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Lancum House Requires improvement

Reports


Inspection carried out on 25 February 2019

During a routine inspection

About the service:

Lancum House is registered to provide accommodation and personal care support for up to 43 older adults. At the time of the inspection, 35 people were living at Lancum House, all 35 people received the regulated activity of personal care.

People’s experience of using this service:

¿ Medicines management required strengthening to ensure there was accurate records of medication in stock and disposal of medication was carried out safely.

¿ People, their relatives and staff told us that the quality of care received was impacted using agency staff.

¿ People didn’t always feel that their possessions were safe.

¿People’s dignity had been compromised by displaying on communal notice boards who was weighed monthly.

¿ Meal time experiences for people required improving.

¿ Quality assurance audits were not always effective in identifying people’s experience of the service and the day to day culture of the service.

¿ Staff understood safeguarding procedures and were confident in reporting concerns.

¿ Risk assessments were in place to manage risks within people’s lives.

¿ Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

¿ Staffing support matched the level of assessed needs within the service during our inspection.

¿ Staff were supervised well and felt confident in their roles.

¿ People were supported to have a varied diet; however, feedback was mixed about the menu choices.

¿ Healthcare needs were met, and people had access to health professionals as required.

¿ People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

¿ People were supported in the least restrictive way possible.

¿ Care plans reflected people likes dislikes and preferences.

¿ People were able to take part in a wide range of activities and outings.

¿ People and their family were involved in their own care planning as much as was possible.

¿ A complaints system was in place and was used effectively.

¿ The registered manager worked in partnership with outside agencies to improve people’s support when required

¿ The service had a registered manager in place, and staff felt well supported by them.

¿ The service met the characteristics for a rating of requires improvement in four or the five key questions we inspected and a rating of good in one. Therefore our overall rating for the service after this inspection was requires improvement. More information is in the full report.

At this inspection we found one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Enforcement: We have asked the provider to send us an action plan telling us what steps they intend to take to make the improvements needed.

Rating at last inspection: Good (report published September 2016)

Why we inspected: This was a planned inspection.

Follow up:

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

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

Inspection carried out on 4 August 2016

During a routine inspection

The inspection took place on 4 August 2016 and was unannounced. Lancum House provides residential care and accommodation for up to 43 older people, including people living with a diagnosis of dementia. On the day of the inspection 39 people were using the service.

A registered manager was 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.

At the last inspection of the service on 23 and 24 July 2015 we asked the provider to take action to improve staff deployment and meeting people’s nutritional and hydration needs. The provider sent us an action plan telling us how they planned to improve. At this inspection we found the actions had been completed.

Systems were in place for reviewing staffing levels. Staff arrangements were adapted to meet people’s changing needs. The staff recruitment systems were robust to ensure people employed at the service were suitable. The service had a proactive approach to staff learning and development to ensure staff had the right competencies, knowledge, qualifications, skills, experience, attitudes and behaviours to meet the range of people’s needs. All staff received support through one to one supervision and annual staff appraisals took place.

Staff protected people, especially people with complex needs, from the risk of poor nutrition and hydration. People’s nutritional needs had been assessed and additional staff support was provided at mealtimes to enable people to eat and drink sufficient amounts. People using the service and their relatives spoke positively about the variety of food on the menu and the quality of food provided. They felt actively involved in this aspect of the service and were able to give feedback on a regular basis.

Staff knew how to recognise signs of potential abuse and what to do to protect people’s safety and welfare when safeguarding concerns were raised. Arrangements were in place for continually reviewing safeguarding concerns, accidents and incidents, to make sure that appropriate action was taken at all times, to protect people from the risks of abuse and avoidable harm.

Staff managed behaviour that may challenge others, in a positive way, to protect people’s dignity and rights. They regularly reviewed how they worked with people, supporting them to manage their behaviour and sought to understand and reduce the causes of behaviour that distressed people or put them at risk of harm. They made sure that people were referred for professional assessment at the earliest opportunity.

