Lenthall House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The manager told us they undertook an analysis and reflection of lessons learnt following an accident or incident. Meetings held each morning which comprised of a representative from each department, including, care, catering, housekeeping and maintenance were used in part to share the outcome and analysis of incidents to support development and learning. In addition, lessons learnt were shared across other services (care homes) within the company, and scenarios based on real experiences and events were used to as examples to support staff in their training.

Staff were clear about accident and incident reporting, and escalation. Staff said incidents were investigated and a lesson learnt document was available for all staff to read and sign. They told us incidents were discussed in staff handover meetings each day, and shared via messages sent via the handheld devices linked to the electronic care record system. A staff member said, “If there is ever an issue with safety, we get it on handover and there is a ‘lesson learnt’ document, which is printed for all staff to read and sign.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Referrals were made in response to people’s changing needs to both health and social care agencies in a timely and effective way. This supported people’s continued care, including when people transferred to other care settings or hospital, which included the sharing of information to support a smooth and safe transition.

Relatives spoke positively of how staff shared information with external health and social care professionals to support people’s health and wellbeing when they moved from or into other care or hospital settings. A relative said, “My [person] had a fall a few months ago. The home was very good in sharing previous information about their health with the paramedics and hospital staff”

Referrals for admission to the service were received through the residential brokerage team, via the local authority or direct from people from the local community. Upon receipt of a referral an assessment of the person’s needs was carried out by the service or funding authority, involving the person and their family. Where people moved to the service from another care facility or hospital the staff team work collaboratively with all relevant agencies to share information and ensure safety.

Processes were in place to support the person and their relatives when they moved into the service. A relative told us, “If a family is struggling with their parent going into care, they can spend the whole day there with them if they want to, they are flexible that way. Whatever is best for the resident’s wellbeing.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Relatives spoke positively about safety and care. A relative told us, “Staff seem aware of risks and will work with residents in various ways to ensure they are safe.”

Staff had undertaken training on safeguarding and understood their responsibilities to protect people from abuse and harm. Staff were now confident to raise concerns with the management team. A staff member told us, “We would report things, such as unexplained bruising to the manager and complete an incident form and body map.”

The manager told us any safeguarding concerns were raised with the local safeguarding team, using the local authority portal referral system or by phone to the safeguarding team directly. Where appropriate other agencies, including the police and the Care Quality Commission were informed.

Staff had undertaken training on the Mental Capacity Act 2005 (MCA). However, some staff found it difficult to respond to questions to evidence their knowledge and understanding about the MCA, Deprivations of Liberty Safeguards (DoLS) and the role of paid persons representatives (PPR). Staff were aware that all care interactions required the consent of the person, and were aware some people had DoLS authorisations in place.

The manager was in the process of strengthening systems and processes which documented and monitored safeguarding concerns and DoLS. Evidence demonstrated conditions linked to people’s DoLS had been actioned. The provider shared concerns appropriately with statutory agencies in line with their responsibilities.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s relatives told us they were confident in staff being able to keep their family member safe, and to take the appropriate action when required. A relative told us, “I have visited at various times and there always seem to be enough staff around. It’s good that you see the same faces too, so I know they understand how [person] can be at times, and know what to do to keep her safe.” A second relative said, “My [person] did have a fall in his room, it wasn’t anyone’s fault. He stepped on the sensor met which alerted staff. Staff soon found him and called the paramedics.”

There was a collaborative approach with people being involved in decisions where risks had been identified, which included supporting a positive risk taking approach. For example, a person who had capacity to make an informed decision, chose not to adopt the measures to mitigate the risk.

Risks associated with specific needs, for example catheter care and diabetes could be improved to better reflect potential risks associated with infection, including the signs and symptoms for which staff should look out for which may indicate infection. The manager confirmed they would review people’s care records and refer to good practice guidance.

