Archived: Leven House

Leven House was last inspected in January 2017 and was found to be compliant with the required regulations and rated as Good.

Leven House is a ‘care home’. People in care homes receive accommodation and 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. Care is primarily provided to older people requiring residential or respite care and the service can accommodate up to ten people. There were ten people living at the home at time of the inspection.

A registered manager is a person who has registered with the Care Quality Commission (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. At the time of our inspection there was an acting manager in post who had applied to be registered with CQC.

We found arrangements were not in place to ensure people were given their medicines in a safe manner.

Accidents and incidents were not always well recorded and were not reviewed for trend analysis.

Risks assessments for people were not robust or reflective of their current risks and needs.

We found an unlocked door which housed a storage area containing items such as liquid paint stripper and a carpet in a corridor that was taped down as it had lifted. These could mean potential hazards. The manager addressed the cupboard immediately and told us they would address the flooring trip risk.

There was a recruitment procedure in place, reducing the risk of an unsuitable person being employed to work with vulnerable people.

Staff who were new to the service told us they underwent an induction period, however this was not well recorded.

We found training records were in place which demonstrated staff had received appropriate training. Staff told us they had received training in moving and handling, administering medicines and first aid.

Records relating to the Deprivation of Liberty Safeguards were not well maintained meaning it was difficult to track if people had current authorisations in place .

The service had considered people’s food and fluid intake and put in place specific plans to meet individual people’s needs. Relatives were confident people were receiving the required nutrition.

We found staff were now receiving appropriate support through supervision and appraisal and the manager had a plan going forward to address supervisions.

People and their relatives and told us the service was caring.

The service supported people to engage in the local community to prevent social isolation and to have pets where they chose to.

Assessment records were not always well completed. Care plans were in place however these were not always up to date or contained information required to support a person safely.

Quality audits had not been in place since July 2017. This meant the provider was not assessing and monitoring the service to improve the quality.

Policies and procedures that we viewed were out of date with many showing no review undertaken since 2010.

People’s views had not been sought since 2016 although people we spoke with knew how to raise a concern and told us they felt listened to by the staff and manager at the home.

During our inspection 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 the report.

Leven House is a residential care home offering accommodation and personal care for up to 10 people. Care is primarily provided to older people requiring residential or respite care. There were eight people living at the home at time of inspection.

The service had two registered managers at the time of inspection, one of whom was in post. We were told the other was intending to apply to de-register as they were not working at the service any longer. 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 that improvements had been made in a number of areas, but that some areas of record keeping and quality assurance were still in need of further development by the registered manager.

Staff knew how to keep people safe and prevent harm from occurring. The staff were confident they could raise any concerns about poor practice in the service and these would be addressed to ensure people were protected from harm. People in the service felt safe and able to raise any concerns.

Staffing was organised to ensure people received adequate support to meet their needs throughout the day and night. Recruitment records demonstrated there were systems in place to employ staff who were suitable to work with vulnerable people.

People’s medicines were managed by staff who were trained and monitored to ensure people received their medicines safely. We saw that recent changes to medicines management had been made by the new registered manager.

Staff received support from senior staff to ensure they carried out their roles effectively through mentoring and training. Supervision processes were in place to enable staff to receive feedback on their performance and identify further training needs. Appraisal of all staff was overdue and action was taken by the registered manager after the inspection to ensure this was in place in future.

People could make choices about their food and drinks and alternatives were offered if requested. People were given support to eat and drink where required.

Arrangements were in place to request external health and social care services to help keep people well. External professionals’ advice was sought when needed and incorporated into care plans.

Staff demonstrated they had an awareness and knowledge of the Mental Capacity Act 2005. The service had made appropriate applications for people who may be deprived of their liberty.

Staff provided care with kindness and compassion; we saw smiles and interaction between people and staff. People could make choices about how they wanted to be supported and staff listened to what they had to say.

People were treated with respect. Staff understood how to provide care in a dignified manner and respected people’s right to privacy and to make choices. The staff team knew the care and support needs of people well and took an interest in people and their families to provide individualised care.

People had their needs assessed and staff knew how to support people according to their preferences and choices. Care records showed that changes were made in response to requests from people using the service, relatives and external professionals.

Staff knew people as individuals and respected their choices. People were supported to enjoy a range of activities. People could raise any concerns and felt confident these would be addressed promptly by the registered manager and senior staff.

The home had a registered manager who was visible and hands on. There were systems in place to make sure the service learnt from events such as accidents and incidents, complaints and investigations. The provider had notified us of all incidents that occurred as required. When we identified areas for improvement around the environment, records and staff appraisal immediate action was taken.

People and relatives views were sought by the service through surveys and day to day contact. People, relatives and staff spoken with all felt the registered manager was caring and responsive.

We undertook this focused inspection to check if the provider was now meeting the legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Leven House on our website at www.cqc.org.uk.

