We carried out a review of the data available to us about Leybourne on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Leybourne, you can give feedback on this service.
About the service
Leybourne is a residential care home providing personal care for to up to eight people with a physical and/or a learning disability or autistic people. At the time of our inspection there were eight people using the service.
People’s experience of using this service and what we found
Based on our review of safe and well-led the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right Support
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.
Right Care
Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff assessed and wherever possible mitigated risks people might face.
Right Culture
People received support from staff who were kind and caring. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.
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 25 October 2019).
Why we inspected
We received some concerns in relation to the management of a transition, communication and the culture of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains good.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Leybourne on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Leybourne is a residential care home providing personal care for up to eight people with physical and/or learning disabilities. There were seven people living there at the time of the inspection.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People received a personalised service from supportive staff. People said they liked the staff and enjoyed being with them. Staff made sure people had enjoyable experiences and a happy social life.
People were encouraged to make their own decisions and staff understood how people communicated their choices. People were enabled to achieve independent living goals. Staff made sure that people were treated with dignity and respect and in a way that was free from discrimination.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
Staff received the relevant training and support to assist people in the right way with their individual lifestyles.
There had been significant improvements in the way the service was managed. The provider had addressed the previous shortfalls in how medicines, complaints and quality assurance systems were managed.
Staff praised the values and ethos of the management and staff team. They were committed to providing high quality, person-centred support for people to be able to live fulfilled lives.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 1 August 2018) and there were multiple breaches of regulation. The provider completed an action plan 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.
Why we inspected
This was a planned inspection based on the previous rating.
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.
Leybourne 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. The home is registered to provide support for up to eight people over two floors. Residential care is provided for people with a learning disability, physical disability or those with an autistic type condition. Nursing care is not provided at the home. On both days of the inspection there were six people using the service.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
At the time of the inspection there was no registered manager registered at the home. The previous registered manager had left the home and cancelled their registration in March 2018. A new manager had been appointed but it had been in post only around three weeks. A registered manager is a person who has registered with the 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. We were supported on the inspection by the manager, the previous interim manager and the provider’s nominated individual.
Prior to the inspection we were aware of a number of safeguarding issues at the home. Some of these are still ongoing and we will monitor the outcome of these investigations. Staff were aware of safeguarding issues and told us they now felt confident in reporting any concerns around potential abuse. They said they felt more confident in reporting any concerns higher up in the organisation as part of the provider’s whistleblowing policy.
Checks were carried out on the equipment and safety of the home. The majority of checks carried out on systems and equipment were satisfactory. However, some upstairs rooms did not have window restrictors fitted. It was also unclear if the home had been subject to an up to date fixed electrical check and records were not available to demonstrate that appropriate fire drills had recently been undertaken. Risk assessments linked to people’s care were available but not always clearly linked to the delivery of day to day care. Professionals we spoke with told us they felt some risk assessments lacked detail. The home was maintained in a clean and tidy manner.
Staff and relatives told us they felt there were enough staff at the home. Staff told us they were able to accompany people to access the community and support them with their personal care needs. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience.
We found some issues with the safe management of medicines. Medicine administration records (MARs) were not always well completed and instructions for the use of creams and lotions and ‘as required’ medicines were not always available or detailed enough. Management of medicine did not always meet NICE guidance.
The manager told us there was no overarching records of what training staff had completed. Work was ongoing to address this through a review of individual records. Staff told us they had access to a range of training and some certificates were available in staff files. Staff confirmed access to appropriate supervision had improved since the new manager arrived. Staff said they had not yet been subject to an annual appraisal as the services had only been operational for 12 months.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. Appropriate applications for DoLS had been made and there was evidence best interests decisions had been made, when appropriate. Some people had relatives appointed as deputies to help support their decision making. Staff were aware of this and said they wanted to work closely with relatives and court appointees to ensure good care.
Prior to the inspection suggestions had been made that people were not always supported to access appropriate health care. At the inspection we found people had recently accessed health care services to help maintain their physical and psychological wellbeing. People were supported to access adequate levels of food and drink, although some relatives felt staff could promote healthier options more.
The home had been refurbished within the last 12 months and decoration was of a good standard. The manager felt the service needed to be more homely and was working with people who lived at the home and the provider’s estates department to address this.
We observed there to be good relationships between people and staff. People looked happy and relaxed in staff company. Staff displayed a good understanding of people as individuals and of treating them with dignity and respect. We found limited evidence to suggest people had been actively involved in their care reviews, although we were told a weekly ‘house meeting’ took place, to support people to making decisions. The majority of relatives told us they felt involved in care decisions.
People’s needs had been assessed and individualised care plans had been developed that addressed identified needs. Some care plans had detailed information for care staff to follow. Other care plans lacked specific detail about how to support people or had not been updated to reflect recent professional advice. Reviews of care plans were not always appropriately detailed or effectively recorded. People were supported to attend various events and activities in the local community. Activities also took place within the home and people clearly enjoyed these.
Prior to the inspection were had been made aware of a number of complaints and issues raised with the service, some of which had been dealt with as potential safeguarding matters. Complaints records were not well completed and did not detail all of the matters we were aware of. It was not possible to be sure these issues had been appropriately followed up and responded to.
Regular checks and audits were carried out on the service by managers and senior staff within the organisation. These checks had not highlighted the issues identified at this inspection. It was also not clear actions were completed in timely manner or that the quality of these actions was checked. Staff were positive about the new manager and felt she had made a positive impact on the service. Professionals and relatives were hopeful the new manager would be able to improve the service and care standards at the home. They said initial impressions were good. Staff told us there was a good staff team and felt well supported by colleagues. Daily records at the home were variable. Some had good detail about the individual and their presentation, whilst others were less well completed and not always person centred.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the Safe care and treatment, Responding to complaints and Good governance. You can see what action we told the provider to take at the back of the full version of the report.