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Lanchester Court Requires improvement

Reports


Inspection carried out on 27 August 2019

During an inspection looking at part of the service

About the service

Lanchester Court provides residential and nursing care and support for up to people with learning, neurological and physical disabilities. The service was registered to support up to 22 people. At the time of inspection, 21 people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. The building was separated into different areas which contained rooms and self-contained flats. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Medicines were not always safely managed. Records and quality monitoring systems for medicines needed to be improved. People said they were generally happy using the service and said they were safe. Staff were recruited safely and understood the procedures for reporting abuse. The safety of the building had been maintained.

People’s needs were assessed before they started using the service. Staff were suitably trained and received regular supervisions and appraisals. People were supported with their nutritional needs and to access a range of health care professionals. 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.

There was a clear management structure and staff were supported in their roles by the management team. People were involved in the design and improvement of the service through regular ‘My Say’ meetings and questionnaires. Staff felt listened to and able to share their views through various forums.

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 24 August 2018).

Why we inspected

We received concerns in relation to the management of medicines and staff training. As a result, we undertook a focused inspection to review the Key Questions of Safe, Effective and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvement. Please see the Safe 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lanchester Court on our website at www.cqc.org.uk.

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

Inspection carried out on 27 June 2018

During a routine inspection

The inspection took place on 27 June and 3 July 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be coming.

Lanchester Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lanchester Court provides residential and nursing care and support for up to 22 people with learning, neurological and physical disabilities. At the time of our inspection there were 18 people living in the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have an active registered manager. A new manager had been recruited and there was an acting manager in place, overseeing the service. 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 in December 2016 we found that there was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to staff supervisions and appraisals. We found that supervisions and appraisals had not been consistently maintained for all staff with some staff not receiving appraisals since 2014. During this inspection we found the service had made improvements.

When we previously inspected Lanchester Court in December 2016, the service was not meeting all regulatory standards and was rated ‘Requires Improvement’. At this inspection we found the service had improved to 'Good'.

People felt safe living at the service. Staff had completed training in safeguarding people and the manager actively raised any safeguarding concerns with the local authority.

Risks to people’s safety and wellbeing were assessed and managed. Environmental risk assessments were also in place.

There were enough staff to meet people’s needs. Staff continued to be recruited in a safe way with all necessary checks carried out prior to their employment.

People continued to receive their medicines in a timely way and in line with prescribed instructions. Staff administering medicines were adequately trained and had their competencies checked. Regular medicines audits were completed by senior staff.

Staff received up to date training, regular supervisions and an annual appraisal to support them in their roles.

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.

People were assisted to access a range of health professionals and recommendations following healthcare interventions were clearly recorded in care records and incorporated into care plans, where appropriate.

People and a relative/friend were complimentary about staff and told us the service was caring and friendly. Staff treated people with dignity and respect when supporting them with daily tasks as well as when having conversations and speaking with them.

People had access to advocacy services if they wished to receive independent support. Some people had advocacy services involved in decision making relating to specific aspects of their care.

People had a range of care plans in place that were personalised and tailored to meet their individual needs. Care plans were very detailed to ensure staff knew how to support people with daily ta

Inspection carried out on 20 December 2016

During a routine inspection

This was an unannounced inspection which took place on the 20 and 22 December 2016.

The service was last inspected in April 2016 and recommendations were made relating to making decisions in a person’s best interests, staff having regular supervisions, providing care with dignity and to the dining experience.

Lanchester Court is a residential nursing care home providing accommodation and nursing care for up to 22 people. There were 18 people living there at time of inspection. Care and support is provided for people with learning, neurological and physical disabilities.

The service had a registered manager 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.

We found that checks by the provider proactively identified issues in the service that posed risks to people. We found the environment had been maintained to ensure it was a safe place for people.

People and staff told us they felt there was enough staff to provide support. We saw that nursing, care and ancillary staff were deployed over the week to support people and provide one to one staffing as required.

Staff had been trained and supported to raise any concerns about people’s safety and wellbeing. Staff knew how to identify possible safeguarding concerns and felt able to raise these with senior staff.

Staff were recruited safely and inducted to ensure they had the required skills and were safe to work with vulnerable people. People’s medicines were well-managed by the service.

Staff were trained and monitored to make sure people received their medicines safely. Care plans were in place to support the use of ‘when required’ medicines.

Staff were trained in and demonstrated they had knowledge of the Mental Capacity Act 2005, and this was reflected in some work supporting a person to decide about serious medical treatment.

