Lunesdale House

We found the following examples of good practice.

The provider had very robust systems in place to protect people from the risk of coronavirus (COVID-19) and other infections. They had been proactive in identifying the risks from coronavirus (COVID-19) at the start of the pandemic and had taken prompt steps to protect people.

The provider had adapted aspects of the service to support social distancing. They gave people clear guidance about maintaining their safety during the pandemic.

The provider had developed person-centred visiting arrangements which protected people from the risk of infection and took account of individuals’ needs and wishes.

The provider followed best practice when people moved into the home.

The provider had sufficient supplies of Personal Protective Equipment, (PPE), to protect people from the risk of infection. The staff were trained in the safe use of PPE.

The provider and care manager were available in the home to monitor staff use of PPE and to guide and advise staff if needed.

The provider had arranged for regular coronavirus (COVID-19) testing for all staff and people who lived in the home.

The staff team kept the home clean and hygienic. Frequently touched surfaces were cleaned regularly throughout the day to reduce the risk of infection.

There was a well-established, experienced staff team working in the home. All shifts were covered by the home’s staff team. The provider ensured staff returning from leave had a negative coronavirus (COVID-19) test result before they resumed working in the home.

Further information is in the detailed findings below.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question safe to at least good. At this inspection we found that the provider had completed those actions and we found the service was meeting the fundamental standards of quality and safety.

Lunesdale House is registered to provide accommodation and care for up to19 people. On the day of this inspection the home was fully occupied. The service is situated near the small town of Milnthorpe.

There was a registered manager in post. 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. In this service the registered provider is also the registered manager.

Records for managing risks during moving and handling had improved since our last inspection. However some staff we spoke with were not always clear about what actions they would take if someone fell and required lifting from the floor.

Medicines were being administered and kept safely. We have made a recommendation that the provider ensures that the records for administration of variable dose medications identifies the quantities given.

There were sufficient numbers of suitable staff to meet people’s needs. Staff training was ongoing and people had received sufficient training to safely support and care for people. Staff were supported by the registered and care manager through regular staff meetings, supervision and appraisals.

We saw that the service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people.

When employing fit and proper persons the recruitment process had included all of the required checks of suitability.

People’s rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

Hazards to people’s safety had been identified and managed. People were supported to access activities that were made available to them and pastimes of their choice.

People’s dignity and privacy were actively promoted by the staff supporting them.

People were treated with respect and their relatives made very positive comments about the staff team who supported them.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the provision.

The focus of the service was on promoting people’s rights. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Some incidents requiring notifications to be made to CQC had not been done. The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process.

Further information is in the detailed findings below

Lunesdale House is a residential care home providing accommodation and personal care for up to 19 older people. All the accommodation is in single bedrooms with ensuite facilities. There is car parking to the front of the home and well-kept gardens.

The service 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 that staff had received sufficient training in moving and handling.

The service had equipment to meet people’s identified needs.

The provider pre-admission assessment ensured that only people with minimal moving and handling needs were cared for in the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – regulation 17 – Good Governance (2) (c) Maintain securely and accurate, complete and contemporaneous record in respect of each service user.

We considered our inspection findings to answer the questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service did not have effective systems in place to ensure that people were protected from the risks associated with the unsafe use of medicines. This was because the provider did not have effective processes in place to make sure medicines were managed safely. We saw that most medicines were stored safely but insulin was not stored safely because there was no dedicated lockable medication fridge.

Is the service effective?

We saw that some staff that were administering medication had not had a competency assessment to show they were competent to do so. We also found that some staff had not had up to date medicines handling training. If staff have not had good quality up to date training this could place people at risk of harm.

Is the service caring?

We found that the head of care had a lot of knowledge about the people who lived in the home. They also had good knowledge regarding why medication was being given and about variable doses of medicines. However we saw that there were no formal plans in place and therefore people were at risk of being given too much or too little medication or inconsistent doses.

We found when people were prescribed the same medication such as tablets for pain relief or liquid for constipation they were not given doses from their own supply. We found that these medicines which had been prescribed for individual people were being shared with other people in the home. This was not a safe practice and did not respect people's personal property or their inclusion in the management of their own medicines.

Is the service responsive?

We found that care plans for people's medication needs lacked information and detail. People were prescribed medicines to be taken when required and we found that medicines prescribed in this way did not have any information available to guide staff as to how to give them.

We found that care planning information did not provide details about how to take medicines which should be taken 30 to 60 minutes before food or on an empty stomach. We found medication that had been prescribed to be taken with food was given together with medication that needed to be taken before meals. This meant that some medicines may not work properly and have the desired therapeutic effect.

Is the service well-led?

There were no audits (checks) made about medicines management to ensure the systems in place provided good quality and safe medicines management.

We saw that the records for the receipt of some medicines were incomplete which meant it was not possible to make checks to ensure they had not been mishandled. We found that some controlled drugs were in the home but records of receipt had not been made in the register in accordance with current legislation.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People we spoke with during the visit were positive about the way they had been supported to be independent and make every day choices. They told us that they 'trusted' the staff and that staff listened to what they wanted and how they wanted to be supported.

We saw that risk assessments had been carried out to help make sure that people who lived there received appropriate care. We saw that the premises were clean and homely and the home and grounds were being well maintained for the use of people living there. People told us that their rooms were cleaned every day.

