Archived: Lightbowne Hall

We found the following examples of good practice.

The home had made safe arrangements for visits from relatives. It had installed large screens in its conservatory to create a safe visiting lounge. The visitors’ lounge had a separate entrance from the outside where visitors entered. Visits had to be booked in advance. Domestic staff cleaned the lounge between appointments.

The home had visiting protocols in place for relatives of people at the end of their lives. Staff screened visitors on arrival and took their temperature. Visitors took a Covid test and donned personal protective equipment before they entered their relative’s bedroom. Staff provided a ‘comfort tray’ of refreshments during such visits, which was removed after the visit.

Staff placed a trolley that held personal protective equipment (PPE) outside the room of any people who were self-isolating or had Covid-19. Staff placed a waste bin inside the person’s room so that staff could doff PPE when they left the room. A discreet sticker on the bedroom door identified to staff those who were self-isolating or had Covid-19.

Staff had access to a separate changing room away from the residential units. Staff changed into their uniforms for their shift and donned PPE. Staff changed out of their uniforms when they finished their shifts.

The home had a very high standard of visible cleanliness and hygiene. The home had a highly motivated team of two domestic staff, who worked daytime hours from Monday to Sunday. Care staff undertook cleaning duties at other times. The home had a steam cleaning machine, which domestic staff used to deep clean and disinfect bedrooms and visiting areas.

The provider had a comprehensive business continuity plan for the Covid-19 pandemic. This included policy and practice for recruiting agency workers, visiting protocols, and managing positive or suspected Covid-19 outbreaks.

Further information is in the detailed findings below.

Lightbowne Hall is a residential care home that provides personal care and accommodation for up to 52 people, some of whom are living with dementia. There were 44 people living there at the time of our inspection.

People’s experience of using this service

Staffing arrangements had improved and were regularly reviewed by the registered manager to ensure these continually supported people's safety.

Staff were recruited safely; they received regular support and training. New staff were provided with an induction which provided them with the relevant knowledge and skills for their roles. The registered manager reviewed staffing arrangements on a regular basis, so they could continually improve these when required to effectively meet people's individual needs.

There was a positive and relaxed atmosphere in the home which we found to be homely and well run. People living in the home interacted freely and staff were seen to be caring and supportive.

People were supported to receive their medicines and were happy with the arrangements in place for staff to assist them with their medicines. However, we found some PRN (as required) protocols needed further detail to inform staff when people may need to administer these medicines. We passed this feedback on to the registered manager who ensured they were reviewed during the inspection.

People we spoke with told us staff responded to their health needs. People were supported to eat and drink enough and had a choice as to where to eat their meals. We did however receive a small number of negative comments regarding the quality of food on offer, which the service was already aware of and plans were in place to resolve this.

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's needs were assessed, and they had care plans in place. However, we found two of the five care plans we looked at had not been updated to reflect a recent change in equipment used. On the second day of the inspection the care plans had been updated. We made a recommendation about this.

People received caring and kind support from staff who respected their dignity and privacy. They were encouraged to be independent and staff understood their needs well and understood how to care for them

in a personalised way.

The environment was adapted to meet people's needs. Regular monitoring of the home ensured that quality of care was regularly reviewed, and improvement measures were in place.

At this inspection, we found the managerial oversight of the service had improved and the quality assurance checks in place enabled the registered manager and senior staff to pro-actively respond to identified events.

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 24 August 2018) where three breaches of regulations were identified. The provider completed an action plan and attended a meeting with CQC 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.

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.

Lightbowne Hall 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.

Lightbowne Hall is a large three storey detached property in Manchester. The home provides residential care for up to 52 people. At the time of the inspection there were 50 people living in the home. The home has large communal areas on each floor with separate dining areas. Each floor also has a quiet lounge. The kitchen and laundry facilities are on the ground floor of the building and there is a hairdresser’s salon on the first floor. All floors are accessible by a lift and stairs.

Our last inspection took place on 27 June 2017 when we rated the service requires improvement. At that inspection we found the provider had implemented a number of positive improvements. However, at this inspection we have found the provider has failed to sustain these improvements and we have identified three new breaches of legal requirements in relation to insufficient staffing levels, care planning and activities, and the quality assurance systems. We requested the provider to tell us in an action plan how they were going to put right the concerns in respect of these breaches.

The manager had been at the service for approximately two months at the time of this inspection. On the second day of inspection the manager confirmed he had received confirmation of his registration with the Care Quality Commission (CQC). 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 home is run.