Risk assessments were proportionate and centred around people’s needs. Strategies were put in place to ensure that anticipated risks to people’s health and welfare were managed appropriately.

Systems were in place to ensure that staff managed medicines consistently and safely. People received their medicines as prescribed. Where appropriate, the service involved people and their representatives in the regular review and risk assessment of their medicines.

Staff understood the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. They put these into practice to ensure that people’s human rights were respected. Staff considered people’s capacity to make decisions and the support they needed to do so. Decisions that were made in people’s best interests had been made through involving their representatives and other professionals.

People’s health needs and preferences were regularly reviewed. Appropriate referrals were made to other health and social care professionals, so that preventative action was taken at the right time to keep people in good or the best of health.

People received care and support from staff that knew them well. The relationships be

Inspection carried out on 23 and 24 July 2015

During a routine inspection

Lancum House provides residential care and accommodation for up to 43 older people, including people living with a diagnosis of dementia. On the day of our visit, there were 41 people living at the home. The inspection was unannounced and took place on 23 and 24 July 2015.

The registered manager had left employment in July 2015. We were informed that the registered managers’ post was currently being advertised and the area manager and a deputy manager from another care home within the same organisation were managing the home in the interim. 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.

The numbers of staff on duty did not fully support people with high dependency to be attended to in a timely manner.

People had individualised care plans in place that reflected their needs and detailed their choices about how they preferred their care and support to be provided. However the staffing resources did not allow time for staff to provide the support people needed to engage in their choice of activities.

People’s nutritional needs had been assessed and they were supported to make choices about their food and drink. However the mealtimes were not always a pleasurable experience, for people with high dependency and living with dementia, as they did not always receive the full support they needed to eat and drink.

The staff treated people with kindness and respect; however, due to people having to wait for the staff availability, people were sometimes placed at risk of their dignity not being maintained.

Quality assurance systems were carried out to assess and monitor the quality of the service. The views of people living at the home and their representatives were sought. However resident meetings had not taken place as frequently as scheduled and matters raised at meetings had not always been fully addressed.

The staff were knowledgeable about the risks of abuse and knew how to respond appropriately to any safeguarding concerns to ensure people’s safety and welfare.

The staff recruitment systems were robust to ensure people employed at the home were suitable. All staff were provided with induction training and on-going training, which included accredited training. All staff received support through one to one supervision and annual staff appraisal.

Risk assessments were in place to reduce and manage the risks to peoples’ health and welfare and suitable arrangements were in place for the safe administration and management of medicines.

The staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA 2005) and the Deprivation of Liberty Safeguards (DoLS) codes of practice.

People were supported to see health and social care professionals as and when required and prompt medical attention was sought in response to sudden illness.

People were encouraged to raise any concerns they had about the quality of the service they received, complaints were taken seriously and responded to appropriately.

We identified that the provider was not meeting regulatory requirements and were in breach of a number 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.

Inspection carried out on 13 January 2014

During an inspection looking at part of the service

During our visit on 15 October 2013 we found that assessments and care plans did not always reflect people's needs and people were not consistently receiving care as specified in their care plans. When we visited on 13 January 2014 we found that improvements had been made.

The manager explained that staff were now based in a specific part of the home and that the team leader�s hours had been changed. Staff confirmed that this helped to offer more consistent care.

We looked in detail at care records for five people and looked at a sample of monitoring charts which staff filled in to ensure that people were receiving the care and assistance they needed. We saw that team leaders were signing the monitoring charts each day to confirm that they had checked that they were accurate and that people were receiving appropriate care.

We saw that assessments and care plans contained the information that staff needed to meet people�s needs and that care plans had been updated when people�s needs changed.

Inspection carried out on 15 October 2013

During an inspection looking at part of the service

We spoke with five people who lived at Lancum house. They told us that they were happy with the care they received. Although people spoke highly of their care we identified some areas where improvements were needed.

