Archived: Lancaster House

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 products in use. We noted the provider had installed paper towel dispensers in bathrooms, to replace cotton hand towels, however hand hygiene guidance was not in place and liquid soap bottles were still being used rather than wall mounted soap dispensers, which is contrary to Department of Health guidance.

We identified some issues during our review of medicines management. We saw the service continued to not use ‘as required’ medicine protocols or topical medicine charts. We found records of topical medicine usage were not completed consistently and we noted one person’s transdermal patch had not been applied as per prescription. We also identified aspects of good practice especially around the receipt and booking in of medication when it was delivered to the home.

Each person we spoke with told us they felt safe. The home had safeguarding policies and procedures in place, although did not have a dedicated safeguarding file and log of referrals, with referrals stored electronically in email folders. Staff had been trained in safeguarding vulnerable adults and had knowledge of how to identify and report any safeguarding or whistleblowing concerns. We did note a safeguarding issue raised by the local hospital regarding a person who used the service had not been reported to the Care Quality Commission, as is required by law.

People who used the service and staff we spoke with felt there was not enough staff employed to effectively meet people’s needs. We saw staff members had left and despite actively trying to recruit, the home had not been successful in replacing these staff. Whilst the reduced staffing levels had not impacted on people’s feeling of safety, we did notice an impact on the support people received to complete planned tasks and activities. People continued to be encouraged to retain their independence and were free to come and go as they wished.

We looked at five care files in detail, which were stored electronically on a laptop. We found limited improvements and additions had been made since the previous inspection, with numerous gaps in information and an overall lack of detailed guidance for staff to follow, to ensure people’s needs were being met. We saw mental health care plans and risk assessments had been drawn up to sit alongside the existing care plans; however these had yet to be implemented.

We found the service was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Training in both areas had been facilitated, and staff had a reasonable understanding of both sets of legislation. However there was not an MCA / DoLS policy in place and some of the wording used in care plans could be seen as oppressive.

Staff told us training had improved with a number of sessions being held over the last six months, including training in mental health awareness, which considering the nature of the service, had been a noticeable omission at the previous inspection. The training matrix had not been fully updated during the inspection, however we were able to confirm sessions had been held and the registered manager updated and forwarded the matrix to us following the inspection.

The provider’s action plan following the previous inspection stated staff would receive supervision on a bi-monthly basis, however our review of staff records demonstrated this was not being done. Whilst there had been an increase in the frequency of meetings, none of the staff had completed more than three meetings since January.

People told us they enjoyed the food provided by the service and received enough to eat and drink. People could choose when and where to eat, with meals being prepared for people to eat later, if they did not wish to eat at the allocated meal time.

Throughout the inspection we noted a positive atmosphere within the home. People were animated and engaged in conversation and friendly ‘banter’ with each other and members of staff. People we spoke with were complimentary about the staff and the standard of care received. Resident meetings had been held, with people given the opportunity to suggest agenda items, as well as being informed about things relating to the home.

We saw a new auditing and quality monitoring system had been introduced, which had been designed by the provider. However this had not been used fully or effectively and none of the issues noted during this inspection had been identified by the registered manager or the auditing process.

We noted some issues in fire safety processes when reviewing safety procedures and checks. Not all checks had been carried out in agreed timescales and personal emergency evacuation plan (PEEPS) were still not in place.

The overall rating for this service is ‘Inadequate’ and the service remains 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 canc

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 place, with all referrals being stored electronically. Staff had been trained in safeguarding vulnerable adults and had knowledge of how to identify and report any safeguarding or whistleblowing concerns.

People who used the service and staff we spoke with said there was enough staff employed to meet people’s needs. The service encouraged people to retain their independence and they were free to come and go as they wished, with staff there to provide support and assistance when required or requested.

