Lancaster Grange

We found the following examples of good practice.

The home was currently closed due to an outbreak of COVID-19. However, the provider ensured people still had access to an ‘essential care giver’. This is a named person who can still visit during a COVID-19 outbreak. This helped to reduce the risk of loneliness and improved people’s mental health and wellbeing.

The provider had processes in place that ensured that people living at Lancaster Grange had regular access to friends and families. This included three named visitors. Visitors were requested to book their visits online, enabling the provider to plan for the number of visitors arriving at the home. Prior to entry to the home, visitors were required to provide a negative Lateral Flow Test (LFT) result and to show evidence that they had received the appropriate vaccinations. Visitors were required to wear Protective Personal Equipment (PPE) in accordance with the provider’s COVID-19 policies and procedures. Visitors were not permitted to access communal areas during the outbreak of COVID-19. This helped to reduce the risk of the spread of infection. Any visitors not complying with these requirements were not permitted access to the home.

People were supported to use and access their environment in a safe way. Social distancing was encouraged wherever possible. We observed people sitting in communal areas a suitable distance from each other to reduce the risk of the spread of COVID-19. Efforts had been made to support people living with dementia to maintain social distancing. Rooms were well ventilated.

At the time of the inspection, eight people had tested positive for COVID-19. Safe isolation procedures were in place to protect others from the risk of infection. We observed barrier nursing taking place and there were strict PPE criteria for staff to follow when providing personal care for people. The home had separate units where access could be restricted. People had en-suite facilities in their bedrooms. These and other parts of the environment made isolation procedures easier to commence and safely manage. PPE stations were placed outside people’s bedroom for staff to use. Appropriate procedures were also in place to dispose of used PPE safely. We observed staff doing so.

The home was not currently accepting new admissions. This decision was taken due to the outbreak of COVID-19. Once the home reopens, the provider will commence admissions. Safe admission and re-admissions protocols were in place. People were required to provide negative LFT results and to isolate until further negative test results had been confirmed.

It was acknowledged isolation for people living with dementia was problematic. For those people, specific staff were assigned to support them and were ready to identify any potential risks. Wherever possible, staff refrained from mixing in other parts of the home, reducing the risk of the spread of infection.

There were ample supplies of PPE at the home. The provider had a regular supply and during the COVID-19 outbreak at the home supply levels remained high. Staff received training on how to ‘Don and Doff’ (put on and take off) their PPE to reduce the risk of cross-contamination. Posters, leaflets and other guidance materials were placed around the home in toilets, bathrooms, notice boards and other communal areas informing staff how to ensure safe procedures were followed. Staff explained to people why PPE was needed, and people accepted this.

A robust testing regime was in place. All staff and people living at the home were tested regularly and in accordance with government guidance. Staff test results were recorded on a central database. This enabled the provider to check the vaccination status of staff, if any had not received a booster for example, this would be identified quickly. All staff were fully vaccinated. Most people living at the home had been fully vaccinated and received a booster.

The layout of the premises ensured the risk of the spread of COVID-19 was reduced. There was ample outside space for visitors to use and there were also indoor adapted facilities that ensured people could continue to see friends and families. Regular cleaning of all touch points and other key areas was carried out throughout the day. A housekeeper was assigned to each unit. They followed a daily cleaning routine that was designed to help to reduce the risk of the spread of infection.

There were enough staff to support people safely and to cover any staff holidays, sickness and COVID-19 isolation. There had been some pressures on staff numbers. When needed in urgent situations, managerial and administrative staff, (all who were trained to administer care), provided assistance. This ensured any staff shortages did not have a direct impact on people’s health and safety. Where needed, regular agency staff provided cover for shifts. A negative LFT result and vaccine passport was required prior to agency staff commencing their role.

The provider considered staff member’s wellbeing. A variety of initiatives were in place to support staff whose mental health and wellbeing may have been affected by the pandemic. This included, but was not limited to, a ‘thank you’ bonus and access to counselling services.

The provider had assessed the impact of potential ‘winter pressures’ and acted accordingly. Regular COVID-19, outbreak and other related audits were carried out to help identify any areas of concern. Action plans were in place and reviewed.

Lancaster Grange is a residential care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

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

There were systems in place to keep people safe from the risk of abuse. People and relatives felt the service was safe. Staff understood how to recognise and report concerns or abuse. There were enough staff to keep people safe and meet their needs. People’s needs were assessed, and any risks associated with health conditions documented. Risks associated with the service environment were assessed and mitigated. People received their prescribed medicines safely. People were protected from the risk of acquiring infections and the service was clean. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences.

People's needs were assessed with them prior to moving into the service. The provider ensured staff had training and support to develop their personal care skills. People were supported to maintain a healthy balanced diet and to eat and drink well. People were supported by staff to access healthcare services when required. The provider had taken steps to ensure the environment was suitable for people's needs.

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 using the service were supported by staff who cared for them and treated them with respect. Staff had the information they needed to provide individualised care and support. People were encouraged to make decisions regarding their day to day routines and express their views about their personal preferences. People’s care was provided in ways which promoted their dignity and respected their independence.

People were regularly asked for their views about their care. People’s care plans were detailed, containing information about how they liked to be supported, and their daily routines and preferences. People were given information about their care in accessible formats where they wanted this. People were supported to maintain their interests and take part in activities that were important and enjoyable for them. The provider had a system in place to respond to complaints and concerns. People and their relatives were encouraged to talk about their wishes regarding care towards the end of their lives.

