well-led.

Although a new audit and quality and monitoring system had been introduced, this was not being used effectively and had not identified the issues we noted during inspection.

Meetings with staff had been completed, to ensure the dissemination of information was maintained.

Policies and procedures had been updated, although there was no robust system in place for reviewing these.

Annual questionnaires were given to people and relatives to request feedback on the service.