Lent Rise 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. Fifty one people were living at the home at the time of our visit.
We previously inspected the service on 13 December 2017 and looked at the ‘safe’ and ‘well-led’ domains. This was in response to concerning information about allegations people had sustained avoidable harm, that medicines were not properly managed, that people had experienced abuse or neglect and that there was ineffective management of the service.
At that time we found multiple breaches of the regulations related to medicines practice, safeguarding people from abuse or harm, acting in an open and transparent way (duty of candour), assessing and mitigating risks to people’s health and safety, recruitment of staff, providing person-centred care and effective governance of the service.
The overall rating for the service was assessed as ‘Inadequate’ and the service was placed in ‘special measures’. We took urgent enforcement action following our last inspection and required the provider to send us a report each week of the actions they were taking to improve the service. We also imposed conditions on the provider’s registration to prevent any admissions to the home.
This inspection took place on 31 January and 01 February 2018. It was an unannounced responsive inspection to follow up on our previous findings. We returned on this occasion to check whether people were safe and that the provider was taking the necessary action to improve the quality of care and reducing the risks to people.
The service did not have a registered manager in post for over a year. 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 time of our inspection, a manager was appointed who intended to apply for registration.
The overall rating for the service from this inspection 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 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.
People continued to be placed at risk of harm. We found continued breaches of the regulations. Where improvements had been made, it was too early to see that these were sustained and that regulations were fully met.
The provider was taking action and had put in extra staffing resources to make improvements at the home. However, progress was slow in a number of areas such as updating people’s care plans and improving fire safety. Improvements were being made to ensure people were assisted to move safely and had the right equipment in place.
The majority of people we spoke with told us they felt listened to and were involved in their care. They said staff were kind and caring. Their comments included “So far no problems. Staff are very attentive,” “They look after me very well,” “Very nice, kind, compassionate” and “Very kind, running backwards and forwards, always willing.”
People and relatives told us about the impact of staff changes and high use of agency staff. Comments included “Used to be very good, was perfect initially couldn’t fault anything. Now staff change so much, new people don’t get enough training and don’t stay for any length of time.” Another person said “There are a new series of staff, lots of younger people, (we) have to tell them what you want.” A relative told us “There are many agency staff who don’t know the residents. All the experienced staff have been suspended. (This) can be quite challenging to the residents.”
Improvements had been made to the storage and recording of people’s medicines. However, we found a discrepancy in the disposal records of one controlled medicine which we asked the provider to look into. They did this and attributed the discrepancy to a recording error.
The home had been visited by the environmental health officer since our last inspection. They served hygiene improvement notices in response to their findings. We found the home was making improvements to food hygiene measures and the chef managers were keen to put matters right.
Governance systems and processes were not robust enough to ensure there was a co-ordinated approach to implementing improvements. There were inconsistent checks to ensure staff completed work delegated to them. This meant some actions in the provider’s improvement plan were marked as completed when they were still not implemented.
People were placed at risk of harm and inconsistent care by the standard of record-keeping at the home. For example, staff had not followed good practice in the management of injuries and pressure wounds. Other important records such as recruitment files did not contain all required checks.
We found continued breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We also found a continued breach of the Care Quality Commission (Registration) Regulations 2009.
You can see what action we told the provider to take at the back of the full version of this report.