Leven House is a residential care home offering accommodation and personal care for up to 10 people. Care is primarily provided to older people requiring residential or respite care. There were eight people living at the home at the time of the inspection.

There was a registered manager in post. 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 that guidance on safeguarding and whistle-blowing for staff was now in place and staff knew what to do if they had any concerns. All risks to people’s personal safety had been assessed and were being managed. The process for record keeping around people’s finances was still not fully robust.

Records kept to support people’s wellbeing had been improved since our last inspection. However some records were not always completed correctly with calculations around people’s weights being completed inconsistently.

People told us they sometimes found the food repetitive or not to their choosing. They did not feel they had been offered control over menu’s.

People were deprived of their liberty in their best interests, but the provider’s policy was not in line with current practice.

People were given personalised care but support to help people meet their social needs had not improved. People told us they felt under stimulated and records did not demonstrate that activities were routinely provided.

Overall areas identified at the last inspection had been improved upon by the service. However, some of the recommendations identified at the last inspection had not been acted upon and some checks in the home were not being completed and had not been identified by the registered manager.

The registered manager had sent us notifications of incidents as required.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

There were enough staff employed across the day and at night to provide people's care and support. The manager or deputy manager was on duty each day and they could be contacted at other times in the event of any emergencies.

Arrangements for the management of medication were not fully robust. Staff who gave medication had been trained but their competency in handling medication was not assessed. The medication procedure was not always followed and there was no audit system to identify and act on any discrepancies.

Personal care records did not always accurately reflect people's needs and how they were planned to be met. This put people at risk of receiving inappropriate or unsafe care.

Compliance actions have been set in relation to medicines management and record keeping and the provider must tell us how they will make improvements.

Is the service effective?

People living at the home, and most of the relatives we talked with, were happy with the care and felt their needs were being met. They told us, 'The staff really are very good and look after everyone', and, 'I can't fault the care'.

Care staff were not given all necessary training to equip them for their roles and to meet the needs of the people they cared for. There were also no suitable arrangements in place to regularly supervise and appraise staff performance. A compliance action has been set and the provider must tell us how they plan to improve the ways that they support staff in their professional development.

Is the service caring?

People and most of the relatives we talked with spoke highly of the staff, describing them as 'fabulous', 'fantastic', and 'very kind'. Our observations confirmed that staff were caring towards people and treated them as individuals. A health care professional also told us they had observed positive and caring interactions each time they had visited the home.

Is the service responsive?

We found that people's diverse needs had not been fully assessed and care was not always appropriately planned.

People were supported to maintain relationships with their families and some people followed their own interests. But there was limited social stimulation provided and no planned activities or outings to help people meet their social needs and access the community.

Is the service well-led?

The home had a registered manager who was also the provider.

The manager demonstrated a sensitive and caring approach to meeting people's care needs but did not always provide robust and professional systems for staff to follow. She was in the process of taking advice on how to improve the management of the service.

People's views about the service were sought, as were those of their relatives. One relative felt there were areas of the service they wanted to be improved and they were taking these up with the manager. An effective quality assurance system had not yet been introduced. A compliance action has been set and the provider must tell us how they plan to improve the way they check the quality of the service.

We saw that the manager provided what was required by the people who used the service in a way that demonstrated their knowledge of each individual's needs. We saw that there was a warm and friendly family atmosphere which was confirmed when we spoke with the people who used the service. We spoke with relatives. One relative told us, 'I'm a hundred per cent happy with the home. I wouldn't trust my brother's care anywhere else. The staff tell me everything. I am very satisfied with the care my brother receives'. Another relative told us, 'I think the service is absolutely brilliant. My dad is so well looked after and valued by the staff'.

'I love living at this home, I'm so well looked after hinny and very well fed. This is fine for me.'

'Yes I like it here, the staff do help me.'

'I am fine here, the staff have helped me. I like to do craft work.'

'I like to come here for a holiday. I will be back for another break.'

We saw that people who used the service were spoken to and supported in a sensitive and respectful manner. The manager told us that people who used the service were involved in day to day decision-making wherever possible.

The manager told us that she involved the relatives of people living in the home. She told us that all the people who used the service were supported to have regular contact with their families.

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people were involved in their care and were treated with respect.

We found that people who used the service had their care and welfare needs met.

We found that there were good systems in place for the involvement of other health or social care professionals.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that people's views were important and listened to. We found that there was an effective complaints system in place.

We saw that people understood and had consented to their care and treatment. We saw that people were safe and that there were sufficient suitably qualified and experienced staff on duty. We found that the home had effective systems in place to monitor its own performance

The people staying in the service were very positive about the way that the home was managed. Comments included: 'I can't complain about anything. They (the staff) do everything for me' and 'The concern shown for you as an individual is great.'