Archived: Lashbrook House

Lashbrook House is a care home providing accommodation for up to 46 older people, including people living with dementia in one adapted building. At the time of the inspection there were 27 people living at the home.

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

Prior to our inspection we received information raising concerns about staff training in relation to safety and their subsequent competence. There were also concerns regarding a lack of risk assessments. Concerns were also raised about the quality of the nursing staff and their knowledge about people. The service has struggled to recruit nurses due to the rural location of the home.

We inspected the home, which included visiting the home and speaking with staff and the manager. We found staff had received training in relation to safety and were competent in keeping people safe. Nurses we spoke to were knowledgeable about people and their individual needs. The manager was actively recruiting nursing staff and had two competent care practitioners who supported nurses with some clinical duties.

We found risks in relation to falls, manual handling, pressure sores, weight loss and choking were assessed and there were risk management plans to guide staff in keeping people safe.

We found people were protected from the risk of acquiring infections and the service was clean. Personal protective equipment was readily available to staff and all staff were following the latest guidance.

We looked at the providers quality assurance systems around accidents and incidents, audits of risk assessments and care plans as well as health and safety processes. These were effective and used to drive improvement.

Rating at last inspection

The last rating for this service was good (Published 24 September 2020).

Why we inspected

We received concerns in relation to staff training in safety, staff knowledge of people’s needs and poor risk management. As a result, we undertook a targeted 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.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection to corroborate the concerns we had received before the inspection or to indicate that people were at risk of harm. Please see the safe, effective and well-led sections of this full report.

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

Follow up

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

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

Lashbrook House is a residential care home providing personal and nursing care for up to 46 older people, some of whom lived with dementia. At the time of the inspection, the service was supporting 26 people.

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

The provider had made improvements since the last inspection. Overall medicines were being managed safely at the home in line with national guidance. We have made a recommendation about ensuring the electronic medicines system fully reflects people’s allergies.

Care records were detailed and up to date. This meant risks to people were assessed and managed to minimise potential harm.

Improvements had been made since the last inspection in relation to governance and oversight. Systems were effective in identifying and addressing quality concerns.

People were positive about living at Lashbrook House. Their relatives were also confident in the care their loved ones received at the home. They were supported by sufficient numbers of staff who were knowledgeable about their needs and had time to spend with them.

There were effective infection prevention and control systems in place to ensure the risk of infection was managed.

Everyone we spoke with was positive about the new home manager and complimentary about how hard the home manager and staff had worked during the COVID-19 pandemic to keep people and staff safe.

Relatives told us they had regular contact with the service throughout the COVID-19 pandemic and they felt confident to raise any concerns.

There was an open culture and staff were complimentary about the improved staff morale that had been achieved with the support of the home manager.

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 requires improvement (published 9 March 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe and Well-led which contained the previous breaches. The key question Responsive also had a breach but we ensured this was met by reviewing the Well Led section of the inspection.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

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

Lashbrook House is a residential care home providing personal and nursing care to 34 people aged 65 and over at the time of the inspection. The service can support up to 46 people over two floors.

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

The provider had recruited a new manager since the last inspection who was making significant improvements to the quality of the service. The improved systems had identified issues we found on this inspection. However, the provider had failed to take effective action to ensure they were meeting the regulations in line with the action we told them to take following the last inspection.

Medicines were not always managed safely. People were not always supported in line with their care plans which meant risks to people were not always effectively managed. People’s care records did not always include consistent information.

People felt safe and were protected by staff who knew how to report concerns relating to harm and abuse. There were sufficient staff to meet people’s needs. There were improved systems in place to monitor accidents and incidents.

Staff felt supported by the manager. The manager had arranged a range of training to enhance staff skills and knowledge. People enjoyed the food and individual dietary needs were met. People were supported to access health and social care professionals when needed.

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.

People enjoyed a range of activities. People knew how to make complaints and complaints were dealt with effectively. People were supported with end of life care and benefitted from access to the community palliative care team.

Everyone was positive about the manager and felt the quality of care was improving. The manager was committed to improving the service and was being supported by the provider to ensure improvements continued.

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 requires improvement (published 9 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We carried out a targeted inspection on 17 October 2019 (published 6 November 2019) to follow up on the enforcement action we took in relation to people’s safety. At this inspection we found some improvements had been made, however the provider was still in breach of regulations which has resulted in requirement notices.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will request an action plan from the provider to understand what they will do to continue 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 we receive any concerning information we may inspect sooner.

Lashbrook House is a residential care home providing personal and nursing care for up to 46 people aged 65 and over at the time of the inspection. At the time of the inspection there were 41 people using the service.

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

The provider had made some improvements to the service. However, not all the requirements of the warning notice had been met. Risks relating to pressure damage and behaviours that may challenge were still not managed effectively to ensure people were safe. Following the inspection the manager took prompt, effective action to address the remaining issues.