We looked at four care files in detail, each contained detailed personalised information about the people who used the service, their background and life history. Care files were stored electronically and covered a range of areas including care plans and risk assessments. However we saw there were a number of gaps in people’s records, with care plans being started but left unfinished, no risk management plans in place for behaviours or situations which were documented as being a potential hazard. Records of medical appointments attended or the involvement of professionals were also inconsistent.

We found the service was not working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Training in both areas had yet to be facilitated, despite being identified as an issue at the previous inspection in May 2016. As a result staff knowledge around capacity, restrictive practice and best interest decision making was variable.

Staff told us training at the service required improvement. The training matrix identified that since the last inspection in May 2016, only one training session had been completed in first aid. We saw that aside from this session and training in safeguarding completed in April 2016, most people had not completed any additional training since their induction, in some cases this was over five years ago. Despite the service providing support to people with a mental health diagnosis, only two people had completed any training in this area.

The supervision policy stated staff would receive supervision on a bi-monthly basis, however our review of staff records demonstrated this was not being done. Most people had only completed one meeting in the last year and one staff member had not had a meeting since 2013.

People told us they enjoyed the food provided by the service and received enough to eat and drink. People could choose when and where to eat, with provision being made in the way of a packed lunch or monies being given to people who would be out during meal time.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be patient, caring and treated people with dignity and respect. People who used the service were complimentary about the staff and the standard of care received.

Complaints were documented in people’s electronic care files, however a centralised log of complaints received was not in place, nor did the service have specific complaints forms which were accessible to people using the service. We also noted the complaints procedure was not displayed anywhere in the service.

The service advertised in its literature that people would be consulted about the service through regular resident meetings; however we saw that none had taken place for some time. We also saw that staff meetings were not being held. Staff told us the need for these meetings had been discussed, but had not been arranged.

The service did complete annual quality assurance questionnaires with people using the service, relatives and professionals. People we spoke with told us they liked having their say and found the forms easy to complete.

The service did not currently use any systems or procedures to monitor the safety, quality and effectiveness of the service. The registered manager told us the only audit currently being carried out was in regards to medication, and we saw this just involved a stock count, rather than an audit of the entire process. Documentation was in place, including a comprehensive audit document, however this was reported as being too complicated to use and a revised version had yet to be drawn up. Neither fire nor environmental risk assessments were in place, although regular checks of fire equipment and fire drills had been completed.

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 demonstrate that staff received the appropriate support and professional development.

We found the service undertook a limited number of audits and checks to monitor the quality of services provided. We were told that daily monitoring of medication was undertaken, which had not been recorded. The last medication audit we looked at was dated December 2015. We found no evidence of any audits relating to the maintenance of the home or evidence that training needs were regularly monitored to ensure staff were suitably trained to undertake their roles. We found the service lacked effective auditing systems to monitor the quality of service provision.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service failed to assess and monitor the quality of service provision effectively.

We found people were protected against the risks of abuse, because the service had appropriate recruitment procedures in place.

We found people were protected against the risks associated with medicines, because the provider had appropriate arrangements in place to manage medicines safely.

During our inspection we checked to see how people’s nutritional needs were met. Staff prepared meals for people with choices available. We found that people’s individual nutritional needs were assessed and planned for by the home.

People told us that staff treated them respectfully, were friendly and helpful.

During the inspection we saw people were offered choices around how they wished to spend their day, or what they wanted to eat for lunch.

Staff we spoke with demonstrated a good knowledge of person-centred care principles and the importance of respecting peoples’ rights and preferences.

The structure of the care plans was clear and easy to access information. All care plans were reviewed annually with other professionals.

The home arranged ‘Keyworker Sessions’ with people to meet people’s specific needs. A member of staff would be assigned to a person to provide one-to-one support for certain areas of need or development.

We found the service routinely and actively listened to people to address any concerns or complaints.

Staff told us they believed there was an open and transparent atmosphere in the home, they felt supported in their role and that the manager was very approachable.

The home had policies and procedures in place, which covered all aspects of the service, however these were in need of review and updating to ensure they covered the most recent best practice guidance.

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.

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.

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."