We carried out a review of the data available to us about Lambton House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Lambton House, you can give feedback on this service.
Lambton House is a residential care home providing personal care for up to 57 older people, some of whom were living with a dementia. At the time of the inspection the service was supporting 41 people.
People’s experience of using this service and what we found
People were happy at the service, and received the care and support they wanted. People and relatives said staff were caring and kind.
Medicines were managed safely. Risks to people were assessed and action taken to reduce the changes of them occurring. The premises were generally clean and tidy, but in some areas redecoration was needed to ensure effective cleaning could take place. The registered manager acted on this immediately. People were safeguarded from abuse.
Staff were supported with regular training, supervision and appraisal. People received effective support with eating and drinking. The environment had improved to make it more dementia friendly, and further improvements were planned. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.
People received the care and support they wanted. Care records were regularly reviewed to ensure they reflected people’s choices. A wide range of activities took place, which people said they enjoyed. The provider had a clear complaints process in place.
Good governance systems were in place to monitor and improve standards. The culture and values of the service promoted positive outcomes for people. Staff worked in effective partnership with a range of external professionals.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 12 February 2020) and there were breaches of regulation.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended that the provider review and improve people’s dining experience, medicines management, mental capacity records and the daily experiences of people living with a dementia. At this inspection we found the provider had reviewed and made improvements to all of these areas.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lambton House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice
• There was sufficient personal protective equipment (PPE) such as aprons, gloves and masks. Staff had undertaken training in putting on and taking off PPE and other Covid-19 related training.
• Steps had been taken to promote social distancing, such as frequent signage and seating being rearranged.
• Management had good processes for communicating changes in guidance with staff and to support staff with any anxieties about working during a pandemic.
• Management praised staff for the way they supported people who used the service emotionally and for maintaining a positive atmosphere in the home.
• Infection control audits and checks were carried out. The registered manager was continually reviewing and improving the checks being made to ensure good practice guidance was followed.
Further information is in the detailed findings below.
Lambton House is a residential care home providing personal care for up to 57 people aged 55 and over, some of who are living with dementia. At the time of the inspection the service was supporting 42 people.
People’s experience of using this service and what we found
At our last inspection medicines were not being managed safely. Quality assurance systems were not robust and had failed to identify the areas of concern. At this inspection we found we found some areas of improvement had been made. However, further improvements regarding the care and supervision people received and, the overall governance of the service were still required.
Staff were not always available to safely supervise people. The registered manager told us they used a dependency tool to calculate staffing levels and were working above this level.
People’s dining experience required improving to make it a more enjoyable experience. Further improvements were required to records for monitoring people’s eating and drinking. Most people told us they enjoyed the food provided and there was a choice.
We have made a recommendation for people’s dining experiences to be improved.
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. Most staff sought consent from people when assisting them. Records needed improving to show how people and their representatives had been involved in decisions about their care.
We have made a recommendation for MCA records to be improved.
People were able to participate in some activities. Improvements were required to provide more inclusive and stimulating activities for people living with dementia.
We have made a recommendation for improvements to be made to enhance the daily experiences of people living with dementia.
Medicines were now managed safely but further improvements remain.
We have made a recommendation for improvements to the management of medicines following national guidelines.
Improvements to the assessments of risks for people’s health had been made. Additional improvements and monitoring were required to ensure they reflected people’s current health needs.
Improvements to people’s care plans had been made. Further improvements were required to make them more person centred. Staff knew people's care needs well. People and relatives told us staff were kind and caring.
Staff recruitment was safe. Staff received training in line with the providers training policy and had received further training in monitoring people’s weight and risk levels. Further training was required to enhance staff knowledge in the care people received who were living with dementia and/or mental ill health.
Some improvements had been made to the provider’s quality assurance checks. However, these require further development as they had not identified the issues found during this inspection. The service worked with a range of professionals to best meet people’s needs.
Staff understood how to safeguard people from abuse. People's privacy and dignity was maintained. The registered manager used information following accidents and incidents to learn lessons. An effective complaints system was in place.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update: The last rating for this service was requires improvement (published 5 July 2019). The service remains requires improvement. This service has been rated requires improvement for the last two consecutive inspection.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to risks to people’s safety and the quality monitoring of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Lambton House is a residential care home providing personal care to 57 people aged 65 and over. At the time of the inspection the service provided support and accommodation for 47 people, some of who were living with dementia or a physical disability.
