Photo: Leyland Rest Home

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This unannounced inspection of Leyland Rest Home took place on 10 March 2015.

Leyland Rest Home was inspected on 2 September 2014 and found to be in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breach of Regulation 10 related to inadequate processes to seek the views of people living at the home and the views of their families regarding changes to the service. In addition, managerial roles and responsibilities were not clear which was impacting on the decisions making arrangements. The Care Quality Commission (CQC) received an action plan from the provider to outline how improvements would be made. Satisfactory improvements had been made with respect to this breach.

Located close to Southport promenade and the town centre, Leyland Rest Home provides accommodation and care for up to 33 people. The building is a large Victorian house with gardens to the front and back. The home has three lounge areas, a dining room and lift access to all floors. Twenty seven people were living there at the time of the inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality

 

Leyland Rest Home Inspection report 06/05/2015 Summary of findings

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 the staffing levels were inadequate to ensure people’s safety was maintained at all times. Three care staff were on duty during the day to provide care for people over three floors. Four people had high dependency needs and often required the support of two staff. Dependency assessments had been completed for each person to support with deciding on staffing levels but the assessments we looked at had not been reviewed since June 2014 so they may not have reflected people’s current needs. You can see what action we told the provider to take at the back of the full version of this report.

People’s individual risk assessments had not been reviewed in a timely way to take account of any new risks or incidents that had occurred. Risk assessments and associated care plans had not been completed for new people who had recently moved into the home. You can see what action we told the provider to take at the back of the full version of this report.

Not all staff were clear about what adult safeguarding meant. Less than half the staff team were up-to-date with adult safeguarding training. Frequent altercations between people living at the home were not being treated as, or reported as, a safeguarding concern. The safeguarding policy for the home was inaccurate as it made reference to staff using physical restraint. Staff confirmed they had not used physical restraint and were not trained in its use. You can see what action we told the provider to take at the back of the full version of this report.

Not all medicines were stored in a safe way. We observed prescribed topical medicines (creams) in people’s bedrooms were not stored securely. A risk assessment had not taken place to confirm a person was able and safe to manage their own medicines. There were a number of missing staff signatures on medication administration records. The medication policy was last reviewed in May 2009 and was not in accordance with

good practice national guidance for managing medicines in care homes. You can see what action we told the provider to take at the back of the full version of this report.

Safe and effective recruitment practices were in place. Staff training was not up-to-date and staff told us they had not received regular supervision and an annual appraisal. You can see what action we told the provider to take at the back of the full version of this report.

We found that areas of the home, including bedrooms and bathrooms, were unclean and unhygienic. For example, we observed black mould on bathroom tiles and taps despite the room having recently been prepared for a new person to move in. Wheelchairs and other equipment were dirty. Furniture in shared areas was unclean and upholstery was torn. You can see what action we told the provider to take at the back of the full version of this report.

Arrangements to check the risk associated with the equipment used, such as hoists and wheelchairs were not robust. For example, wheelchair risk assessments were unchanged since 2008. You can see what action we told the provider to take at the back of the full version of this report.

Arrangements to monitor the safety of the environment were not rigorous. For example, many areas of the building, including people’s bedrooms were in a poor state of repair. The wallpaper and or paint were peeling from walls in some rooms. Not all of the hot water pipes in areas accessed by people living at the home were insulated. Some of the carpets had an unpleasant odour. Lighting was insufficient in some areas. You can see what action we told the provider to take at the back of the full version of this report.

People had access to health care when they needed it, including their GP, dentist, optician and chiropodist. A visiting healthcare professional told us staff responded promptly to people’s changing health care needs.

The staff we spoke with had not received awareness training in relation to the Mental Capacity Act (2005) and had a limited understanding of how it applied in practice. Nobody living at the home was subject to a Deprivation of Liberty Safeguarding (DoLS) plan. Some people used bedrails and there was no record to indicate how people consented to the use of this equipment. We made a recommendation regarding consent and the Mental Capacity Act (2005).

Overall, people were satisfied with the meals and access to drinks. The dining room was not well staffed at lunch time so there was limited support to encourage people to eat and to monitor what people had actually eaten. We made a recommendation about this.

Staff were caring and kind in the way they supported people. They treated people with compassion and respect. They ensured people’s privacy when supporting them with personal care activities. People had been given the opportunity to express their preferred gender of staff to provide support. People and/or their representative were not routinely involved in on-going care plan reviews.

Assessments and person centred plans had not been completed for people who recently moved into the home.

We found that staff had a limited knowledge of the backgrounds and needs of the new people. You can see what action we told the provider to take at the back of the full version of this report.

A complaints procedure was in place and displayed. People we spoke with and families were aware of how to raise concerns. The complaints process was not being used appropriately by staff. For example, some incidents and grievances were recorded as complaints. A complaint a visiting family member told us they made that had been dealt with effectively had not been recorded. We made a recommendation about this.

A system to audit the care records had been developed and each of the care records were being audited three monthly. Meetings were being held at the home for people living there to express their views about service.

 

We always ask the following five questions of services.

Is the service safe? – Inadequate

The service was not safe.
Medicines were not always managed in a safe way.

Staffing levels were inadequate to ensure the safety of the people living at the home.

Arrangements to ensure people were safeguarded against the risk of abuse were not robust.

Effective arrangements were in place for the recruitment of staff.

We identified risks associated with the safety of the environment and equipment.

Appropriate standards of cleanliness were not being maintained.

 

Is the service effective? – Requires Improvement

The service was not always effective.

People had access to health care when they needed it, including their GP, dentist, optician and chiropodist. A visiting healthcare professional told us staff responded promptly to people’s changing health care needs.

Staff we spoke with were not receiving regular supervision and their training was not up-to-date.

People were satisfied with the meals. There was insufficient staff support at lunch time to ensure people received support with their meal and had adequate to eat and drink.

Although staff sought consent from people before providing care, they were unclear about principles of the Mental Capacity Act (2005) and how it applied to their practice.

 

Is the service caring? – Requires Improvement

The service was not always caring.

Staff were caring and kind in the way they supported people. They treated people with dignity and respect. They ensured people’s privacy when providing support with personal care activities.

People living at the home or their representative were not routinely involved in care plan reviews.

 

Is the service responsive? – Requires Improvement

The service was not always responsive.

Person centred plans were in place for people who had lived at the home for some time. They had not been developed for people who recently moved into the home.

Staff were unsure of the needs and background of people who had recently moved in.

Recreational activities were not taking place in line with the planned programme.

A complaints process was in place. A visiting family member told us about a complaint they had made that had been resolved to their satisfaction.

 

Is the service well-led? Requires Improvement

The service was not always well-led.

A Provider Information Return (PIR) had not been submitted even though CQC had requested this in November 2014.

Meetings for people living at the home had been put in place to seek the views of people about the service.

A range of audits were in place but these were not always robust or effective in driving improvements.

Read the full report here

 

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