The service was not staffed safely to meet people's needs. The service was also not staffed in line with the stated provider's minimum staffing levels. As a result, people's basic care needs were not being met. Examples of this included, people not always having their skin integrity needs met and people did not always receive social stimulation within the home, due to a lack of staff.

Staff were observed being kind and compassionate to people throughout the inspection, but their ability to have quality time with people was being compromised by all the tasks they needed to complete.

Demands on staff time meant that staff were not reading people's care plans and risk assessments. Care staff relied on the team leaders to tell them informally and verbal information from other staff. Although care plan records have steadily improved over the last two inspections, essential details were still missing from these, which meant the staff team could not be sure they were using up to date information about people's current needs. Care records were not fully completed which meant people's changing needs could be missed. Monitoring of people's skin integrity repositioning charts were not always completed correctly. This meant people were vulnerable to unsafe and inaccurate care.

People had access to activities, however we received mixed feedback with regards to the activities provided. People were not always protected from social isolation. The range of activities available were not always appropriate or stimulating for people.

We found arrangements in place for the safe management of people's medicines and regular checks were undertaken. People received their medicines as prescribed.

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role. However, staff did not always receive appropriate supervision and regular appraisals in line with the providers policy.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the manager.

People continued to be supported to maintain good health and we saw that people had access to their GP, district nurses and other specialist services.

The registered provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider's policies and systems supported this practice.

It was clear to the inspection team the manager demonstrated a commitment and willingness to improving the quality and safety of care provided at Lightbowne Hall. However, we found the quality assurance and audits systems in place to monitor and improve service delivery were not always effective.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were a breach of Regulation 9, Person centred care, Regulation 18, Staffing and Regulation 17, Good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Lightbowne Hall is a large three storey detached property in Manchester. The home provides residential care for up to 52 people. At the time of the inspection there were 47 people living in the home. The home has large communal areas on each floor with separate dining areas. Each floor also has a quiet lounge. The kitchen and laundry facilities are on the ground floor of the building and there is a hairdresser's on the first floor. All floors are accessible by a lift and stairs. The service provider had transferred in 2015 from Ideal Care homes to Anchor Care homes.

Our last inspection took place on 14 and 16 November 2016 when we rated the service as inadequate overall and for safe and well led. We rated the effective, caring and responsive domains as requires improvement. As the previous inspection in November 2016 had rated the service as inadequate overall, we placed the service into 'Special Measures' because it was inadequate in two of the five domains.

Following our last inspection we issued two warning notices in relation to breaches of regulations relating to the provision of safe care and treatment and good governance. This meant we sent a formal notice to the provider and registered manager that they must become compliant with the regulations by 06 February 2017 in relation to safe care and treatment and good governance. The provider sent us an action plan to tell us the improvements they would make in order to become compliant with the regulations. At this inspection we found the provider had made significant improvements and they were meeting the requirements of the regulations.

At this inspection we found there had been improvements which were sufficient for the service to be rated as requires improvement overall and good in caring, with no inadequate domains. This meant the service could come out of special measures.

The service had a registered manager 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.

We noted improvements in medicines management from the last inspection in November 2016 and some examples of good practice. However, temperatures had not been recorded on three consecutive days in May 2017 and two days in June 2017.

People and care staff told us there were enough staff on duty. The registered manager had used a dependency tool to calculate staffing levels. We observed that people's basic needs were met and the staffing levels at the time our inspection were adequate.

Care assessments and plans had improved since the last inspection and were seen to be detailed and person-centred. However, we identified one person who at times displayed behaviours that may challenge others, that did not have a risk management care plan to help guide staff when supporting them. We found one person living with dementia didn’t have a dementia care plan in place to guide staff about their specific needs.

The involvement of people and their relatives in care planning had improved since our last inspection. Care workers knew people well as individuals and we saw warm and friendly interactions between people and care workers.

We found accident records at the home were comprehensive and evidence showed people were monitored effectively following an accident.

Some senior care staff at the home had received advanced training in end of life care and people had their future wishes recorded in their care plans.

Activities at the home were much improved since our last inspection in November 2016. The area manager held a dementia awareness workshop with staff to share good practice on social stimulation for people. We saw a range of activities being undertaken on the day of the inspection.

Care workers had supervision with senior staff. The registered manager had reviewed the supervision and appraisal system to ensure care workers received an annual appraisal and regular supervisions. Staff received the training they needed to meet people's needs.

A clear system of safety and quality auditing was now in place at Lightbowne Hall. A range of audits and checks were undertaken by the manager to monitor the quality and safety of the service.

