Archived: Lamel Beeches

People’s experience of using this service: People's records were not always adequately maintained and improvements were required to meet legal requirements in relation to governing the service. Quality assurance systems had not been effective in driving improvements across the service. In addition, notifications that the provider is legally required to send to us had not been done so consistently.

People were supported by staff who were caring and knowledgeable about their needs. Staff understood how to care for people safely, but risk assessments were not always regularly reviewed. Some staff were overdue their regular refresher training and supervision. Opportunities to learn from accident and incidents that occurred were not always maximised, to reduce the risk of recurrence. Staff knew how to identify and report any safeguarding concerns. People received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff respected people’s wishes and promoted their privacy and dignity. People told us staff were kind and friendly. There was an extensive range of interesting activities available to people and the provider worked well with other organisations to meet people’s needs.

Further information is in the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published 12 April 2017).

Why we inspected: This was a scheduled inspection based on the service’s previous rating. There had been a serious incident in the year prior to our inspection, which had raised concerns regarding record keeping, falls management and candour with relatives. We therefore brought the scheduled inspection forward to look at these issues.

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

The service is registered to provide nursing or personal care and accommodation for up to 41 older people. The home is located in a residential area of York in North Yorkshire. People who require nursing care and residential care are accommodated in one unit. There is parking space at the home for visitors and staff.

The home is required to have a registered manager in post. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A previous application for a registered manager was submitted to the CQC in August 2016. However, the manager at that time left the organisation on 31st October 2016. During our inspection a new manager was in post and they supported us with our inspection. The manager informed us, and records confirmed they were in the process of submitting an application to be registered with the Care Quality Commission.

Records concerned with people, care workers and the running of the home were maintained securely and were available during our inspection. Some minor areas of information in records were not always recorded or up to date. The registered provider demonstrated an awareness of the concerns we found. They had implemented a system of robust audits and quality assurance checks on all areas of the service. This included time constrained actions for the review and completion for improvement of the identified areas of concern.

People were supported to maintain good health. Care plans identified persons daily care needs which included people's night-time support requirements and daily living. We found some minor recording issues with some of the charts in place in people’s rooms that were used to record activities of care; however, people told us that this care was provided and that this was a recording issue.

People usually consented to care and support from care workers by verbally agreeing to it. Records included provision for people or their representative to sign their agreement to the care and support they received. The manager told us that the organisation was looking to implement a new tool to further improve people’s ability to record their consent.

Care workers received support in their role from managers and senior staff. There was a process for completing and recording supervisions and annual appraisals and we saw this was being reviewed and updated.

Where people required support with their medicines this was done safely and people received their medicines as prescribed. We identified some minor deficiencies with records however, audits were in place to identify these concerns and processes were in place that ensured they would be addressed.

Systems and processes were in place that ensured sufficient numbers of suitably trained and competent care workers were on duty to meet and respond to people’s needs and provide additional one to one support throughout the day. Pre-employment checks on employees were completed that helped to minimise the risk of unsuitable people from working with vulnerable adults.

Care workers confirmed they received induction training when they were new in post and told us that they were happy with the training provided for them. Training for care workers was managed electronically and care workers confirmed they were able to manage some of this on line.

We found that people were protected from the risk of avoidable harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Care workers received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

The registered provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

Systems and processes were in place that helped to identify risks associated with the home environment and when providing care and support with people. Associated support plans enabled people to live in the home in line with their wishes and preferences with minimal restrictions in place and care workers could provide the service safely.

Care workers had received training and understood the requirements of The Mental Capacity Act 2005 and the registered provider was following this legislation.

People were supported with a choice of food at meal times and any special food requirements were catered for. Snacks and hot and cold drinks were available for people throughout the day.

All care workers demonstrated a clear understanding of people’s individual needs and preferences. They were caring and put people at the front of everything they did, treating them with dignity and respect and clearly communicated their intentions for people’s comment and agreement.

Comprehensive packages of activities to meet both people’s individual requests and as a group were provided by a dedicated activities co-ordinator. People spoke with enthusiasm about these changes and we found day trips were popular and in demand from people.