People’s experience of using this service and what we found.
Medicines records continued to not be effectively managed to ensure people received their medicines safely.
Care records were not always updated when there were changes in people’s health needs and to reflect guidance issued by healthcare professionals.
Where people were losing weight, appropriate actions were not consistently being undertaken to monitor and seek timely advice. We have recommended that the provider seeks further training for the whole staff team in this area.
Risks to people’s health were not always recorded accurately or updated in a timely manner, placing people at risk of harm.
The provider’s quality assurance checks had not been effective in highlighting the gaps in medicines, risk to people’s health needs and record keeping.
Staff knew how they would identify any signs of abuse to ensure people were kept safe.
Staff were able to tell us what people’s current needs were despite care records not always being up to date to reflect this.
The provider had a safe recruitment system in place.
The service had appropriate checks and maintenance to ensure the service and equipment was safe for people living at the service.
The provider encouraged people and relatives to give their views. Meetings were held for people and their relatives.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 12 February 2019) and there was a breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 13 December 2018. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment at the service.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lambton House on our website at www.cqc.org.uk.
Enforcement
At this inspection we identified breaches in relation to the safe management of people’s medicines, how the service monitored people’s changing health needs and how the management team checked the quality of the service being provided.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The service provides support and accommodation for up to 57 people assessed as requiring residential care. This includes support for people who may also be living with dementia or a physical disability. At the time of our inspection there were 46 people living at Lambton House.
At our last inspection in September 2016 we rated the service good. At this inspection we found the service had deteriorated in two domains and rated the service as requires improvement in safe and well led. This is the first time the service has been rated requires improvement.
There was a registered manager in post at the time of our inspection who had worked at the service for 26 years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Medicines were not always managed safely. We found records, instructions and staff practices were not always up to date to ensure people received their medicines and nutritional supplements as prescribed. Staff were not following National Institute for Clinical Excellence (NICE) guidelines for the safe management of medicines.
The management team carried out a range of quality monitoring audits at the service. However, some of these audits had failed to pick up the issues with medicines management we found during our inspection. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services. They ensure people are provided with a good service and meet appropriate quality standards and legal obligations.
People were protected from abuse by staff who were trained and knowledgeable about safeguarding adults and understood their responsibilities. The provider had suitable policies and procedures in place for staff to follow to keep people safe. Staff understood their responsibilities in relation to respecting people’s privacy and dignity.
Where people had been assessed as at risk of harm there were plans in place for staff to follow to minimise the risk for the person.
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.
People's care needs were assessed and detailed plans were in place to meet their individual needs. People told us they were cared for by staff who knew them very well, promoted their independence and understood how to support them.
There was enough staff employed at the service to provide people with safe care. We saw the provider regularly reviewed the staffing levels to ensure people had the maximum amount of time with staff.
There was a range of stimulating and engaging activities provided by the service which included outings, arts and crafts, reminiscing sessions, sing-a-longs, baking and pamper sessions.
People enjoyed the food they received and had choice over meals in line with their preferences and cultural needs. People were supported to maintain their health and had regular contract with health professionals.
People lived in premises which were adapted to meet people’s individual needs, well maintained, clean and safe. The provider employed their own maintenance team who carried out a range of health and safety checks throughout the service to ensure its safety.
The provider had a robust recruitment system in place to ensure they employed suitable people.
The provider had a training programme in place for management and all care staff. Staff told us they received training in all aspects of their role which enabled them to provide good standards of person-centred care. New staff received a suitable induction.
Staff received regular supervision and an annual appraisal which allowed the registered manager to plan further training to support staff development.
The service had an effective complaints process in place and people were aware of how to make a complaint should they need to. The service actively encouraged feedback from people and staff and was used by the provider to develop the service.
Leadership was visible with an experienced registered manager in post. The management team was accessible to people and staff. People and their relatives spoke positively of the registered manager, how the service ran and their confidence in any concerns being listened to and acted upon by the registered manager.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment. You can see what action we told the provider to take at the back of the report.
