Lee Valley Care Services Limited

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

Risks in relation to people receiving treatment and care were not managed appropriately. Medicines were not always managed safely, as guidance for the administration of specific medicines were not available. Quality assurance systems were in place, but these were not effective as they did not identify some of the shortfalls identified during our inspection. The registered manager acted upon feedback from the inspection and were in the process of addressing the issues identified.

People told us they felt safe at the service, and they could find a member of staff to help them. Staff rotas showed shifts were covered. People told us they were kept informed about their medicines and why they needed to take them.

Staff demonstrated they were aware of their safeguarding responsibilities and how to report concerns. Lessons learnt took place at the service after an incident and staff confirmed they took part in meetings to learn from incidents.

Staff were supported in their role and mostly received appropriate training.

People were able to enjoy food they liked and were supported to have enough to drink.

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. Consent to care and treatment was requested and staff did not force people to do something they did not want to.

The service worked well with external health professionals to ensure people received support when they became unwell.

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 good (published 26 June 2019).

Why we inspected

We received concerns in relation to poor management of medicines, poor maintenance of the environment and poor record keeping. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lee Valley Support Services on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk, safe management of medicines and governance within the service.

We recommended that the service sought further guidance form a reputable source around the assessment of needs for people who used the service and training for staff to have the skill and knowledge to support people with specific health care needs.

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 from 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 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.

The service worked hard to encourage people to maintain socially distanced despite people living at the home finding it difficult at times to fully understand why this was necessary.

Most people did not have regular visitors, even before the Covid-19 pandemic had placed restrictions around visiting. One person did have a relative that used to visit but this person had not wished to during the last year, although the registered manager told us this would be permitted at such time the relative may wish to visit again. They were, however, able to have regular contact by phone with their relative at the home and the registered manager told us that they kept the relative updated about the person’s progress and how they were doing.

A person using the service told us that they had missed being able to participate in their usual daily activities, such as attending a day centre, but had been supported by staff to go out and take walks locally. This person was aware that there were restrictions about what people could or couldn’t do due to the pandemic and was looking forward to these restrictions hopefully being eased in the coming months.

People’s experience of using this service:

People using the service informed us that they were satisfied with the care provided. They appeared comfortable and well cared for. They interacted well with staff and there was a relaxed and homely atmosphere. One relative and three care professionals were positive about the services provided and said that people were well cared for.

Risk assessments had been documented. Risks to people’s health and wellbeing were regularly assessed. There were procedures in place for dealing with emergency situations. Personal emergency evacuation plan’s (PEEPs) were in place for people.

Staff had received training on how to safeguard people and were aware of the procedure to follow if they suspected that people were subject to abuse

The home had suitable arrangements for the ordering, storage, administration and disposal of medicines. People had received their medicines as prescribed.

The home had adequate staffing levels and staff were able to attend to people’s needs. This was also confirmed by staff and most relatives.

People were supported to live a healthy life. Staff supported people to have a healthy and nutritious diet that was in line with their individual dietary needs and preferences. People had access to healthcare professionals when needed.

The service worked towards ensuring that people received personalised care and support that met their individual needs and choices. Care documentation included details about people’s individual needs and preferences. People’s care had been reviewed with them and their representatives to ensure they met their changing needs.

Staff received appropriate training to ensure they had the right knowledge and skills to support people in a safe and effective way. The registered manager supported staff by providing them with regular supervision and a yearly appraisal of their performance.

Staff knew people well and had a caring approach to their work. They understood the importance of treating people with dignity, protecting people's privacy and respecting their differences and human rights.

The premises were well maintained. Regular checks and inspections of equipment had been carried out. Fire safety arrangements were in place to ensure that people were protected in the event of a fire. There was an updated fire risk assessment and regular fire drills had been carried out. Smoking was not allowed within the home and checks were in place to ensure that people adhered to these rules.

The service had arrangements for infection control. The premises had been kept clean and no unpleasant odours were noted.

The requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) were met. The home had made the necessary applications for DoLS where people’s liberty needed to be restricted for their own safety.

Staff supported people to participate in activities both in the home and in the community.

There was a formal complaints procedure in place which was available to people and their representatives.

The home had a management structure with a team of care workers, a deputy manager and the registered manager. The morale within the home was good and staff worked well with one another. Staff felt supported by their managers.

Management monitored the quality of the service and we saw evidence that regular audits and checks had been carried out to improve the service. These included areas such as care documentation, health and safety, cleanliness of the premises and medicines management and staff training.

Rating at last inspection: The service had been inspected on 20 October 2016 and rated as Good.

Why we inspected: This was a scheduled planned comprehensive inspection.

Follow up: We will continue to monitor the service through the information we receive.

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

At our last inspection on 20 April 2016 we found a breach of legal requirements and sent the provider and registered manager a warning notice. We send warning notices to a registered person where the quality of the care they are responsible for falls below what is legally required. Legal requirements can include the Health and Social Care Act 2008 (‘the Act’) and the regulations made under it, but also other legislation that registered persons are legally obliged to comply with in delivering the service. We found a breach in respect of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to inadequate staffing levels. A warning notice was issued in respect of this breach. We asked the registered provider and registered manager to comply with this breach by 13 May 2016.

At our previous comprehensive inspection on 1 December 2015 we rated the service as “Requires Improvement”. We found two breaches. The first was in respect of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to unsafe or unsuitable premises because of inadequate maintenance. The second was in respect of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider did not have adequate systems in place to identify and manage risks to the safety of people who use services and others.

The home has a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People informed us that they were satisfied with the care and services provided. They said that people were treated with respect and they were safe. There was a safeguarding adults policy and suitable arrangements for safeguarding people. People’s care needs and potential risks to them were assessed and suitable arrangements were in place to ensure their safety. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. The premises were clean and no offensive odours were detected. There was a record of essential inspections and maintenance carried out. There were suitable arrangements for fire safety which included alarm checks, drills, training and a fire equipment contract. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records. Care workers were aware of action to take in the event of a fire.

Care workers had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough care workers to meet people's needs. There was always a minimum of two care workers on duty during the day and night shifts. Care workers worked as a team and communication was good.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS).

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. Their healthcare needs were monitored and arrangements made for them to be attended to.

The home had a varied activities programme. However, some people informed us that they would like more activities. The registered manager agreed to review the activities available and ensure that more were provided for people. There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents meetings and one to one sessions had been held for people. However, these meetings were infrequent. We recommend that the service review the effectiveness and frequency of meetings so that people have more opportunity to express their views and have their preferences responded to.The complaints procedure was on display in the home. No complaints had been recorded since the last inspection. The registered manager explained that none had been received.

People expressed confidence in the management of the service and informed us that the registered manager and care workers were responsive towards them. Requirements we made at previous inspections had been responded to. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence. We received positive feedback from a healthcare professional regarding the management of the home.

Prior to the inspection we received a notification of a serious incident affecting a person using the service. Deficiencies related to fire safety including a

fire risk assessments which was not sufficiently comprehensive were noted. We looked at whether other people were at risk of a similar incident. We found that the provider had taken action to ensure a similar incident would not take place again. We are now satisfied that there are adequate fire safety arrangements in place. Fire safety requirements had been complied with and this included a comprehensive fire risk assessments and further fire training for staff.

At our last comprehensive inspection on 1 December 2015 we found two breaches of legal requirements. This is because the provider did not have effective systems for safe care and treatment and for monitoring the quality of care. After the comprehensive inspection, the registered provider sent us an action plan telling us how they would meet legal requirements. We undertook this focused inspection on the 20 April 2016 to check that they had followed their plan and to confirm that they now met legal requirements in relation to safe care and treatment. This inspection was also undertaken following a fire incident in the home.

This report only covers our findings in relation to safe care and treatment. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Lee Valley Care Services Limited’ on our website at www.cqc.org.uk’.

