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Archived: Lancaster House Inadequate

Reports


Inspection carried out on 13 September 2017

During a routine inspection

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 carried out on 25 January 2017

During a routine inspection

We carried out an unannounced inspection of Lancaster House on 25 and 27 January 2017.

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 and is 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.

The home was last inspected on 03 May 2016, when we rated the service as ‘requires improvement’ overall. We also identified three breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to ensuring premises and equipment was properly maintained, ensuring staff received appropriate support and professional development and good governance. We asked the provider to take action to improve the overall standard of the premises, ensure quality assurance and auditing systems were in place and being utilised and staff received the necessary support and professional development to enable them to carry out their roles effectively.

At this inspection we identified 10 breaches in seven of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including continuing breaches relating to premises and equipment, staffing and good governance along with additional breaches relating to safe care and treatment, management of medicines, safeguarding people from abuse or improper practice, person-centred care and receiving and acting on complaints. We are currently considering our enforcement options.

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.

The service was not being cleaned effectively, with areas of dust, cobwebs and other stains noted during a walk round of the premises. Infection control processes were also absent, especially in relation to hand hygiene practices, with no guidance available and cotton hand towels, rather than paper towels being provided in all bathrooms and toilets. The service employed a cleaner, however they were currently suspended resulting in care staff being responsible for these tasks. Cleaning equipment was stored safely and securely and Control of Substances Hazardous to Health (COSHH) forms were in place for the cleaning products in use.

We identified on-going issues with the overall décor and maintenance of the property. We saw broken or damaged fixtures and fittings, including bath panels and shower curtains, with no record that these had been noted by the service. Paintwork in a number of areas was worn, cracked or flaking away, the majority of the carpets throughout the service were old and stained and in some places had completely worn through. Most of the communal areas were also cluttered, with a variety of items such as boxes and step ladders left lying around. The registered manager stated this was due to a lack of storage and all bedrooms being occupied.

Our review of medicines management highlighted a controlled drug was not being stored correctly. We also noted the service did not use ‘as required’ medicine protocols or topical medicine charts and the system in place for documenting medicines received and in use, made it difficult to ensure stock levels were correct. We did see that the Medicine Administration Record (MAR) chart was being filled in correctly and robust systems were in place to ensure staff knew what medicines people took and at what time.

People we spoke with told us they felt safe. The home had safeguarding policies and procedures in pl

Inspection carried out on 3 May 2016

During a routine inspection

This was an unannounced inspection carried out on the 03 May 2016.

Lancaster House is a care home providing personal care and accommodation for up to 13 adults with a mental health needs. The home is a large semi-detached house and is 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 Cairn House, which is also a care home owned by the same provider. The manager for both homes is located in Lancaster House.

There was no registered manager in post at the time of our inspection, however the current manager for the service was in the process of registering with the Care Quality Commission (CQC) at the time of the inspection. ‘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.’

During this inspection we found three breaches 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 the report.

We looked around the premises to ensure it was clean, safe and properly maintained. We found that the building in places together with the general décor was neglected and in a poor state of repair throughout. In one bedroom we visited the inside of the wooden window frame was black with mould. The bedroom wall paper was extensively stained with damp and mould patches, which were unsightly and posed a health risk to the occupant of the room.

We found further examples of where the internal décor had been neglected, with evidence of damp patches visible on the walls with wall paper peeling off both in private bedrooms and bathrooms. In other areas we saw evidence that the plaster was blistering off the wall.

Externally on the ground floor, we saw that wooden window frames were completely rotten in places. Throughout the building including communal areas and bedrooms, we saw repeated examples of stained and worn carpets, worn and stained furniture and broken bedroom sink units and storage cupboards.

This was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to premises and equipment. This was because the service had failed to ensure the premises and equipment were properly maintained. CQC are currently considering their enforcement options in relation to the failure to meet the requirement of regulations in this instance.

We found the service could not demonstrate that staff had received the appropriate support and professional development to undertake their roles. Following initial induction training, there was limited evidence of further training having been provided in relation to specific areas such as medication and safeguarding. Of the four members of staff trained in first aid, we found their qualification had since expired. This meant there were no members of staff currently certified to administer first aid in the home in the event of an accident or emergency.

We saw that two members of staff received medication training in 2006, another two member of staff received their training in 2009 with another member of staff receiving their training in 2010. No refresher training had been sourced since then to ensure staff were following up to date guidance and procedures when administering medication.

All staff we spoke with confirmed they received supervision with the manager. However when we reviewed personnel records, supervision records were inconsistent with some staff not having had any recent supervision.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because the provider could not demonst

During a check to make sure that the improvements required had been made

A system of audits had been introduced; these included a monthly care plan review meeting with the manager and two members of staff.

The provider told us the new auditing system would ensure the assessment of needs form would be completed to include people’s preferences and dietary requirements.

Inspection carried out on 3 May 2013

During a routine inspection

During our inspection we spoke with five people who used the service, the manager, three support workers and the provider. People told us they felt involved in their care and support was provided to them in a respectful way. The five people we spoke with said they were happy living at Lancaster House and with the quality of care and support provided. One person told us, “This has been my home for years and it feels like home to me. I wouldn’t want to be anywhere else”. People told us the staff were kind, supportive and caring towards them and encouraged them to be part of the wider community.

We asked the people we spoke with their views on the quality of the service provided by Lancaster House. They told us that they had excellent relationships with support staff and described them as ‘good at what they do’, ‘friendly’ and ‘brilliant’.

People we spoke with told us that the staff provided care and support in a way that helped them. They knew who to talk to if they had any concerns. One person said “I would chat with the manager or the owners; they are all like my family". They were confident that any concerns they had would be dealt with appropriately.

We found minor concerns in relation to the record keeping for care plans and risk assessments. The ones we looked at did not include sufficient evidence to show that people received care and support according to their individual preferences.

Inspection carried out on 15 January 2013

During a routine inspection

During our visit we spoke with four people using the service, the manager, two support workers and the provider. People told us they felt involved in their care and support was provided to them in a respectful way. The four people we spoke with said they were happy living at Lancaster House and told us they felt they were doing well. People told us the staff were supportive and caring towards them and encouraged them to be part of the wider community.

Staff told us they supported people and encouraged them to carry out their hobbies and interests. One person told us, "I enjoyed a visit to the Christmas market and I attend a group to help me manage my condition. I think the staff here are very good."

There was a programme for staff training that was relevant to the work they undertook. Staff we spoke with had the knowledge and skills to meet the needs of the people they supported in a confident and competent way.

People living in Lancaster House were encouraged to express their views and participate in decisions about how the service was run. One person told us;" I like to help around the house, sometimes I help prepare the meals. I like my bedroom now it's just been repainted."

Reports under our old system of regulation (including those from before CQC was created)