The provider did not have a registered manager in post, and had not had one since January 2019. The provider and manager undertook audits of all aspects of the service to review the quality of care. Staff were motivated and proud to work for the service. The provider and manager had systems in place to ensure compliance with duty of candour. The provider regularly sought the views of people, relatives and staff regarding the quality of the service. The manager and provider worked in partnership with outside agencies to improve people’s care. People were supported to maintain contact with their family, friends and local community.

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 Inadequate (published 14 August 2019 and there were multiple breaches of regulations. We issued the provider with two Warning Notices to comply with Regulations 12 (Safe care and treatment) and 18 (Staffing). 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.

This service has been in Special Measures since August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. At our last inspection, we served the provider with two Warning Notices. This was in relation to breaches of regulations 12 (Safe care and treatment) and 18 (Staffing). We found the provider had taken appropriate action to address the issues found on our last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to Regulation 18 Staffing, Regulation 12 Safe Care and Treatment, Regulation 14 Meeting Nutritional and Hydration Needs and Regulation 17 Good Governance at this inspection.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection, in December 2016 the service was rated Good.

At this inspection on 13 September 2017 we found that the service remained Good.

The service had a manager in post who was in the process of registering with the Care Quality Commission. 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 and associated Regulations about how the service is run.

The service provided excellent person centred care that had a positive impact on people's lives. Staff, relatives, and people living at the service felt the care at the service was exceptional and people were enabled to have a good quality life.

People had access to personalised activities that complemented their individual interests and preferences. There were exceptional links with the local community and people were supported to participate in community events and other events that were important and meaningful to them. This provided people with a sense of purpose and wellbeing. Regular outings were also organised outside of the home and people were encouraged to pursue their own interests and hobbies.

People continued to receive safe care. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. People had risk assessments in place to enable them to be as independent as they could be in a safe manner.

Effective recruitment processes were in place and followed by the service and there were enough staff to meet people’s needs. People received their prescribed medicines as prescribed.

The care that people received continued to be effective. There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff received an induction process and on-going training to ensure they were able to provide care based on current practice when supporting people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff were well supported with regular supervisions and appraisals. People were supported to maintain good health and nutrition.

Staff provided care and support in a caring and meaningful way and people had developed positive relationships with them. Staff were caring and treated people with respect, kindness and courtesy. They knew the people who used the service well and people and relatives, where appropriate, were involved in the planning of their care and support.

People continued to receive care that was responsive to their needs. People's care plans had been developed with them to identify what support they required and how they would like this to be provided. People knew how to complain. There was a complaints procedure in place which was accessible to all.

The culture was open and honest and focused on each person as an individual. Staff put people first, and were committed to continually improving each person's quality of life. Quality assurance systems ensured people received a high quality service driven by improvement.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lancaster Grange on our website at www.cqc.org.uk

We undertook this unannounced focused inspection of this location on 2 November 2016. Lancaster Grange is run and managed by Barchester Healthcare Homes Limited. The service provides nursing care and support for up to 60 people. The service is provided over two floors with two units on each floor; during our visit one unit on the first floor was closed. On the day of our inspection 32 people were using the service.

The service had a registered manager in place at the time of our 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 and associated Regulations about how the service is run.

When we last visited the service we found people were not supported by sufficient numbers of staff to meet their needs. This impacted on the ability of staff to ensure people were appropriately supported with their nutritional needs. During this inspection we found the ratio of staff to the number of people who used the service had improved. In addition the registered manager had worked to improve the support people required to meet their needs by deploying support staff at key times in the day to assist with aspects of care.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority when needed. Risks to people’s safety were assessed and reviewed on a regular basis. These risks were managed in such a way as to both protect people and allow them to retain their independence.

People received their medicines safely from suitably trained staff. Staff had a full understanding of people’s care needs and received regular training and support to give them the skills and knowledge to meet these needs.

When we last visited the service staff were not receiving support through regular supervisions during this inspection we found staff received support from the management team through supervisions and the registered manager had an on-going supervision programme in place.

There were systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

The service had a registered manager in place at the time of our 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 and associated Regulations about how the service is run.

When we previously inspected the service on 18, 19 and 23 March 2015 we found there were breaches of regulations. This was because improvements were required to ensure that incidents of a safeguarding nature were handled appropriately, people received care and support from adequate numbers of experienced staff and medicines were administered and stored safely. There were also improvements needed in relation to the information available to staff in people’s care plans.

We previously found there was a lack of support for staff who did not have confidence in the management team and although there were systems in place to monitor the quality of the service they had not been utilised effectively to highlight shortfalls in the quality of the service. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan and told us they would make the improvements. During this inspection we looked at whether the provider had met the legal requirements in relation to the breaches of regulation we found at the last inspection. We found that although some improvements had been made there were further improvements required.

People were not supported with sufficient numbers of staff to meet their needs. This impacted on staffs ability to ensure people were appropriately supported with their nutritional needs.

Whilst there had been significant improvements in how risks to people were managed there were still times when information was not recorded appropriately.

People felt safe in the service and were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The manager shared information with the local authority and CQC when needed. People received their medicines as prescribed and the management of medicines was safe.

People were supported by staff who had received appropriate mandatory training. However staff supervisions were not always undertaken regularly.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

Referrals were made to health care professionals when needed and people who used the service, or their representatives, were encouraged to contribute to the planning of their care.

People were treated in a caring and respectful manner and staff delivered support in a relaxed and considerate manner.

People who used the service, or their representatives, were encouraged to be involved in decisions and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.