Archived: Leylands Rest Home

Updated 30 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 3 and 8 February 2017 and was unannounced.

The inspection was carried out over two days. On the first day there were two inspectors and on the second day two inspectors and a specialist advisor in mental capacity act and deprivation of liberty safeguards were present.

Before the inspection we reviewed the information we held about the service. This included speaking with the local authority contracts and safeguarding teams. We had asked the provider to complete a Provider Information Return (PIR) prior this inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This document had been completed and returned to us within the required timescale.

During our inspection we looked at nine people’s care records, eight people’s medication records and three staff files as well as records relating to the management of the service. We spoke with the Registered manager, five members of staff, the cook and the registered provider.

Updated 30 March 2018

This inspection took place over two days on 3 and 8 February 2017 and was unannounced.

At the last inspection in January 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We found breaches of regulations relating to person centred care, dignity and respect, safe care and treatment, staffing and good governance. We issued a warning notice in relation to good governance and requirement actions for the other breaches. Following the inspection we told the provider they must improve. The commissioners at the local authority were made aware of our concerns and the provider agreed to a voluntary suspension of placements.

Leylands Rest Home is registered to provide accommodation and personal care for up to 17 older people, including people living with dementia. There are nine single and four shared bedrooms, each with en-suite facilities. There are two lounges, a dining room and a bathroom on the ground floor. On the first day of the inspection there were 12 people living at the home and there were 11 people on the second day of our inspection.

The registered manager has been at the service since it's registration with the Care Quality Commission in April 2015 and was the registered manager of the home under the previous registration. 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.

People told us they liked the registered manager and staff.

Standards of hygiene and infection control were poor and not all of the necessary environmental safety checks had been completed.

Staff knew about different forms of abuse and knew how to report their concerns.

Risks to people were not well managed. Risk assessments lacked detail, for example, where a scoring system was used for assessing people’s risk of developing pressure sores, staff did not know what the score meant. Accidents were not always recorded appropriately. Staff used unsafe and inappropriate moving and handling techniques.

We noted some improvements in management of medicines. However systems were not being followed to make sure people received their medicines in line with the prescriber’s and manufacturer’s instructions.

The registered manager was not able to explain or show us how staffing levels had been calculated. We were concerned there were not enough staff on duty at all times to meet the needs of people living at the home. Recruitment processes were followed to make sure new staff were safe and suitable to work in the care sector. Staff told us they felt supported by the registered manager.

Staff were well-meaning in their approach but people's privacy and dignity were sometimes compromised. There was a lack of person centred approach and people living with dementia were not always supported to enable them to make choices. Staff training was badly organised and insufficient to support staff in their roles.

People did not receive nutritionally balanced diets. Food was of poor quality and there was little choice available. People’s cultural dietary requirements were not met.

Procedures were not always followed to make sure make sure service was compliant with the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards

People were supported by community healthcare professionals. However the advice given was not always included in care plans.

Generally care plans provided staff with sufficient information about people’s needs and how they preferred their care, treatment and support to be delivered. A relative we spoke with told us they were fully involved in developing their care plan and attended regular review meetings to discuss their care and treatment.

People were not provided with appropriate and person centred stimulation. People had limited access to the community as they had to pay for staff to accompany them on individual outings.

There was no information about the home available to people as neither a Statement of Purpose nor a Service user guide were available.

There was a lack of effective and strong leadership. Quality assurance systems had been put in place however these were not fully embedded or robust which is evident from the continued breaches we found at this inspection.

We found continued shortfalls in the care and service provided to people. We identified seven breaches in regulations. These related to staffing, person-centred care, dignity and respect, consent, the premises, safe care and treatment and good governance. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.