At the last inspection we found the service was not undertaking regular fire drills, to ensure staff were fully prepared in an emergency, such as a fire. At this inspection we found the service was now ensuring staff received fire safety training and conducted regular fire safety drills for both day and night staff.

We found staff were recruited safely. Suitable checks were made to ensure people recruited were of good character and had appropriate experience and qualifications.

We reviewed the information and support available to ensure people received adequate nutrition and hydration. We found records were held as required to support people at risk of not receiving enough nutrition and hydration. We found advice given by specialist teams including GPs and dieticians were followed. Records in relation to monitoring people's intake of food and fluids were completed when required.

The registered manager had followed the home's policies and procedures when responding to complaints. We found complaints had greatly reduced since our last inspection.

We found that the home was properly maintained to ensure people's safety was not compromised. We found a number of refurbishment works had commenced, with new flooring being laid and the installation of a new café on the first floor. The home had made some new adaptations of the environment of the home to assist people living with dementia.

Staff sought consent from people they supported before providing care. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how to support people effectively, however we found some consent forms had not always been completed in line with the MCA 2005.

Staff maintained people's dignity, and respected their privacy. Care records were kept confidentially.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

The atmosphere and culture at the home was much improved. The managers each knew their own roles and responsibilities. Staff expressed confidence in the management team and in each other. There were regular staff meetings where staff could contribute their views.

Lightbowne Hall is a large three storey detached property in Manchester. The home provides residential care for up to 52 people. At the time of the inspection there were 50 people living in the home. The home has large communal areas on each floor with separate dining areas. Each floor also has a quiet lounge. The kitchen and laundry facilities are on the ground floor of the building and there is a hairdresser’s on the first floor. All floors are accessible by a lift and stairs. The service provider had transferred in 2015 from Ideal Care homes to Anchor Care homes.

At the comprehensive inspection of Lightbowne Hall on 16 July and 4 August 2015 we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). We issued the provider with seven requirements stating they must take action to address these breaches. We shared our concerns with the local authority safeguarding team.

Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan, and to confirm that they now met all of the legal requirements.

During this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations.

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 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 the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC). 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 registered manager was on annual leave at the time of the inspection. There were arrangements in place to cover the management of the service including an area manager and support from the deputy managers.

People's medicines were not managed safely. For example, we found one person had recently been discharged from hospital with a new medication supply that would last for ten days, therefore the service was required to order more medication with the local pharmacy. We noted this did not happen in a timely manner and resulted in the person missing five doses of their medicines.

We found accident records at the home were comprehensive and evidence showed people were monitored effectively following an accident. However, we found one incident had not been responded to in a timely manner, resulting in a person not receiving medical attention for two days.

Audits on the home’s quality were not accurate which meant systems to improve the quality of provision at the home were not always effective. We found the home in breach of the regulation in relation to good governance as there were not effective systems in place to monitor the quality of the service. Surveys were completed but the information was not collated and used to improve the provision of care at the home.

At the last inspection we found there were not sufficient levels of staff of staff on duty. At this inspection we found staffing levels had increased and people we spoke with confirmed staffing levels were adequate.

During this inspection, we found that the provider had made some improvements to safe care and treatment. Risks to people's health and well-being were identified and a plan was in place to manage those risks appropriately. Staff had access to this information and they were able to reduce the recurrence of the identified risk. Risk assessments were reviewed regularly when there was a change in people’s needs.

Care plans were based on the needs identified within the assessment, however we found three care plans did not have a dementia specific care plan in place, and therefore it did not reflect the current needs of these three people.

People had access to activities, however we received mixed feedback with regards to the activities provided. People were not always protected from social isolation. The range of activities available were not always appropriate or stimulating for people.

At the last inspection we found individual plans to support people in an emergency had been formulated on their admission to the home but had not been reviewed since. At this inspection we found people had a personal evacuation plan that reflected their current level of mobility. However, we found the service was not undertaking regular fire drills, to ensure staff were fully prepared in an emergency, such as a fire.

We found staff were recruited safely. Suitable checks were made to ensure people recruited were of good character and had appropriate experience and qualifications.

We reviewed the information and support available to ensure people received adequate nutrition and hydration. We found records were held as required to support people at risk of not receiving enough nutrition and hydration. We found advice given by specialist teams including GPs and dieticians were followed. Records in relation to monitoring people’s intake of food and fluids were completed when required.

Staff had received appropriate training, supervision, and appraisals to support them in their roles. Staff, with the support of their line manager, identified their professional needs and development and took action to achieve them, although we noted supervisions did not happen as often as stated in the provider’s policy.

