Archived: The Laleham

The Laleham provides accommodation and personal care for up to 60 people. Some people may be living with dementia. Bedrooms are on three separate floors and are accessed by a passenger lift. There are various communal rooms, including lounges and dining rooms. The service faces the sea and has parking at the front. There were 45 people using the service when we inspected.

People’s experience of using this service:

The provider had not referred all incidents to the local safeguarding team as required.

There were inconsistencies in the recording of incidents. Further analysis was required to ensure consistency in management oversight and to identify patterns and trends in all areas to prevent or reduce repeated incidents.

The provider used a dependency tool to establish how many staff were required. Although there were enough staff to meet people’s needs during the day, staffing was reduced through the night and the provider was unable to tell us how they calculated the number of staff required at night. The provider had not taken into consideration the layout of the service of specific needs of people.

Staff had not always been recruited safely. Staff files contained unexplained gaps in their employment history and missing information.

Risk management was not consistent. For example, behaviour guidance was missing for people who could display behaviours that could challenge others and there were no risk assessments about the use or storage of an oxygen cylinder a person used. Other risks had been identified and action taken to reduce any potential harm, for example environmental risks.

Most medicines were safely received, stored and administered and regularly audited to check for any errors. We found some opened undated liquid medicines and unclear guidance for the administration of medicines which had strict protocols around administration. The provider acted to improve this after the inspection.

The environment was clean, however, chipped paint, especially to lower areas of doors and door frames, exposed bare wood. Bare wood is absorbent of fluids and therefore difficult to clean. Staff had enough personal protective equipment to carry out cleaning duties safely.

Staff had not always received training to enable them to meet people’s specific needs.

The service was an older large property with a complex layout. Although some thought had been put in to making areas of the service more identifiable, more was required. Some people living with dementia may find it difficult to find their way around the building.

There had been numerous management changes which had impacted on the consistency, development and continuous oversight of the service. Although auditing processes were in place to analyse risk and the delivery of care, audits had failed to identify the issues we found during our visit.

The registered persons had not submitting safeguarding notifications to the Care Quality Commission in an appropriate and timely manner in line with our guidelines.

People, visitors and relatives had been asked to complete feedback forms about the quality of the care provided. Analyses and action to improve from the feedback provided had not always been acted on in a timely way.

The service was compliant with the Mental Capacity Act 2005. People needs were assessed before being offered placements at the service. People needs were re-assessed and action taken where required so staff could continue to support people to meet any changed needs.

People were offered a variety of meal choices and alternatives were prepared if people did not like what was offered on the daily menu.

Staff were responsive to people’s health needs. People had been supported to access healthcare resources such as dieticians, SALT, psychiatrists, mental health teams, consultants and specialist nurses.

Staff spoke with people with kindness and respect, people were asked for permission before being supported with any care needs.

People were offered different activities. Throughout the inspection we observed people taking part in various activities such as quizzes and crafts. Staff made sure people who preferred to stay in their bedrooms had one to one time to avoid isolation.

The complaints procedure had not been written in an easy to read format for people living with dementia. The policy was not available in large print or any other formats for people.

Each person had their own individual care plan which detailed the support they required. Some information was missing from the care plans which the head of care was in the process of updating.

Rating at last inspection:

The service was rated Good at the last inspection on 15 & 17 August 2017 (the report was published on 18 September 2017). At this inspection we found overall the service met the characteristics of requires improvement.

Why we inspected:

This inspection was brought forward due to information of concern we received in relation to the building and environment of the service.

Enforcement:

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.

Follow up:

We will ask the registered provider to send us their action plan to tell us how they will improve the service. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Laleham provides accommodation and personal care for up to 60 people. Some people may be living with dementia. Bedrooms are on three separate floors and are accessed by a passenger lift. There are various communal rooms, including lounges and dining rooms. The service faces the sea and has parking at the front. There were 51 people using the service when we inspected.

There was a registered manager working at the service. 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 of the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was not available on the first day of the inspection; we were supported by the head of care, senior carer and administrator. We met with the registered manager on the second day of the inspection.

We last inspected the service in August 2016. We found significant shortfalls in the service. The provider had failed to make sure care plans were person centred. The registered persons had not given staff detailed guidance to ensure people were supported safely with their mobility and behaviours that may challenge. The registered persons did not have effective systems in place to monitor and mitigate the risks to people’s health, safety and welfare. The registered persons had not kept accurate and complete records in respect of each person. The registered persons had failed to ensure there were enough staff on duty at all times to meet people’s needs.

We asked the provider to provide an action plan to explain how they were going to make improvements to the service. At this inspection we found that improvements had been made.

At the last inspection, potential risks had been identified but the measures to reduce these risks were not detailed enough to keep people safe. At this inspection, there was detailed guidance for staff to follow to mitigate potential risks and keep people safe including how to move people safely.

At the last inspection, there were not sufficient staff on duty at night to meet people’s needs. Staffing levels had been increased and there were sufficient staff on duty. Staff were recruited safely. Staff were supported by the registered manager through one to one supervisions and yearly appraisals.

Staff received training to make sure they had the skills and knowledge to carry out their roles. At the last inspection, specialist training such as diabetes and challenging behaviour had not been completed by staff. At this inspection, senior staff had received training in diabetes and further training sessions were booked. Staff had received training in how to manage behaviour that might challenge.

At the last inspection, medicines were not always stored at the recommended temperature to ensure medicines were effective. At this inspection, medicines were stored safely, people received their medicines when they needed them.

People’s care plans at the last inspection, were not always accurate. Details about people’s healthcare needs had not been recorded consistently. At this inspection, care plans were detailed and had been reviewed regularly and up dated to reflect people’s changing needs. People had signed to say they had discussed their care plan and attended reviews with healthcare professionals.