Staff told us that improvements at the home were evident since the new manager had commenced in post and that morale had improved. People told us they felt well supported and able to raise issues with the management team. We observed a warm and friendly atmosphere and it was evident that the manager and deputy were working hard to review all aspects of the service.

This inspection was carried out to follow up previously identified breaches from our November inspection and to check that the registered provider had carried out the actions recorded in their action plan dated April 2015. The inspection in November 2015 identified a continued breach of regulation 12(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to the proper and safe management of medicines. There was also an identified breach of Regulation 12(1) and 12(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as care and treatment was not provided in a safe way. At this inspection on 2 March 2016, we found that the registered provider had implemented sufficient improvements since the November 2015 inspection and that the breaches had been met.

This inspection on 02 March 2016 was a focused inspection to look at specific areas of concern. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Lamel Beeches on our website at www.cqc.org.uk. Lamel Beeches provides care and support to 41 older people. At the time of our inspection, the home was providing care and support to 31 people. The home is part of The Joseph Rowntree Housing Trust. Lamel Beeches is situated on the west side of York with an elevated position overlooking the city, with its major transport links. It is set in well-maintained, mature gardens, has car parking on site and has lift access to both floors.

At the time of our inspection, there was an acting manager, supported by senior management from the parent provider. Lamel Beeches did not have a registered manager in post since December 2015. 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 registered provider told us they were actively advertising to recruit for the post of registered manager.

People spoke positively about the care they received. It was clear from talking to people and looking at care plans that care was person centred. People told us they felt safe and we found that staff knew how to protect people from avoidable harm.

Risk assessments and risk management plans were in place and included the use of bed rails for people. We saw these were reviewed with people and their families in line with people’s changing needs and this was documented in their care plans.

The registered provider had implemented a revised policy and procedure for the safe use and management of bed-rails and staff had undertaken appropriate training and were competent in their use. Documented weekly safety and maintenance checks were in place with recorded actions and outcomes.

We saw medication was effectively administered with clear guidelines. Methods of recording, administering and disposing of people’s medication were in place. Controlled drugs (CD’s) were securely stored with up to date record keeping. People had a medication risk assessment in place and all staff giving medicines had completed appropriate training and had received ongoing assessment of their competence. Some records for fridge temperatures were incomplete and staff did not routinely reconcile people’s medicines with their GP on admission to the home. Medicines audits were performed monthly, with clear documented action plans and outcomes where errors or omissions were identified.

The registered provider used a dependency tool to ensure adequate staffing to meet people’s needs. We saw the home used agency staff but these were consistent staff.

Staff were recruited safely and relevant recruitment checks were completed before they started work.

At the time of our inspection, the home was clean and smelt pleasant. We saw that checks on the environment were completed and maintenance certificates viewed during our visit were up to date.

People told us they were well cared for and liked living at Lamal Beeches. Comments included "It is very nice and I am well looked after." And "It is very good, very comfortable."

People told us that they liked the food although some people said that they would like more choice to be available. Comments included "I like the food. It is very good." And "The food is lovely but we don't get asked what we like and don't like."

Staff received training and supervision and in the main there were plans in place to keep this updated.

The home had good quality monitoring systems in place which helped to seek the views and opinions of people using the service.

People told us that they were well cared for. They said they liked living at the home. We looked at care records and found that in the main they were detailed and person centred. We found some areas within these records which could be expanded upon.

The home had systems and processes in place to safeguard people from abuse. The staff we spoke with were clear about whistle blowing procedures and said they had received training which helped to protect people.

We looked at medication systems and found good systems in place which helped to protect people. People were able to self medicate and medication was stored in people's individual rooms.

We looked at the environment and found that regular checks were made to keep it well maintained and safe. We identified some minor issues with redecoration which would benefit from attention. People's rooms were individually furnished to make them homely.

We looked at staff recruitment systems and found that these were effective. The home carried out appropriate checks.

We looked at systems for managing complaints. These were robust and people told us that they would feel confident in raising any concerns.