Risks associated with people’s individual care and treatment needs had been assessed and were regularly reviewed. This included the risk of developing pressures sores, swallowing difficulties and falls risk. Where risks were identified, a care plan and risk assessment were developed so staff knew what action to take to reduce any risk of harm. Where people were at risk of falls, assistive technology was used such as sensor mats to alert staff when people were moving independently, enabling staff to respond and provider support.

Staff now had a good understanding of risk and followed assessments to mitigate risk. They provided a clear account as to the individual risks associated with people’s care. Staff understood their role in mitigating the risk, which included the use of distraction techniques when people became anxious or distressed. They understood the importance of working with family members and other professionals to promote safety, with consideration to what was in the best interests of the person.

Staff had undertaking training in keeping people safe, which included the use of equipment and safe moving and handling practices. Staff were seen safely supporting people using equipment, including a hoist.

The manager advised us staff encouraged and supported people to make informed decisions, providing clear information about risks and benefit. Staff monitored and kept under review people’s needs to learn what works well, and whether any adjustments were needed.

The provider detected potential risks in the care environment. In the main they made sure equipment, facilities and technology supported the delivery of safe care. However, the timeliness of internal and external repairs and maintenance is an area which would benefit from further improvement.

When asked about the environment, a person told us, "It's decorated well, all nice and clean.” Relatives acknowledged some improvements had been made to the environment. However, relatives raised concerns that assurances made by the provider had still not been met. A relative told us, “There was a meeting with the co-directors and family members where we were told about refurbishment and what was going to be done. Some of which has never been completed, carpeting replaced, curtains to replace broken vertical blinds, rather than just the odd blind replaced in a different colour as has been done. At least the nasty chairs have gone from the lounge and dining room. The lounge looks better and a more inviting place to sit.” A second relative said, “The promised new floor covering to replace the old carpet never appeared. Hard flooring might be more appropriate anyway.”

Improvements were ongoing, and we saw repairs being made to fire doors. An improvement plan was in place, which documented environmental improvements completed. The plan detailed planned improvements, which included the replacement of carpets in the lounge and the introduction of a café, by repurposing a communal room. People had been consulted as to the décor and furnishing, and relatives views had been sought at a meeting.

The manager informed us a facilities manager had recently been appointed which meant they had a dedicated point of contact for any environmental or maintenance concerns. A member of staff from the maintenance team told us, “The manager hasn’t been here long, however, in the short time he has, maintenance things are getting done. I can go to him and then he will order what I need. That seems to have changed for the better.”

The manager spoke of improvements planned in the central courtyard following discussions with the company contracted to maintain the gardens, and we noted some benches in the garden had been painted. A relative told us, “There are family members now helping with the gardening at the weekend and I think plants are being supplied. The courtyard still needs addressing though as its becoming overgrown with weeds and it’s the area most residents use.”

People’s bedrooms were decorated to a good standard and were personalised with photographs, and items, including furniture which people had brought with them when they moved into the service. We observed equipment had been serviced and to be in good working order. Adaptations and equipment were appropriate to meet people’s needs, such as walk-in showers and handrails. Fire risks were assessed, and staff completed fire safety training.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were recruited in a safe way. Appropriate checks were carried out prior to people commencing work, to enable the provider to be confident suitable staff with the right skills and experienced were employed.

Records showed staff had undertaken training in a range of topics related to health, safety and welfare. Most staff had also undertaken training specific to people’s needs, which included training on improving skills and understanding the needs of people with a learning disability those living with dementia.

Relatives’ expressed confidence in the ability of staff to meet people’s needs. A relative told us, “Carers are well trained and they all know how to work with his [specific health care need]. Those that didn’t were trained by the nurse, very soon after he arrived.” A second relative said, “Staff seem knowledgeable about dementia and how to work with it, and have a lovely relationship with residents.”

Staff spoke positively of the training they received, which included training provided by external health care professionals specific to people’s individual health needs. A staff member told us, “We had a nurse show us how to support a person with [specific health related task]. It’s good to be trained on this, to help the person.”

