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We are carrying out a review of quality at Lancaster Grange. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 14 August 2019

About the service

The home provides accommodation, nursing and personal care for up to 60 older adults and people living with dementia. There were 55 people living in the home on the day of our inspection. The home accommodates 55 people across four separate wings over two floors, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

People, relatives and staff consistently told us that staffing levels were not sufficient to meet the needs of people using the service. Records showed that staffing levels did not always reflect the ratio stipulated by the provider. Observations during the inspection confirmed that people are often left unattended while staff are dealing with other issues.

Risks were not being managed effectively. People at high risk of skin breakdown were not being repositioned at the agreed intervals. Fluid intake was not always being recorded for people and risks associated with choking and falls were not being managed effectively which placed people at risk of avoidable harm.

Medicines were not managed effectively. People were at risk of not having medicines administered as prescribed.

Systems and processes were in place to ensure that the home was clean and to reduce the risk of spread of infection. Systems and processes were in place to protect people from abuse, staff were knowledgeable about how to respond to abuse.

Advice provided by health professionals was not always acted upon.

Records showed that people are assessed prior to admission and have a full care plan developed following this. Staff receive the training they need to meet people's needs. People received a nutritious healthy diet and have access to drinks and snacks.

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.

Staff were observed to be kind and caring toward people. People and relatives spoke very highly of the staff and have told us that they are happy with the way that staff interact with them.

People and relatives told us that their views and opinions were not always listened and responded to.

Staff were knowledgeable about how to maintain people's privacy and dignity. People and relatives confirmed that staff do their best to promote people’s independence and maintain their dignity. Staff understood the principals of confidentiality.

No one living at the home was at the end of their life. Staff were knowledgeable about how to support people at the end of life to ensure that they had a dignified death. Future planning had been done with people to ensure that their wishes were reflected clearly.

The home was without a registered manager and a deputy manager. The deputy manager had been appointed and was due to start their role. An experienced operations manager had been appointed internally on a temporary basis and was in the process of registering themselves to act as the registered manager. At the point of writing this report, we have not received an application.

Governance systems and audits were in place and used regularly but did not always identify risk. Risk that was identified during the inspection had not been identified in previous audits. Manager’s walk rounds had identified some issues and were being addressed.

Relatives have told us that they did not feel that the organisation listens to concerns and often does not communicate effectively with them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 18 October 2017 )

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks. We hav

Inspection areas

Safe

Inadequate

Updated 14 August 2019

The service was not safe.

Details are in our safe findings below.

Effective

Requires improvement

Updated 14 August 2019

The service was not always effective.

Details are in our effective findings below.

Caring

Requires improvement

Updated 14 August 2019

The service was not always caring.

Details are in our caring findings below.

Responsive

Requires improvement

Updated 14 August 2019

The service was not always responsive.

Details are in our responsive findings below.

Well-led

Inadequate

Updated 14 August 2019

The service was not well-led.

Details are in our well-Led findings below.