Archived: Leahurst

This inspection took place on 23 April 2015 and was an unannounced inspection. A further visit took place on the 30 April to meet with the registered manager and provider to give feedback on the inspection findings.

The home was previously inspected in November 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Leahurst provides a service for 26 adults with mental health needs. There are two buildings, the main building which has a separately accessed first floor three bedroom flat at the rear and the lodge a three bedroom detached property which is in front of the main building. The flat and the lodge have their own kitchen, bathroom and living areas.

There was a registered manager in place at the home. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were 20 people living at the home on the day of our visit. We spoke with people living at Leahurst and they said they were happy and felt supported.

From our observations and from speaking with staff we found that they knew people well and were aware of people’s preferences and care and support needs.

However, we found a number of 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 had concerns about the quality of risk management and assessment at the home. There was a lack of detailed in depth individualised risk assessments that were reviewed regularly. A fire risk assessment for the home was in place. However, there were no Personal Evacuation Emergency Plans (PEEPS) completed for each person so that staff would not know the best way to help people evacuate the building in the event of an emergency.

Following a visit by the Infection Control Team on 20 March 2015 the home had recently had a deep clean, however, some areas within the home were not clean.

Sufficient numbers of staff were not provided to ensure that the home was cleaned to a high standard and that this standard was maintained.

Following a medicine audit on 18 March 2015 completed by the NHS Cheshire and Merseyside Commissioning Support Group some issues had been raised. The registered manager told us that some areas had been dealt with immediately and an action plan was in place to address the remaining issues raised.

We were concerned however, that people who live at the home were queuing outside the medicine room for their medications and this meant that independence and person centred care was not being fully promoted and the privacy and dignity of people was not being fully met.

We looked at the staff training records and this showed that staff had not received any mandatory or other related training since 2013/14. All staff need to receive up to date training which is evidence based that allows them to maintain and update their knowledge and skills.

The registered manager stated that due to staff working extra hours formal supervisions had not been taking place since December and January. We were told that staff meetings had not taken place for the same reason.

We found Leahurst had a policy in place with regard to the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) says that before care and treatment is carried out for someone it must be established whether or not they have capacity to consent to that treatment. If not, any care or treatment decisions must be made in a person’s best interests. However, we found that very few of the staff had received training in this  area and staff spoken with had little understanding and knowledge of how to ensure the rights of people with limited mental capacity to make decisions were respected. This lack of staff knowledge meant that the provider was not protecting the rights of people who used the service by arranging for an assessment to be carried out which would test whether or not people were being deprived of their liberty and whether or not that was done so lawfully.

People spoken with said that their meetings with the registered manager had stopped at the present time and people said they missed the meetings.

People had few activities to participate in. The list of activities that was available within the home were very basic, for example card games, bingo, large board games.

The care plans did not always contain details of the person’s current situation. There was nothing to suggest the person had been involved in their plan.

There was no established system for the overall assessment and monitoring of service quality by the registered provider to assure that people lived in a safe, effective caring, responsive and well led home.

We looked at the process for recruiting staff at Leahurst. Staff records viewed showed that there was a thorough recruitment process in place, to ensure that all necessary checks were completed prior to the staff member commencing their employment.

Staff that we spoke with demonstrated that they understood the principles of safeguarding of vulnerable adults, and were able to describe different types of abuse and provide examples of indicators that abuse might be taking place.

None of the people who used the service spoken with expressed any dissatisfaction with the quality and range of the meals provided. Drinks were freely available and the people had access to a small kitchen area near to the lounges to make their own drinks.

We saw recorded evidence that people had been supported to attend appointments with, for example, psychiatrists, general practitioners, and at local hospitals. There was evidence that members of the local community mental health team had been involved in meetings about people’s care.

Most of the people had lived in the home for many years and the majority of the staff had also been employed within the home on a long term basis. The staff and people who use the service had a good rapport with one another and the home had a friendly, warm and caring atmosphere throughout.

People and staff said the registered manager was well liked and respected and knew the people living at the home very well.