This inspection took place on 21 and 22 May 2018 and was unannounced. This meant the provider was not aware we intended to carry out an inspection. The inspection was undertaken by one inspector. We also spoke with relatives and professionals during the weeks commencing 28 May 2018 and 4 June 2018.
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.