When we visited Lancum House 7 and 14 January 2013 we found that care records did not consistently detail the care people required. We also found that staff were not following the advice given by healthcare professionals. When we visited on 18 April 2013 we found that there had been some improvement to people's care plans and how their needs were being met but we also found some areas that required improvement.

We visited on 15 October 2013 to check whether improvements had been made. During our visit on 15 October 2013 we found that assessments and care plans did not always reflect people�s needs and people were not consistently receiving care as specified in their care plans.

Inspection carried out on 18 April 2013

During an inspection looking at part of the service

We saw that staff talked with people in a caring and sensitive manner and gave explanations when they assisted people.

When we visited Lancum House 7 and 14 January 2013 we found that care records did not consistently detail the care people required. We also found that staff were not following the advice given by healthcare professionals. When we visited on 18 April 2013 we found that there had been some improvement to people�s care plans and how their needs were being met but we also found some areas that required improvement.

We found that not all staff knew how to weigh people correctly or what action they needed to take if the results show weight loss. This means that people are not being fully protected from the risks of malnutrition.

We received mixed feedback about whether people had to wait for assistance with two out of the four people we spoke with telling us that they sometimes have to wait when they needed help. All told us that they were happy with the care they received. We did not observe anyone having to wait for assistance during our visit.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

Inspection carried out on 7, 14 January 2013

During an inspection looking at part of the service

We spoke with eight people who lived at the home. We received positive comments about the home and about the staff. However, five out of the eight people told us that they had to wait when they needed staff assistance. One person told us �sometimes when I am having a shower staff get called away and I have to wait 10 minutes for them to come back.�

We spoke with six members of staff. They told us that sometimes people have to wait when they need assistance. One staff member told us �people have to wait � we have to prioritise� another staff member said �when we are doing personal care other people get left� explaining that people have to wait to get up in the morning and to use the toilet when they need to.

We found that care records did not consistently detail people�s current needs or the care they required by staff. We found that assessments and care records contained contradictory information. We found that people�s needs in relation to pressure care and nutrition were not being adequately met.

Inspection carried out on 20 July 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an �expert by experience� (people who have experience of using services and who can provide that perspective).

We spoke with nine people who used the service and three relatives of people who used the service.

One person who used the service told us, "I'm very happy here. The carers are marvellous. The food is marvellous. I can always have what I want. I can't imagine not being here, staff are nice."

Another person told us, �I like being here, the food is as good as it gets."

A relative referring to a family member�s experience at the home told us, �He likes the company of others so this environment is well suited to him; he seems to be happy; the staff seem to be caring."

A relative of a lady who used the service told us, "Staff go out of their way to ask what she wants to eat. She has often told me that she'd had a lovely dinner." The same person told us that he and his relative had been involved in the care plan when his relative had first come to live at the home. He added that he had observed that, "There were lots of activities for people to join in."

Inspection carried out on 23 September 2011

During a routine inspection

Residents were involved in making decisions about their care and their views about how the service was run were taken into account. One resident said she always attended residents meetings, activities were available to take part in and she enjoyed it when visiting entertainers came into the home. One resident said she sometimes attended church services and people from the local church visit the home.

One resident said they had completed questionnaires asking their views on the quality of the service provided at Lancum House they said they would not hesitate to speak to the manager if they were unhappy with any aspect of care at the home.

We observed a small group of residents being supported by staff taking part in an organised activity; the residents seemed to enjoy the activity which was placing themed picture stickers in books. Some residents were occupied in their own choice of activities such as knitting.

We observed that residents receiving their lunch on time and the food looked well presented and appetising. We observed residents being assisted to eat and given regular drinks by staff which was done sensitively and respectfully.

We spoke with three residents who told us they liked living at Lancum House; they felt safe and the staff were good to them.

Two relatives we spoke with were in general satisfied with the care provided at Lancum House; they spoke of staff being very helpful and approachable.

One resident said she noticed that the staff always seemed to be busy and worked long hours. A relative said there had been a shortage of staff and the numbers of staff had increased noticeably in recent months.

Reports under our old system of regulation (including those from before CQC was created)