Archived: Leylands Rest Home

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.

At our inspection in February 2017 we found 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 took enforcement action in relation to these breaches.

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. At the time of this inspection there were six people living at the home.

The registered manager left the service following our inspection in February 2017. A new manager was appointed but, at the time of the inspection, had not made application to the Care Quality Commission to become 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.

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

Staff were not working to people’s care plans to maintain their safety.

Staffing levels were increased during our inspection as we identified there were not enough staff available to meet people’s needs.

Staff had been recruited safely but had not had the training they needed to support them in their roles.

Risk assessments were in place but did not include detail of actions staff should take to mitigate risks to people.

Accidents and incidents were recorded, however, they were not analysed and there was no evidence of learning or actions taken to reduce the risk of recurrence

The service was not always working within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

We found people had access to healthcare as needed.

Standards in relation to nutrition and food provision had improved and people told us they enjoyed the food at the home.

Staff appeared caring in their approach but did not meet people’s needs in relation to privacy and dignity.

People were not provided with appropriate and person centred stimulation.

There was not a registered manager in place and the provider had failed to provide effective and strong leadership. Quality assurance systems had been put in place however these were not appropriate or robust which is evident from the continued breaches we found at this inspection.

We found shortfalls in the care and service provided to people. We identified seven continued breaches in regulations. These related to staffing, person-centred care, dignity and respect, consent, the premises, safe care and treatment and good governance.

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

The Care Quality Commission are taking enforcement action in response to the provider’s failure to improve standards of quality and safety within the home. Full information about The Care Quality Commission’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The provider made a decision to close the home shortly after the conclusion of this inspection.

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 day of the inspection there were 16 people living at the home.

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 who lived at the home, staff and visitors told us they had confidence in the registered manager.

People who used the service told us they felt safe and thought there were enough staff available to meet their needs. However, we found issues in relation to the safe management of medicines, lack of effective risk assessments and safety of the environment.

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 manager. People and relatives we spoke with told us they liked the staff.

Staff were in need of training updates to make sure they had the knowledge and skills to carry out their roles effectively.

Although homely, the environment was in need of refurbishment and redecoration.

The service was compliant with the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards.

People told us they enjoyed the food at the home but felt restricted in choices. Mealtimes were not always managed in a way to make sure people enjoyed the mealtime experience.

People were supported by community healthcare professionals and these services were accessed in a timely way to make sure people’s health care needs were met.

Staff were caring in their approach but people's privacy and dignity were sometimes compromised.

Care records were not up date.

Visitors told us they were always made to feel welcome and if they had any concerns or complaints they would feel able to take these up with the staff or registered manager. However the complaints procedure lacked detail and was not up to date.

The registered manager was knowledgeable about their role and provided good leadership to staff.

Systems for auditing the quality and safety of the home were not always up to date, robust or effective.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 time frame.

If not enough improvement is made within this time frame 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.

We recommend the service looks at ways in which all of the people living at the home can be engaged in appropriate and meaningful activities of their choice.

We identified five breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.