Archived: Lancaster House

Updated 25 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 13, 20 and 21 September 2017. The first day of the inspection was unannounced.

The inspection team consisted of two adult social care inspectors from the Care Quality Commission (CQC).

Before commencing the inspection we looked at any information we held about the service. This included any notifications that had been received. A notification must be sent to the Care Quality Commission every time a significant incident has taken place, for example where a person who uses the service experiences a serious injury. We checked any complaints, whistleblowing or safeguarding information sent to CQC. We also contacted the local authority and mental health commissioning team to request any information they had about the service. This was used to inform our inspection judgements.

During the course of the inspection we spoke to the owner, registered manager and two staff members. We also spoke to five people who lived at the home.

We looked around the home, including communal areas and people’s bedrooms. We viewed a variety of documentation and records. This included four staff files, five care plans, five Medication Administration Record (MAR) charts, policies and procedures and audit documentation.

Updated 25 November 2017

We carried out an inspection of Lancaster House on 13, 20 and 27 September 2017. The first day of the inspection was unannounced.

Lancaster House is a care home providing personal care and accommodation for up to 13 adults with a mental health need. The home is a large semi-detached house situated on the main bus routes close to a busy slip road leading off Eccles Old Road onto the A6. The driveway and back garden are shared with the house next door, Cairn House, which is also a care home owned by the same provider. At the time of inspection 10 people were using the service.

The home was last inspected on 25 and 27 January 2017, when we rated the service as ‘Inadequate’ overall. We also identified 10 breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including continuing breaches with premises and equipment, staffing and good governance, along with additional breaches with safe care and treatment, management of medicines, safeguarding people from abuse or improper practice, person-centred care and receiving and acting on complaints.

We took enforcement action and issued the provider and registered manager with warning notices in regards to premises and equipment and good governance, to formally request action be taken to address the overall standard or the premises and ensure quality assurance and auditing systems were in place and being utilised. We also asked the provider to take action to ensure people were actively involved in their care, ensure staff received the necessary support and professional development to enable them to carry out their roles effectively, assess the risk of and control the spread of infections, ensure the proper and safe management of medicines, ensure they acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and ensure they had an system for the identifying, receiving, recording and handling of complaints.

At this inspection we identified eight continuing breaches in four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including breaches relating to, staffing, safe care and treatment, management of medicines, person-centred care and good governance and one breach of the Care Quality Commission (Registration) Regulations 2009, due to a failure to inform the commission of notifiable incidents. We also made a recommendation in relation to following best practice in relation to the MCA and DoLS. We are considering our enforcement actions in relation to these regulatory breaches.

At the time of the inspection the home had a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found remedial action had been taken to address previously identified issues with the overall décor and maintenance of the property. A schedule of works had been produced which the provider and registered manager had overseen. Bedrooms and bathrooms had been re-decorated, damaged or broken fixtures and fittings had been replaced and attempts to de-clutter communal areas had taken place. We noted work was ongoing and the hall, stairs and landing along with replacement of carpets had purposefully been left until last, to ensure all building and painting tasks had been completed.

We saw staff continued to be responsible for cleaning tasks, with checklists in place detailing what tasks needed to be completed in each room. We found the home to be reasonably clean; however some fixtures, fittings and ornaments required dusting. Cleaning equipment was stored safely and securely and Control of Substances Hazardous to Health (COSHH) forms were in place for the cleaning products in use. We noted the provider had installed paper towel dispensers in bathrooms, to replace cotton hand towels, however hand hygiene guidance was not in place and liquid soap bottles were still being used rather than wall mounted soap dispensers, which is contrary to Department of Health guidance.

We identified some issues during our review of medicines management. We saw the service continued to not use ‘as required’ medicine protocols or topical medicine charts. We found records of topical medicine usage were not completed consistently and we noted one person’s transdermal patch had not been applied as per prescription. We also identified aspects of good practice especially around the receipt and booking in of medication when it was delivered to the home.

Each person we spoke with told us they felt safe. The home had safeguarding policies and procedures in place, although did not have a dedicated safeguarding file and log of referrals, with referrals stored electronically in email folders. Staff had been trained in safeguarding vulnerable adults and had knowledge of how to identify and report any safeguarding or whistleblowing concerns. We did note a safeguarding issue raised by the local hospital regarding a person who used the service had not been reported to the Care Quality Commission, as is required by law.

People who used the service and staff we spoke with felt there was not enough staff employed to effectively meet people’s needs. We saw staff members had left and despite actively trying to recruit, the home had not been successful in replacing these staff. Whilst the reduced staffing levels had not impacted on people’s feeling of safety, we did notice an impact on the support people received to complete planned tasks and activities. People continued to be encouraged to retain their independence and were free to come and go as they wished.

We looked at five care files in detail, which were stored electronically on a laptop. We found limited improvements and additions had been made since the previous inspection, with numerous gaps in information and an overall lack of detailed guidance for staff to follow, to ensure people’s needs were being met. We saw mental health care plans and risk assessments had been drawn up to sit alongside the existing care plans; however these had yet to be implemented.

We found the service was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Training in both areas had been facilitated, and staff had a reasonable understanding of both sets of legislation. However there was not an MCA / DoLS policy in place and some of the wording used in care plans could be seen as oppressive.

Staff told us training had improved with a number of sessions being held over the last six months, including training in mental health awareness, which considering the nature of the service, had been a noticeable omission at the previous inspection. The training matrix had not been fully updated during the inspection, however we were able to confirm sessions had been held and the registered manager updated and forwarded the matrix to us following the inspection.

The provider’s action plan following the previous inspection stated staff would receive supervision on a bi-monthly basis, however our review of staff records demonstrated this was not being done. Whilst there had been an increase in the frequency of meetings, none of the staff had completed more than three meetings since January.

People told us they enjoyed the food provided by the service and received enough to eat and drink. People could choose when and where to eat, with meals being prepared for people to eat later, if they did not wish to eat at the allocated meal time.

Throughout the inspection we noted a positive atmosphere within the home. People were animated and engaged in conversation and friendly ‘banter’ with each other and members of staff. People we spoke with were complimentary about the staff and the standard of care received. Resident meetings had been held, with people given the opportunity to suggest agenda items, as well as being informed about things relating to the home.

We saw a new auditing and quality monitoring system had been introduced, which had been designed by the provider. However this had not been used fully or effectively and none of the issues noted during this inspection had been identified by the registered manager or the auditing process.

We noted some issues in fire safety processes when reviewing safety procedures and checks. Not all checks had been carried out in agreed timescales and personal emergency evacuation plan (PEEPS) were still not in place.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to canc