Improvements had been made for people who were at risk of choking to ensure risks were managed. High risk medicines were managed effectively and people received these medicines as prescribed.

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

The last rating for this service was requires improvement (published 9 October 2019) when there were multiple breaches of regulations.

Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 6 September 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider and the registered manager following our last inspection in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice.

We undertook this targeted inspection to check they now met legal requirements for Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers our findings in relation to the safe care and treatment in the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

Follow up

Following the inspection we met with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lashbrook House is a residential care home providing personal and nursing care to 45 people aged 65 and over at the time of the inspection. The service supported people with a range of conditions which included people living with dementia.

Lashbrook House accommodates up to 46 people in one adapted building.

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

The quality of care had deteriorated since the last inspection. People’s safety was at risk. Risks to people had not always been assessed and plans were not always in place to reduce risks. Where risks were identified, and plans were in place, these were not always followed. Medicines were not always managed safely. Systems in place to manage accidents and incidents to mitigate the risk of reoccurrence were not effective. People’s needs were not always met in a timely manner.

The systems in place to monitor the quality of the service and audit systems were not always effective and issues found on inspection were not identified. The culture in the service was task focused with an emphasis on completing records. People were not always aware of who the registered manager was. Staff did not feel valued.

Staff did not always take timely action to access healthcare support for people, with the potential to result in poorer outcomes for people. Staff did not always have the skills and knowledge to support people’s needs effectively. We observed interactions that showed staff lacked the skills to support people living with dementia. People enjoyed a varied diet that met their needs. People were supported to personalise their rooms.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service were in place but were not always followed. We have made a recommendation regarding the practice related to the Mental Capacity Act 2005.

We saw some caring interactions and people told us staff were caring. However, we also saw interactions that were not respectful and did not value individuals. People were not always involved in decisions about their care.

There were not always care plans in place for people. Where care plans were in place these were not always complete and up to date. We have made a recommendation regarding the provider's responsibility to meet the Accessible Information Standard (AIS). People had access to a range of activities which they enjoyed.

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 2 March 2019)

Why we inspected

The inspection was prompted in part due to concerns received about risks associated with medicines, dietary needs and lack of action to contact health professionals. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

The provider has increased management support at the service to ensure prompt action is taken to improve the service. This includes on-site support from the nominated individual.

Enforcement

We have identified breaches in relation to the safety of people using the service and the systems in place to monitor the quality of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lashbrook House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lashbrook is registered to accommodate up to 46 people in one adapted building. At the time of our inspection there were 43 people using the service. The service supports older people with a range of conditions and includes providing support for people living with dementia.

There was 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format in some domains because our overall rating of the service has not changed since our last inspection.

There was a person-centred culture that valued people as unique individuals and respected their rights. People were treated with kindness and compassion by staff who knew them well.

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 strong and effective management team who led by example to promote people’s rights and ensure they were supported to live full and meaningful lives. There were effective systems to enable the management team to monitor and improve the service.

Staff were well supported and received training to ensure they had the skills and knowledge to meet people’s needs. Staff were positive about the leadership in the service and the improvements that had been made.

People were not always supported in line with health professional guidance. However, the registered manager took immediate and effective action to address issues raised.

Medicines were managed safely. There were sufficient staff to ensure people’s needs were met in a timely manner. People were protected from harm and abuse by staff who understood their responsibilities to identify and report any concerns.

Lashbrook House is a care home providing accommodation for people requiring personal and nursing care. The service supports older people with a variety of conditions which includes people living with dementia. At the time of our visit there were 36 people living in the service.

The service had a new manager who had submitted their application to CQC to become the registered manager. 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 manager was passionate about providing high quality care and was looking at ways to improve the service. A schedule of works had been developed to improve the environment and works were underway when we visited. Where concerns were raised in relation to the quality of care, the manager took prompt and effective action to address issues.

People were positive about living at Lashbrook House and the kindness of staff supporting them. People enjoyed the food and were offered a choice at every meal.

Throughout the inspection there was a cheerful atmosphere and we saw many kind and caring interactions. People were engaged in activities and enjoyed a musical entertainer during the afternoon.

People's needs were assessed and care plans developed to identify how people's needs would be met. Risks to people were identified, however risks were not always managed. Specialist equipment was not regularly monitored to ensure it was being used in line with manufacturers guidance.

Staff felt supported and valued. Staff received regular supervision and training to ensure their skills and knowledge were up to date. Staff understood their responsibilities to identify and report concerns relating to safeguarding vulnerable people. People were supported by staff who understood the principles of the Mental Capacity Act 2005 (MCA). Staff were kept up to date with people's changing needs through daily meetings. However, staff did not always support people in line with guidance in their care plans.

The manager sought people's views about the service through regular meetings. Questionnaires had been sent out to seek feedback about the service and look for ways to continually improve.

There were effective quality assurance processes in place to monitor and improve the service.