The home has a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

At this focused inspection, we found that the provider taken action to comply with some aspects of safe care and treatment. Most fire safety arrangements were in place and maintenance deficiencies we previously identified had been rectified. A new fire risk assessment had been carried out and the full report was received by the provider the day after our visit. Risk assessments had been carried out to identify potential risks to people and these included PEEPs (personal emergency and evacuation plans). Some essential information related to fire safety were not available as the registered manager stated that they were with the London fire service who were investigating the recent fire incident. We however, observed that risk assessments related to people smoking were in place. We also observed that people smoked in a designated area outside the home.

When we arrived at the home at 8.30 am, we found only one care worker on duty during the night shift. Two care workers were due to be on duty as indicated on the rota. This staffing level is inadequate and may put people at risk in the event of a fire or an untoward incident. Adequate staffing levels are also needed as some people have extra care needs which may put them and others at risk. We have issued a warning notice in respect of this deficiency.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have served a warning notice in respect of this breach. You can see what actions we told the provider to take at the back of the full version of the report.

At our last inspection on 10 April 2014 the service met all the regulations we looked at.

The home has a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People and their representatives informed us that they were satisfied with the care and services provided. They said that people were treated with respect and they were safe. There was a safeguarding adults policy and suitable arrangements for safeguarding people. People’s care needs and potential risks to them were assessed. Staff prepared appropriate care plans to ensure that that people were safe and well cared for. Their healthcare needs were monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Consultation meetings had been held for people. The home had an activities programme but effort is needed to ensure that people were encouraged to participate in more activities so that they received more social and therapeutic stimulation.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS).

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People were mostly satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough staff to meet people's needs. Staff worked as a team and communication was good.

People and their representatives expressed confidence in the management of the service. The results of the last satisfaction survey and feedback from people indicated that they were satisfied with the care and services provided. Staff were aware of the values and aims of the service and this included treating people with respect and dignity and promoting their independence.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. We however, noted that on arrival at the home there was an unpleasant odour. The registered manager was taking action to rectify the problem. A sofa in the lounge had a hole in it. The registered manager stated that a person who used the service had damaged it recently and it would be repaired. Following the inspection, they have advised us that they have replaced the sofa. The bottom of the ground floor lounge door was worn and in need of repairs or replacement. The fire safety arrangements were not satisfactory and action was needed to rectify deficiencies identified. We have made a requirement in this report in respect of these. The registered manager stated that action would be taken to rectify deficiencies and improve fire safety.

The home had arrangements for quality assurance and for responding to complaints. Complaints made had been promptly responded to. Regular audits and checks had been carried out by the registered manager of the home. We however, noted that these were not sufficiently comprehensive and had not identified and promptly rectified certain important deficiencies such as fire safety issues, outdated policies and procedures, the absence of personal emergency and evacuation plans. Inadequate quality monitoring arrangements may result in people not receiving a high standard of care and it may also place people’s safety at risk. We have made a requirement in this report in respect of this.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

We met four people who were currently using the service, and four members of staff, including the Registered Manager. Most of the people who used the service were not able or willing to communicate verbally with us. We spent some time observing how staff interacted with them and how they communicated their needs and wishes to the staff. We followed the written guidance for communication for one person. At first they responded with 'yes' and 'no' to our questions, but then held a conversation with us about what they enjoyed doing and their life before living at Lee Valley services Limited.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who we spoke with said that they felt safe in the home. One person told us about their previous life, which included a time when they were homeless. They said that Lee Valley Care Services Limited provided them with accommodation that they liked and the support that they needed.

The communal rooms and bedrooms were furnished with comfortable domestic style furniture. Bedrooms could be locked to ensure privacy for the people who used them. We observed an improvement to safety in the premises since our last inspection. The carpets in the downstairs hallway and first floor landing had been replaced with wood laminate flooring to ensure that there was no risk of tripping on worn carpets.

