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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.

Reports


Inspection carried out on 4 June 2019

During a routine inspection

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 carried out on 13 September 2017

During a routine inspection

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. On the day of our inspection 48 people were using the service.

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.

Inspection carried out on 2 November 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 30 and 31 March 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

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.

Inspection carried out on 30 March 2016

During a routine inspection

We undertook the unannounced inspection of this location on 30 and 31 March 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, one unit on the first floor was not open. On the first day of our inspection 37 people were using the service and 36 people were present on day two.

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.

Inspection carried out on 18, 19 and 23 March 2015

During a routine inspection

We performed the unannounced inspection on 18, 19 and 23 March 2015. Lancaster Grange is situated on the outskirts of the town of Newark in Nottinghamshire. The home is registered to accommodate up to 60 people in four separate units. The home has two floors with a passenger lift for people to access the upper floor. On the day of our inspection 41 people were using the service.

The service had a registered manager in place at the time of our inspection although they were not on duty throughout 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.

Staff were aware of their roles and responsibilities to protect people from the risk of abuse but did not feel confident in initiating the organisations whistleblowing procedures without fear of recrimination.

People could not be assured that incidents would be responded to appropriately. We found that there were adverse incidents had occurred in the service these had not always been reported to the Care Quality Commission (CQC) which is a legal obligation placed on providers.

People had not received their medicines as prescribed and the management of medicines was not always safe.

Staffing levels were not always maintained at sufficient levels to support people with their individual needs.

Whilst people were encouraged to be involved in planning their care, people’s records did not always provide staff with the required information to respond to their holistic needs.

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.

Specialist diets were provided when required and referrals were made to health care professionals when guidance was needed.

People were treated with dignity and respect. Staff were proactive in promoting people’s choice and incorporated a kind and caring when attitude when supporting people.

People enjoyed the activities and social stimulation they were offered. People were encouraged to be involved in decisions about the service and felt they could report any concerns to the management team.

Whilst systems were in place to monitor the quality of service provision they had not always been utilised effectively to ensure people’s care plans and medicines were managed effectively.