People and relatives said there were sufficient staff. Relatives told us staffing numbers had increased and staff responded promptly. A person told us, "Staff are fabulous, can't fault them, they do everything to help you." A relative told us, “There are always staff around and you don’t hear call bells going off for ages. Staff are quick at answering those and you hear them talking about who is free to answer them.” Another relative said, “I have seen that the staffing levels have definitely got better recently, and they [staff] seem happier in themselves.”

The provider used a dependency took to assess people’s individual care and support needs, which was used to determine staffing levels. People were supported by sufficient numbers of staff. We observed a visible staff presence was maintained in communal areas, ensuring people had prompt access to assistance when required. Throughout the day we observed staff respond in a timely manner to call bells and people’s verbal requests for assistance. Most staff stated there were sufficient staff to meet people’s needs.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had access to personal protective equipment [PPE], which included gloves and aprons. There were sufficient housekeeping staff on duty, who followed cleaning schedules in line with best practice guidance. A member of the Housekeeping team spoke with a sense of pride about their commitment to making people’s environment pleasant, clean and personalised. They had a good understanding of infection prevention control, COSHH (control of substances hazardous to health) and cleaning schedules.

Relatives were positive about the cleanliness of the service and confirmed staff wore PPE. A relative told us, “I can’t get over how they keep the place to clean. It is a credit to them, given the age of the building.” A second relative said, “You see the carers wearing PPE and washing their hands in between helping residents. Everything is kept very clean there.”

Audits and checks confirmed health and safety assessments and ongoing monitoring procedures were in place. Improvements to the environment to support effective infection prevention control (IPC) had been identified by the provider, which included damage to the paint work of skirting boards and the architrave of doors.

We noted light pull cords in bedrooms to be dirty. The manager agreed to replace these and cover them with a protective plastic covering, and add them as a task to the cleaning schedule for the housekeeping team to complete.

Shortfalls in medicine management had been identified. The provider and management team were working to bring about improvement, which included liaising with health care professionals.

The senior management team and manager informed us of an action plan they were working towards in response to an external stakeholders review of their service, which had identified concerns in some aspects of medicine management.

The manager had reviewed the medicine auditing tool so as to make it more robust, and increased the frequency of medicine audits. The pharmacist who supplied medicine to the service had been asked by the manager to undertake an independent audit of medicines.

The senior management team and manager were consulting with health care professionals to make the necessary changes, which included improvements to the instructions given as to how medicines were to be administered by staff. A meeting had been arranged with health care professionals, which included a GP and pharmacist as part of the action plan.

Protocols were in place for medicines which were prescribed for as and when needed. For example, to manage pain or support people during periods of distress and agitation. The manager was actively working with health care professionals to ensure instructions for the use these medicines was clearer, to ensure consistency of use. A staff member told us, when speaking about a person who experienced periods of anxiety and agitation, that the person was prescribed medicine to be given as and when required. They said, “We have a protocol in place with instructions about the dose within a 24 hour period.”

Staff had undertaken training in medicine management, with staff having recently attended refresher training as part of the manager’s action plan to bring about improvement. Health care professionals had provided training, which was ongoing for delegated health care tasks, tailored to meet each person’s need. For example, administration of Insulin and eyedrops, and the application of transdermal patches. A member of staff told us. “Every year my competency is checked. The district nurse does the competency assessments for Insulin; eye drops and pain patches. They check how we do all the procedures, including checking for expiry dates and the use of pain patch cycles.”

Staff we spoke with were aware of people’s preferences when taking medicine. A staff member told us, “We have got a lady who likes to take one tablet at time in a medicine pot. She doesn’t like to take them together as she is scared she will choke.” People received their medicine in a timely way, and we saw people being offered a drink with their medicines.

People had individual medicine care plans that provided staff with important information such as any allergies, and any associated risks, for example those associated with taking blood thinning medicines.