Staff told us they received day to day support from senior staff to ensure they carried out their roles effectively. However, formal supervision and appraisal processes were not used consistently to enable all staff to receive feedback on their performance and identify further training needs. The issue of supervision and appraisal had been raised at a previous inspection and the action taken had not been robust to ensure staff received this in line with the provider’s policy.

Arrangements were in place to request health and social care support to help keep people well.

External professionals’ advice was sought when needed. This was integrated into people’s care plans.

Care was provided with kindness, compassion and in a dignified manner. People could make choices about how they wanted to be supported and were treated with respect. People told us they felt cared for by staff who listened to them.

People who used the service were supported to take part in therapeutic, recreational and leisure activities in the home and the community.

People's care plans were detailed, personalised and reviewed regularly. People had ‘three page profiles’ where staff could see at a glance how best to support them. We saw that some records were placed in peoples bedrooms in order that staff could refer to them as required.

The registered manager responded positively to concerns or complaints and we saw they took clear action to learn from such events.

The registered manager and provider had not always identified and responded to issues in the service around staff supervision and appraisal. We have made a recommendation in relation to this.

The registered manager had made a significant number of improvements to the service across care planning, staffing and the dining experience.

People, relatives, staff and an external professional all felt the registe

Inspection carried out on 7 April 2016

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 29 and 30 October 2015 as a result of concerns we had received about the service. Eight breaches of legal requirements were found. As a result of the inspection findings enforcement action was taken by CQC against the provider. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. These related to the breaches of regulation regarding staff competency and staffing levels, safe care and treatment, cleanliness and suitability of the premises, nutrition and hydration, dignity and respect, requirements of the Mental Capacity Act, record keeping and good governance.

We inspected the service on 7 April 2016 to follow up on the breaches and to carry out a comprehensive inspection as the breaches related to several areas of the peoples’ care and treatment. This inspection found that improvements had been made to ensure people receive safe care and treatment.

Lanchester Court provides accommodation for personal and nursing care for up to 22 people. Care and support is provided for people with learning, neurological and physical disabilities.

A new manager was in place but they were not yet registered 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 2008 and associated Regulations about how the service is run.

Due to their health conditions and complex needs not all people were able to share their views about the service they received.

We found significant improvements had been made to ensure the safe care and treatment of people. People and staff told us they felt safe and there were enough staff on duty at all times to provide safe and individual care to people. There was an improved emphasis on providing person centred care to ensure people received care and support in the way they wanted and at times they chose rather than task centred care being provided. Staff had time to interact and spend time with people and not just when they carried out tasks.

Risk assessments were in place and they accurately identified current risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe and timely way.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

Records had been updated and they were regularly reviewed to reflect peoples’ care and support requirements. Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were mostly respected. We considered some improvement was still required in one area to protect a person’s dignity.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. Not all the relevant people had been involved in the decision making process when people without mental capacity received medicine without their knowledge.

Staff received other opportunities for training to meet peoples’ care needs and in a safe way. A system was in place for staff to receive supervision and appraisal but improvement was necessary to ensure all the staff team received an updated supervision in a timely way.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people and people were being consulted to increase the variety of activities and outing

Inspection carried out on 29 & 30 October 2015

During a routine inspection

This was an unannounced inspection carried out on 29 & 30 October 2015.

We last inspected Lanchester Court in March 2015. At that inspection we found the service was meeting all the legal requirements in force at the time.

Lanchester Court provides accommodation for personal and nursing care for up to 22 people. Care and support is provided for people with learning, neurological and physical disabilities.

A registered manager was in place. 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.

Due to their health conditions and complex needs not all of the people were able to share their views about the service they received.

People told us they felt safe but we had concerns that there were not enough staff on duty at all times to provide safe and individual care to people.

Risk assessments were carried out but they were not all accurate and up to date to identify current risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe and timely way. However we have made a recommendation about the management of some medicines.

Staff received regular training, supervision and appraisal. However, not all staff had received specialist training that showed they were competent to carry out their role.

Systems were not in place to ensure people received a varied diet with special diets when the regular cook was not on duty.

Lanchester Court was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff did not all have a good understanding of the Mental Capacity Act (MCA) 2005 and Best Interest Decision Making and the Mental Health Act 1983 Code of Practice 2015 when people were unable to make decisions themselves.

Not all areas of the home were designed for the comfort of people who used the service.

People were supported to be part of the local community. They were provided with some opportunities to follow their interests and hobbies.

Staff said the manager was supportive and approachable. People were consulted and asked their views about aspects of service provision.

The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection to ensure people received safe and individual care that met their needs.

Enforcement action is being taken as a result of our inspection findings outside of this report.  