Training records showed that staff had received training in safeguarding vulnerable people from abuse. The staff we spoke with understood how to safeguard the people they supported.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had previously sent appropriate notifications of two applications for Deprivation of Liberty Safeguards (DOLS) authorisations to ensure the safety of a person who used the service. These were no longer required, and no one who currently used the service required any restrictions to ensure their safety. The Registered Manager was aware of the procedures for applying for a DOLS authorisation if required.

Is the service effective?

We saw assessments and care plans which included each person's wishes and preferences, and were signed by the person. Care plans contained clear information on each person's personal and healthcare needs to enable the care staff to meet their individual preferences.

Care plans showed that each person was encouraged to be as independent as possible, both in personal care and in practical tasks. One person told us that they liked the meals that were provided, and that they could ask for an alternative if they did not want what was on the menu for any meal. We observed staff encouraging people to eat independently, to clear plates from the table and to get themselves ready to go out during the afternoon.

The care plan and records for one person showed that they had improved in managing to control aggressive outbursts. Guidance was in place for the staff and the community psychiatric nurse visited regularly to monitor the person's progress.

Is the service caring?

Staff we spoke with told us that care plans provided them with the information they needed to care for each person appropriately. There were good records of appointments with appropriate medical professionals such as GP, dentist and community psychiatric nurse.

Care plans recorded how each person ate and the support they needed. For example, one person ate very slowly, but ate all their food with encouragement and if they were given time. We observed staff during lunch encouraging the person to eat, but not rushing them to ensure that they ate as much as they wanted.

We saw records of regular one to one meetings that each person had with a member of staff where they were able to give their views about the service and discuss any concerns. One person who we spoke with told us that if they had any worries it helped to talk with a named member of staff.

Is the service responsive?

People were supported to take part in activities that they enjoyed. Care plans recorded the activities that each person enjoyed and the support they needed. One person told us that they enjoyed attending a day centre once a week, and they sang a song that they had learned there. They said that they also enjoyed going to the caf' of a local supermarket for a meal.

There were monthly meetings for the people who used the service. Subjects discussed included menu choices and activities. At one meeting one person had raised a concern about privacy, and people were encouraged to respect each other's personal space. It was recorded that the minutes were read back to the people who attended the meeting, to ensure that they understood and agreed with the decisions that were made.

No formal complaints were recorded, but the outcomes of showed that the provider acted on any concerns as soon as they were raised in meetings for people who used the service and staff or in responses to satisfaction surveys. Following comments in a survey from one of the relatives a bannister rail was attached to the stairs. A visiting nurse had commented that they would recommend the home to a family member.

Is the service well-led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. This ensured that the quality of the service was continually improving. The Registered Manager carried out a monthly audit of the premises and any repairs needed were acted on immediately.

Staff told us that they were clear about their roles and responsibilities. One member of staff said that the Registered Manager and senior staff were always available to provide support or to answer any questions. Records showed that training and one to one supervision provided appropriate skills and support for staff to meet the needs of the people who used the service.

The supervision records and minutes of staff meetings showed that the Registered Manager supported and encouraged staff to understand the ethos of the home and to improve the quality of the services they provided. The minutes for one staff meeting recorded praise from the Registered Manager for staff on maintaining cleanliness in the home.

We carried out an inspection on the 23 December 2013 to ensure improvements had been made. We found that records were kept appropriately and were fit for purpose.

Care records indicated that the needs of people had been attended to. The care records contained comprehensive assessments, care plans and details of reviews. There was documented evidence that the healthcare needs of people had been attended to and this included details of activities they were involved in and appointments with healthcare professionals.

Appropriate arrangements in place to manage medicines. People informed us that they had been given their medication.

Staff were aware of action to take when responding to allegations or incidents of abuse and they had received training in safeguarding people.

The premises were clean and tidy. Safety inspections of the portable appliances, gas and electrical installations had been carried out. Fire safety arrangements were in place.

Some essential care records and policies associated with the care of people were not well maintained. These records need to be well maintained to ensure that people are protected against unsafe or inappropriate care or treatment.