Lambton House was last inspected by CQC on 30 June 2015. The location was rated Requires Improvement in all five domains. An inspection visit took place on 26 November 2015 to follow up on the risks in relation to people who had diabetes and found that the registered provider had followed their action plan and had made improvements at the service. We checked the remaining actions during this inspection visit.
Lambton House provides care and accommodation for up to 49 people with personal care needs. On the day of our inspection there were 48 people using the service, some of whom had a dementia type condition.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and staff, and described potential risks and the safeguards in place. Staff had been trained in how to safeguard vulnerable adults. Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.
The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.
There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and training sessions were planned for any due or overdue refresher training. Staff received regular supervisions and appraisals.
The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).
The registered provider had followed their action plan and made improvements to the home to make it more dementia friendly, and plans were in place to continue to improve the environment.
People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.
People who used the service, and family members, were complimentary about the standard of care at Lambton House. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.
Care records showed that people’s needs were assessed before they moved into Lambton House and care plans were written in a person centred way.
The registered provider protected people from social isolation however more activities could be provided during the day to stimulate and entertain people who used the service.
People who used the service, and family members, were aware of how to make a complaint and did not raise any concerns during the inspection visit.
Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. Family members told us the management team were approachable and understanding.
This focused inspection took place on 26 November 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.
Lambton House provides care and accommodation for up to 47 people who require nursing or personal care. On the day of our inspection there were 42 people using the service.
The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
At the last unannounced, comprehensive inspection on 24, 29 and 30 June 2015, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Lambton House on our website at www.cqc.org.uk.
This focused inspection took place to follow up the breach relating to the risks to people who had diabetes, which had not been properly assessed and the risks mitigated.
After the comprehensive inspection of June 2015 we asked the provider to take action to make improvements. The provider wrote to us to say what they would do to meet legal requirements in relation to this breach. We undertook this focused inspection to check that the registered provider had followed their action plan and had made improvements at the service.
We found improvements had been made in the way the home protected people against the risks associated with diabetes.
This inspection took place on 24, 29 and 30 June 2015 and was unannounced. This meant the provider did not know we planned to carry out the inspection.
We carried out our last inspection of Lambton House in October 2013 and found the service to be compliant. Since that date the provider changed the name of their company and re-registered with the Care Quality Commission. However the actual provider and the registered manager did not change.
Lambton House provides accommodation for up to 47 people who require personal care. At the time of our inspection there were 42 people living in the home. Lambton House does not provide nursing care. During our inspection we found the majority of people living in the home had dementia type conditions.
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. Lambton House has a registered manager in post.
The provider had robust recruitment and selection procedure in place and carried out all relevant checks when they employed staff.
We found the provider had in place a number of building safety checks including fire, water and electrical testing.
People had emergency evacuation plans in place and these were accessible to emergency services that may be required to evacuate people from the building.
The provider did not have in place plans to administer people’s PRN (as when required) medicines.
The home had not been adapted to meet the needs of people with sensory impairments including people living with dementia. This included the use of colour to enable people to differentiate items and signage to guide people.
Advice and guidance had not been sought to support people with diabetes. There were no additional menu options for people with this condition.
The provider had made Deprivation of Liberty Safeguards applications to the local authority to deprive people of their liberty and keep them safe.
Staff were given appropriate training and support by the provider who had in place staff supervision meetings and appraisals.
We observed staff to be caring and compassionate towards people and staff used their knowledge of people to engage them in conversation. We saw staff supported people with dignity on most occasions.
We found most of the activities were designed around large groups and did not take into account people’s histories, likes and dislikes.
We found people had in place care plans for people which were reviewed at monthly intervals and then a more substantial review was conducted every six months.
People and relatives we spoke with told us they would speak to the registered manager to make a complaint but none had made any complaints. We found there had been no complaints since our last inspection.
The registered manager described to us the improvements they were making to the service including the development of a summer house and developing Hen Power, a programme designed to engage people in keeping chickens. This has been found to improve people’s well-being.
The provider had in place comprehensive audit arrangements to monitor the service.
We found many records which were incomplete or inaccurate.
We found a number of 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