CQC carried out an unannounced comprehensive inspection of this service on 10 March 2015 and identified breaches of regulation in the ‘Safe’, ‘Effective’ and ‘Responsive’ domains. The breaches of regulation were in relation to: the management of medicines; protecting people from abuse; the management of individual risk; risks associated with the environment and equipment; standards of cleanliness; individual care plans and staff training, supervision and appraisal. We asked the provider (owner) to take action to address these concerns.
In addition, we identified minor concerns within the ‘Effective’ and ‘Responsive’ domains. We made recommendations in relation to these concerns.
Following the comprehensive inspection the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook an unannounced focused inspection on 21 September 2015 to check that the provider had met the legal requirements identified in ‘Safe’, ‘Effective’ and ‘Responsive’. We also looked at whether the recommendations identified had been addressed. You can read the report from our comprehensive inspection, by selecting the ‘all reports’ link for Leyland Rest Home on our website at www.cqc.org.uk.
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 four people were living at the home at the time of the inspection.
Although a registered manager was in post, they were not on duty at the time of the inspection. 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 all areas we had concerns about. Improvements had been made to how medication was managed. However, we found further concerns with ensuring the safe management of medicines. You can see what action we told the provider to take at the back of the full version of this report.
Risk assessments and care plans were in place for the people living at the home. These were individualised to the person and the care plans provided clear and concise information about how each person should be supported. Risk assessments and care plans were reviewed on a monthly basis. They were revised to reflect people’s changing needs.
The staff we spoke with could clearly describe how they would recognise abuse and the action they would take to ensure actual or potential abuse was reported. Staff confirmed they had received adult safeguarding training and were aware of what to do if they had a safeguarding concern. The adult safeguarding policy had been revised and was now reflective of the service provided at the home and the local area safeguarding procedure. Information regarding the whistle blowing policy had been issued to all staff.
Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People living at the home, families and staff told us there was sufficient numbers of staff on duty at all times.
Staff told us they were well supported through regular supervision. They said they were up-to-date with the training they were required by the organisation to undertake for the job. Training records confirmed this. The manager said staff appraisals were due to start.
The building was clean, well-lit and clutter free. Measures had been made more robust to monitor the cleanliness and safety of the environment, and equipment. A refurbishment programme was in place; internal decoration had taken place and damaged equipment had been replaced. We found a fire door inappropriately wedged open, which meant people were at risk in the event of a fire. We made a recommendation about this.
People told us they were satisfied with the meals. We observed the lunch time meal. Most people had their lunch at a table in the dining room. Staff support was available where needed. A cold drink was available with lunch and a hot drink after lunch.
Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living at the home and staff throughout the inspection. People living there told us they did not enough recreational activities to occupy them during the day.
Staff sought people’s consent before providing support or care. The home was not undertaking mental capacity assessments in accordance to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had not been submitted to the Local Authority for people who lacked mental capacity. You can see what action we told the provider to take at the back of the full version of this report.
Staff told us the owner and manager was both approachable and supportive. They said they were listened to if they had any concerns.
A policy and procedure was established for managing complaints. The policy had been reviewed in August 2015. The complaints procedure was now being used appropriately as previously staff had been using it to report incidents and grievances.
Audits or checks to monitor the quality of care provided had been improved upon and made more robust.
Is the service safe? – Requires improvement
The service was not always safe.
Medicines were not always managed in a safe way.
Relevant risk assessments had been undertaken depending on each person’s individual needs.
Staff understood what abuse meant and knew what action to take if they thought someone was being abused.
Measures were in place to regularly check the cleanliness and safety of the environment and equipment.
There were enough staff on duty at all times. Appropriate recruitment checks were carried out before new staff started working at the home.
Is the service effective? – Requires improvement
The service was not always effective.
Staff sought the consent of people before providing routine care and support.
The home was not fully adhering to the principles of the Mental Capacity Act (2005) for people who lacked mental capacity to make their own decisions. Deprivation of Liberty Safeguards (DoLS) had not been made for people who lacked capacity.
People told us they liked the food and got plenty to eat and drink.
People had access to external health care professionals. The staff arranged appointments readily when people needed them.
Staff said they were well supported through induction, supervision and on-going training.
Is the service well-led? Requires improvement
The service was not always well-led.
Staff spoke positively about the owner and manager of the home. They said the communication was good and they felt listened to.
Processes for routinely monitoring the quality of the service were more robust and were identifying concerns. Action was taken to address concerns.
At the previous inspection the policies and procedures were out-of-date in that they did not always reflect national guidance or the operation of the home. These were in the process of being revised.
The medicines audit was not effective as it had not identified that some medicines were not being managed in accordance with the Mental Capacity Act (2005).
Is the service responsive? Requires improvement
The service was not always responsive.
People’s care plans were regularly reviewed and reflected their current and individual needs. We observed that care requests were responded to in a timely way.
Is the service caring? Good
The service was caring.
People told us they were happy with the care they received. We observed positive engagement between people living at the home and staff.
Staff treated people with respect, privacy and dignity. They had a good understanding of people’s needs and preferences.
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