People told us they knew how to complain if they were unhappy and records showed the service responded appropriately to complaints they had received. One relative commented that the service did not respond appropriately to their complaint; the area manager arranged a meeting with this person shortly after to discuss their complaint.

We found that the home was properly maintained to ensure people's safety was not compromised, however we found two carpets within the home that were heavily stained and threadbare. These carpets had been identified during a number of home audits, but had not yet been replaced.

Staff sought consent to care from people they supported. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how to support people effectively, however we found some of the staff were not aware of the people living at the home who were subject to a DoLS.

The environment had some adaptations for people living with dementia.

Staff maintained people’s dignity, and respected their privacy. Care records were kept confidentially.

Staff expressed confidence in the management team and in each other. There were regular staff meetings where staff could contribute their views.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We set out amongst other things to answer five key questions: "Is the service safe? Is the service caring? Is the service responsive? Is the service well-led? Is the service effective?"

The evidence that supports this summary can be found in our full report.

Is the service safe?

We saw that the building was well designed for the needs of people living there and with their safety in mind. There were appropriate arrangements in place to ensure people were kept safe within the building. Outside the building there was an enclosed garden and seating areas for people to enjoy in warm weather.

We found that Lightbowne Hall usually identified any issues related to safeguarding and correctly reported them to the local authority and to the CQC. However, we found there were two recent safeguarding issues which had not been reported as they should have been.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found that one application for an urgent DoLS authorisation had been completed incorrectly. The omission was remedied on the day of our visit. However, we found that this contributed to a finding that the service was not meeting the standard on safeguarding.

Is the service caring?

We spoke with four people who all said they felt well looked after. One person said: "The staff here are friendly. They have been very good to me." When we spoke with staff and the manager it was clear they genuinely cared for the people they supported. The service was person centred and took into account the diverse range of people needing support. We found the home respected people's preferences, interests and wishes, and cared about the people using the service. We saw that the home was providing physical exercise for those people who wanted to participate. We thought that there could be a wider range of activities provided.

Is the service responsive?

The service responded to people's needs by providing an appropriate level of care. The manager had tried to involve relatives in reviews of care plans, and was seeking ways to do so more effectively. The service had responded positively to two areas of non-compliance identified in our last inspection.

Is the service effective?

We saw that people were well-cared for, so the service was effectively fulfilling its main purpose. The visitors we met stated that they were very satisfied with how their family members were being looked after. We found that care plans were thorough and based on a good system.

Is the service well-led?

The manager was experienced and was in the process of applying to become registered manager. They were supported by the area manager who made regular visits and was present on the day of our inspection. There was a deputy manager and senior carers, and staff understood the chain of responsibility. The emphasis of the service was on ensuring people received good care and were treated with dignity and respect.

We were told: 'All the carers are very polite and they don't rush me. You need time to do things at my age and they let me go at my own pace'. And: 'The carers make you feel at home as well as the residents'.

We found no evidence that people who used the service or their relatives had been involved in the planning or reviews of their care and treatment. None of the people we spoke with could recall having been involved in consenting to their care.

Relatives we spoke with told us that they had probably given appropriate consent to the care and treatment for their relative, but none could recall having been involved in a review of their relatives care plan.

We found that people's care and welfare needs were met by the service and healthcare professional were regularly consulted.

People told us they felt safe. Staff had been trained in protecting vulnerable people and the service had systems in place to respond to any allegations of abuse.

We found that there were insufficient numbers of staff on duty to respond in a timely manner to people's needs for care and welfare.

The home had a complaints system in place although there was room for improvement in terms of bringing minor complaints to the attention of the manager.

We saw people living at Lightbowne Hall being treated with dignity and respect. We spoke with a selection of people who use the service, the manager, staff, relatives and professionals who had visited the service. Some people we spoke with were living with dementia and not all people were able to fully share with us their views with us.

One person told us "I am very happy here". Another person said "It is very good here” We saw that people expressed their views and were involved in making decisions. One person told us "They do ask me how I want things to be done".

Prior to our visit we had been made aware of concerns about the management of medication. We checked to see if there continued to be problems and found no areas of concern.

We looked at the recruitment of staff, and found the service had undertaken robust checks to make sure staff they employed were suitable to work with people using the service.

People we spoke with said that they felt there were not always enough staff on duty. Although at the time of our inspection we saw no evidence of this.

Staff told us that they liked working at the home and were supported in their work. We saw that processes had been in place to monitor the overall quality of the service provided.