There were sufficient staff working in the home with a range of skills and experience. We found the training plan and programme being used was not being effectively reviewed. This was needed to help ensure that the learning and development of staff was being always based upon the needs of the people living in the home and updated to include best practices.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had appropriate policies and procedures regarding The Mental Capacity Act 2005. However we did not see records to show that staff had received training in this.

Staff had received training on safeguarding vulnerable adults. Staff we spoke with were clear about the procedures to use in reporting any concerns.

Is the service effective?

We found that people's health and care needs had been assessed and they told us they had been involved in deciding the care and life styles they wanted. We were told by people living there that staff always asked them what they wanted doing and gave them explanations about their care and medicines.

The care records we looked at included information about the individual and how they liked to spend their time, their interests and social preferences. Care plans in place showed the aids and equipment needed to support people and how they wanted this support to be provided.

We saw that people's individual needs had been assessed using clinical tools to assess the risk to be managed. However details of the management were not always recorded in detail for staff to manage all assessed needs.

We saw records that showed staff had undertaken some training to give them the skills and knowledge to look after people properly. However staff had not had their development needs reviewed to make sure they all had up to date training that reflected latest best practice.

Is the service caring?

Everyone we spoke to told us they were happy with the care they received in the home and that the staff were 'kind' and 'caring'. One person living there told us, 'There is a lovely atmosphere here, the girls are cheerful and kind and so understanding".

We saw that the staff were kind and considerate in the way the spoke with and supported people. People were given choices about their daily lives and the support they wanted. We observed friendly and respectful interactions between the staff and people in the home.

In some of the care plans we looked at we saw detailed information about individuals that provided personalised information about their preferences, likes and dislikes. This gave staff a background on the person themselves and their lives before they had come to live at Lunesdale House.

Staff we spoke with did know the people living there and their needs and preferences well and were able to tell us about people's preferences on how they wanted to be supported. We observed that staff spent a lot of time interacting with people in a supportive and respectful way and giving people the time they needed to express themselves.

Is the service responsive?

People were able to take part in activities they wanted to inside and outside the home and to decide for themselves how they spent their time. This included their individual religious preferences and being able to attend their own church as well as services in the home.

We saw that where necessary people had been referred to other services to support health needs and access treatment. This was to make sure they received appropriate treatment and support for their needs conditions.

All the eight people we spoke with who lived at Lunesdale House told us that staff were attentive to their needs. We were told by one person how the staff had worked with their family to get their room ready for them before they came there. This made sure that their own familiar things were there for them when they arrived.

We looked in detail at a sample of care plans. We saw that the plans of care plans in place had been reviewed and altered in response to changes in people's needs and preferences.

Is the service well led?

People living in the home told us they felt they could talk to the manager and head of care at any time. We were told that if they asked for something to be done it was.

The home had quality assurance and monitoring system in place. This helped to identify and areas that had problems or needed to change. However recently not all aspects of the quality monitoring system had been followed in practice to monitor all the service provision.

Staff told us that they felt they were well supported with supervision and training and that the manager and head of care were accessible and easy to talk to. Staff confirmed that they met regularly with the head of care for supervision. They also told us that they had confidence in the management to support them should they have concerns about practice matters.

Prior to our inspection we reviewed information that we held on the home and there had been a referral to social services about safeguarding people. The provider had not notified CQC about the referral as required under the regulations. This meant CQC were not able to check that the provider had taken appropriate action in response to the incidents.

We found at this visit that the records on people's choices about daily matters, long term care preferences and ability to make decisions were being consistently reviewed and updated. This meant that the information about how people needed to be supported with making choices, what their individual decisions were and who had legal authority to act for them was made clear. Where changes in their needs and condition had been reported the plans of care reflected them.

We could see that information had been gathered about people's preferences at the end of life or if their physical condition changed. This had been reviewed and updated should someone change their mind about some aspect of their care and support. We saw where people did not want to discuss this aspect of care that had been respected.

"This is where I call home, I'm comfortable here."

"The carers are very obliging and kind but I like to be independent and do what I can for myself."

"There is always someone about and that's very important to me."

"I am content, I have no complaints."

From our observations and conversations with people living there we found they had received the support they needed and were given choices about their care and their social activities. We observed that staff encouraged people to maintain their independence.

We checked on the environment and we saw that the home was orderly, clean and homely. Care plans gave guidance to staff so that people's needs were met. Risk assessments were in place and reviewed regularly. This helped the service stay a safe place for people to live and work in.

We saw from the records kept and asking people that concerns relating to people's health were raised with health care professionals as necessary and changes to medication were recorded. The standard of record keeping within the home was satisfactory overall. The provider had procedures in place for staff recruitment. This helped to make sure that staff were suitable for their roles.

Some procedures to get valid consent were not always followed in practice and were not being monitored and reviewed.

People told us how they spent their days and about following their hobbies where they wanted to and that there were organised activities they could take part in, if they wanted, during the week. People living there told us that they went out when they wanted to with family or friends and also that they were able to follow their own faiths and see their religious ministers. More than one person told us that it was a "very clean and fresh" and "comfortable" place to live. People we talked with confirmed that they got up and had their meals when and where it suited them and also went to bed when they wanted.

People told us the food was "excellent" and "very good" and told us that they were always asked what they wanted and liked and that the staff knew what they liked.