Audits were in place to monitor the quality of the service people received. When shortfalls were identified action plans were put in place to ensure the shortfalls was rectified. Accident and incidents were recorded and reviewed by the registered manager. These were analysed to identify any patterns or trends and plans were put in place to reduce the risk of them happening again in the future.

Checks had been made on the environment to ensure the service was safe. Equipment to support people with their mobility, such as hoists had been checked to ensure people were safe.

Staff knew how to keep people safe from abuse. Staff were confident that if they had any concerns they would be addressed quickly by the registered manager.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff understood their responsibilities under MCA, people’s capacity had been assessed and when required best interests meetings had been held and recorded. Staff encouraged people to make decisions about their day to day care and remain as independent as possible.

People told us that they enjoyed the food. People had a choice of meals and were supported to maintain a healthy diet in line with their choices, preferences and any healthcare needs. People’s health was assessed and monitored. Staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

People’s dignity and privacy was maintained by staff. People told us staff were kind and caring. Staff spent time with people and seemed to be genuinely interested in them and what they wanted to say. Staff explained how they maintained people’s dignity and how they encouraged choice.

There was a programme of activities available for people to enjoy. Some people living with dementia found it difficult to join in some activities. We have made a recommendation that the registered manager ensures that activities are appropriate for people living with dementia.

Information about how to complain was on display in the service. People and relatives knew how to complain and were confident that any concerns they had would be listened to and acted on.

Staff told us that they felt supported by the registered manager and that the service had improved since the last inspection. Staff understood their roles and responsibilities and the vision of the service by treating people with dignity, respect and ensuring people had a voice.

Staff supported people to maintain friendships and relationships. People’s friends and family could visit when they wanted and there were no restrictions on the time of day. People, staff and relatives received an annual survey to enable them to voice their opinions of the service and these were acted on. Staff and resident meetings were held regularly.

Services that provide health and social care to people are required to inform the Care Quality Commission CQC) of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

The Laleham provides accommodation and personal care for up to 60 people. Some people may be living with dementia. Bedrooms are on three separate floors and are accessed by a passenger lift. There are various shared rooms, including lounges and dining rooms. The service faces the sea and has parking at the front. There were 48 people using the service when we inspected.

At the previous unannounced, comprehensive inspection of this service on 21 and 22 May 2015, a breach of one legal requirement was found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach. We undertook this inspection to check that they had followed their plan and to confirm that they now met the legal requirement. At the time of this inspection the provider had complied with the majority of the issues but there was still an outstanding issue with some walking aids which were stacked together in the lounge area. The walking aids were not always placed where people could reach and use them, if they choose to get up and move from their chairs.

There was a new registered manager in place since 21 January 2016. People, relatives, health care professionals and staff told us that the service had improved since the appointment of the new 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.

Potential risks had been identified but the measures to reduce these risks were not detailed enough to give staff the guidance to ensure people were safe. These included the use of bed rails, behaviour risk assessments and moving and handling risk assessments.

There were sufficient staff on duty during the day and evening but at night there were not enough staff available to meet the needs of people in the service. Staff had been recruited safely and received support through one to one meetings with the registered manager and there was a yearly appraisal to discuss their training and development needs. There was a training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively, however, staff had not received further specialist training in diabetes and challenging behaviour to ensure they had a full understanding and knowledge of people’s individual needs.

Medicines were not always stored within the recommended temperatures to ensure they were safe to use. People received their medicines when they needed them.

Checks and audits were in place to monitor the quality of service people received. However, the shortfalls highlighted in this report had not always been identified. Accidents and incidents were recorded and analysed by the registered manager, but trends of the number of accidents/incidents at night had not been identified, six out of the eight accidents recorded in May 2016 had been when night staff were on duty.

Checks had been made on the premises to ensure the service was safe. Equipment to support people with their mobility, such as the hoists had been serviced to ensure that they were safe to use.

People felt safe and were supported by staff who understood how to report and recognise abuse, and systems were in place to ensure that people’s finances were protected.

The requirements of the Mental Capacity Act 2005 (MCA) had been met. The registered manager had assessed people’s capacity to make decisions when this was needed. People who needed to make more complex decisions had best interests meetings with people who knew them well and health care professionals.

People told us they enjoyed the food. They were supported to receive a balanced diet in line with their choices and preferences.

People’s health care needs were monitored and when required health care professional were involved in their care. People living with diabetes or who needed catheter care did not always have sufficient guidelines in their care plan for staff to follow, should they require medical attention.

People received personalised care and support but further details such as the completion of body maps, people’s vision and their hearing abilities had not been recorded. Staff had signed to confirm they had reviewed the care plans but when people’s needs had changed, the changes had not always been updated in the individual sections of the care plan.

Staff treated people with respect and their privacy and dignity was maintained. They were encouraged to be as independent as possible. Staff were kind and caring and took time to listen to what people needed.

There was a programme of activities and people had an opportunity to take part in activities of their choice. Information about how to make a complaint was on display at the service. People and relatives were aware of the complaints procedure and were confident any concerns raised would be listened to and acted upon.

People, relatives and staff told us that the service had improved since the appointment of the new registered manager. Staff were supported by the registered manager and understood their roles and responsibilities. The quality monitoring systems in place had not identified the shortfalls highlighted at the time of the inspection. The summary of the accidents and incidents had not identified the pattern of falls occurring at night time.

The staff understood the vision and values of the service by treating people with dignity, respect and compassion.

People, relatives and staff received an annual survey to enable them to voice their opinions of the service and these were acted on.

We found 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.