About the service Lenthall House is a residential care home providing accommodation and personal care to 35 people aged 65 and over at the time of the inspection. The service can support up to 40 people accommodated over two floors.
People’s experience of using this service and what we found
Risk was not always safely managed. As a result, people were left at increased risk of not receiving the care and support they required in a safe way.
Environmental safety concerns were found in people’s bedrooms and communal areas. Alcohol based hand sanitiser and paraffin based topical creams had been left in people’s bedrooms and communal areas. This increased the risk of harm to people.
Accidents, incidents and falls were dealt with appropriately. However, themes and trends were not always identified, and lessons were not always learnt when things went wrong.
Medicines were not always safely managed. People were not always receiving their medicines as prescribed. Medicines were not always being stored appropriately or administrated safely. This placed people at increased risk of harm.
There were not always enough staff to meet people’s needs and to ensure care records were accurate and up-to-date. The provider was unable to evidence appropriate recording of up-to-date information within care records, care plans and risk assessments to ensure people’s care was person-centred and achieved good outcomes for people.
Effective systems and processes were not always in place to maintain oversight of the service, or effective in identifying areas of concern. Achievable action plans were not always developed, and when action plans were developed there were not always clearly set priorities, timescales and ownership of each issue.
There was a distinct lack of lessons learnt at provider level. Several of the issues identified had previously been raised at other locations under the provider’s registration and the same issues were found at Lenthall House.
People’s relatives and staff provided mixed feedback about the support provided by the management team and the quality of communication.
People’s relatives were not always involved in developing and reviewing their family member’s care.
People were supported by staff who had been recruited safely and who knew people well.
Staff demonstrated a good understanding of safeguarding and the signs of abuse and were able to describe how and who to report concerns to.
Effective infection prevention and control (IPC) policies and procedures were in place and the service was following best practice and Government guidance in relation to the management of COVID-19 and other infections.
The provider and management team had good links with the local communities within which people lived.
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 14 June 2018).
Why we inspected
We received concerns in relation to staffing levels, staff training, recurrent falls and a lack of management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
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.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe 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 Lenthall House on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to risk management, staffing, medicines, the environment and management oversight at this inspection.
We issued a Warning Notice requiring the provider to be compliant by 31 March 2022.
Please see the action we have told the provider to take at the end of this report.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.