Inspection carried out on 10 and 12 March 2015

During a routine inspection

This inspection took place over two days, 10 and 12 March 2015. The first day of the inspection was unannounced. We last inspected Lanchester Court in March 2014. At that inspection we found the service was meeting the regulations that were in force at the time.

Lanchester Court is a residential nursing care home providing accommodation and nursing care for up to 22 people. Care and support is provided for people with learning, neurological and physical disabilities. At the time of the inspection there were 21 people living at the service.

The service had a registered manager who had been in post since July 2013. 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.

There were enough staff to meet people’s needs. People using the service and their relatives told us they were well cared for and felt safe with the staff who provided their care and support.

Medicines records were accurate, complete and the service’s arrangements for the management of medicines protected people. People’s medicines were stored securely.

Accidents and incidents at the home were reviewed and monitored regularly. This was to identify possible trends and to prevent reoccurrences.

Staff recruitment practices at the home ensured that appropriate recruitment checks were carried out to determine the suitability of individuals to work with vulnerable adults. Security checks had been made with the Disclosure and Barring Service (DBS). DBS checks help employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

There were effective processes in place to help ensure people were protected from the risk of abuse and staff were aware of safeguarding adult’s procedures. Staff understood what abuse was and how to report it if required. A whistleblowing policy was available that enabled staff to report any risks or concerns about practice in confidence with the organisation. All relatives we spoke with were positive about the standards of cleanliness and hygiene at the home.

Staff were attentive when assisting people and they responded promptly and kindly to requests for help. People living at the home had appropriate risk assessments in place to ensure risks were evaluated and that appropriate care and support was identified.

Detailed procedures and information was available for staff in the event of an emergency at the home.

People received care from staff who were provided with effective training and support to ensure they had the necessary skills and knowledge to meet their needs effectively.

Staff told us, and records we examined showed that regular supervisions and annual appraisals were being carried out. All new staff received appropriate induction training and were supported in their professional development.

The provider had a Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) policy and detailed information was available for staff. The requirements of MCA were followed and DoLS were appropriately applied to make sure people were not restricted unnecessarily, unless it was in their best interests.

People were supported to make sure they had enough to eat and drink, to have access to healthcare services and to receive on-going healthcare support. Relatives we spoke with told us communication with the service was good.

People told us that staff treated them well and we observed kind and caring interactions between staff and people using the service. Staff were patient, unhurried and took time to explain things to people.

Staff acted in a professional and friendly manner and treated people with dignity and respect. We observed staff supporting people and promoting their dignity and independence wherever possible.

People’s relatives were involved in the care and support their family members received. Care records confirmed the involvement of relatives in care planning and reviews.

Meetings for people using the home and their relatives were held. Advocacy information was accessible to people and their relatives. Surveys were undertaken to seek and act on feedback from people and their relatives in order to improve the service.

Care plans were regularly reviewed and evaluated. They contained up to date and accurate information on people’s needs and risks associated with their care. Health and social care professionals and relatives were involved in the review process where applicable.

A complaints policy and procedure was in place. People and their relatives told us that they felt able to raise any issues or concerns. Complaints received by the service were dealt with effectively and the service had recently received a number of compliments.

People were supported by staff to access their communities, pursue leisure interests and were encouraged to maintain relationships with their families and friends. This meant they kept in regular contact with people who mattered to them and this reduced the risk of social isolation.

The service had a registered manager who was positive and enthusiastic about their role. They told us they was keen to develop their role and help ensure people continually received good quality care and support. The service worked with another organisation to develop staff knowledge and ensure they were up to date with best practice.

Care staff we spoke with told us the management team were approachable and supportive. We received positive feedback from people, their relatives and staff about the management team and how the service was managed and run. Staff meetings were held regularly.

Management regularly checked and audited the quality of service provided and made sure people were satisfied with the service and the care and support they received.

Inspection carried out on 12 March 2014

During an inspection looking at part of the service

The reason for this visit was to check if improvements had been made in the area of staffing following a previous inspection.

We spoke with staff who provided care to people at the home. They were positive about the staffing levels. Comments included, �It�s much better here now we have more staff� and �You have more time to provide personal one to one support because staffing levels are much better�.

We saw there was sufficient qualified, skilled and experienced staff to meet the needs of people.

Inspection carried out on 2 October 2013

During a routine inspection

People were given all the information they needed to make an informed decision about their care and were asked to provide their consent to such care.

We saw people were cared for effectively and care was planned for the individual.

We saw the home had systems in place to manage medicines.

We found there was insufficient support staff on duty to provide care and support to people.

The provider had an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

People who used the service were positive about the care and support provided. Comments included �I like it here� and �The staff are good to me�.

Inspection carried out on 19 October and 26 November 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service. This was because most people using the service had complex needs which meant they were not all able to tell us their experiences.

We saw that people were cared for effectively and that care was planned for the individual. We saw that people were safe and that there were sufficient suitably qualified and experienced staff on duty. We saw that the home had effective systems in place to monitor its performance and manage emergency procedures.

People who used the service and the visitors we met during our inspection were very positive about the way the home was managed. Comments included: "It�s quite good, I�m very happy� and �The staff are canny. I go out to Newcastle. My key worker is very good.�

Inspection carried out on 18 November and 6 December 2011

During an inspection in response to concerns

This visit focused on checking whether concerns, raised with us from an anonymous source, relating to some elements of staffing and care delivery were substantiated.

The people who we met with were very positive about living at the service and told us they experienced comfortable relationships with the staff including the new manager.

They were aware of the recent change of manager and referred to the need for some stability and consistency of management and the staff team. They were accepting that home managers had different approaches and styles but felt that changes in personnel impacted on everyone using the service and how the home functioned on a day to day basis.

They were enthusiastic about the new manager and her aspirations for the home but also talked about what would happen if she left or was unable to achieve the changes she had planned.

We received comments from each person we spoke with regarding the recent decision, made by management, to remove a large screen TV from a much used communal area which was directly opposite the main entrance.

Their comments included, �I can watch my own television in my room but the big TV was there for everyone to watch together�; �I know of people who don�t come to the lounge anymore apart from at mealtimes because the TV has gone�; �the TV was taken away without finding out what we all wanted�; �management want us to use the upstairs lounge and TV rather than congregating around the entrance but that might not fit in with everyone�s wishes�.

Comments on other matters included, �The food is okay, I enjoy it and we always have a choice�; �Yes I feel cared for and respected�; �I am able to do what I want�; �I am very happy with my room and have everything I need in here�; �The staff are all good and the new manager is approachable and comes to talk to me�.

Inspection carried out on 19 April 2011

During an inspection looking at part of the service

Some of the people who use this service could not tell us how they feel about their care due to a variety of complex needs. Those we could speak to were positive about their experience of living at Lanchester Court. One said, "the staff are always nice to us" and another said "they always help us when we need it" and another said "the staff are lovely, and always nice to me". Those we could not speak to were observed when in being support by staff to determine their reaction. They were seen to be interacting with staff in a way that suggested a level of trust and appropriate friendliness.

Inspection carried out on 10 February 2011

During a routine inspection

Gateshead Local Authority told us that they have worked with the service around a number of areas of care delivery following safeguarding issues being raised. This involved a number of visits to the home to assess the necessary changes required and review of the improvements made. These improvements included wound management procedures, record keeping and process issues, medication and management arrangements. As a result of the concerns a temporary suspension of the Local Authority contract was agreed with the service commencing 24th December 2010. Although this was in place during some of the time of this review it has since be lifted. There is now an agreement between the Provider and the Local Authority as to the phased return to admitting new residents into the service.

During the visit the inspector spoke to eight of the people living at the service and three visiting relatives/representatives. We also spoke to the staff on duty including the manager and the senior manager who is currently based at the service.

All of the people living in the home, who were spoken to, said that they were happy with the service provided by the staff. They said that staff responded promptly and politely to any requests for assistance. One person said that she felt that the staff �were always kind� and that they received help to �do the things that they couldn�t do on their own�.

One visiting relative said that they were satisfied with the �quality of the care given� to their relative and were really happy that they had �settled well into the home �. They said that they felt that it was because of the way the staff had helped them in the early stage of the placement.

People said that they were asked about what help they needed when they moved into the service and were consulted about any changes in their care provision. All of those spoken to were aware that they had a care plan. One confirmed that he had read and signed his. Another said that they did not want to see it and were happy with the way that the staff discussed the contents with them when any changes were made. The relatives spoken to said they had been consulted about the care plans.

The people living at Lanchester Court said that the food was good and that there was always a choice at mealtimes. People told us that they were �happy� with the accommodation. One person took time to show us their flat and appeared to be very proud of how they had organised it. She said that she �loved� her flat and that staff always complemented her on how �nice� she had made it.

Inspection carried out on 12 January 2011

During an inspection in response to concerns

We spoke to two people living in the home about their medicines and both said that they received them when required and that staff assisted them appropriately to take their medicines. One person said that when he went out of the home on social leave arrangements were put in place so that he could continue to take his medicines when he was away from the home.

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