Archived: Lavender House

Lavender House is a residential care home providing personal care to up to 32 people. The service provides support to older people. At the time of our inspection there were ten people using the service. Lavender House accommodates people in one adapted building over two floors.

People’s experience of using this service and what we found

The service was not well-led. The provider had failed to take action to improve or assess the safety of the service. Assurance systems to monitor risk and quality were not effective. Audits did not always identify issues and where issues had been identified these had not always been acted upon in a consistent and timely manner. Good practice guidance was not always considered and implemented.

The service was not safe. Routine servicing of equipment had not been completed. Staff did not always follow best practice to prevent and control the spread of infections. This put people at risk of harm. We could not be assured medicines were managed safely. Stock counts for people’s medicines were incorrect and best practice guidance had not always been followed. People and their relatives felt the service was clean but not always well maintained.

There were enough staff to meet people’s needs and staff had been recruited safely. Staff we spoke with were knowledgeable of people’s needs, risks and safeguarding systems. Staff told us they liked working at Lavender House and the registered manager was approachable.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 April 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider was still in breach of regulation.

This service has been rated requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of risk, management of medicines and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service: There had been significant improvements in the service since the last inspection, however work was still required to improve practice in key areas such as risk management. Systems to check that people were receiving safe and good quality care required further development. The provider had not always notified CQC about important events that happened in the service.

Risks to be people had not been effectively reduced and mitigated.

Improvements had been made to the environment. Decorative work had been carried out, and the environment was more ‘dementia friendly’. Infection control procedures were followed. There was adequate staff to meet people’s needs.

People told us the food was of good quality, however further work was required to enable people to make choices regarding their meals. People told us staff were kind and caring. We observed activities taking place. People were supported to access health care.

People and their relatives were engaged with and included in service delivery. We received positive feedback about the registered manager.

Rating at last inspection: Inadequate. (The last report was published 10 October 2018.) This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: The provider was in continued breach of two regulations at this inspection relating to risk management and governance of the service. You can see the action we have told the provider to take at the end of the full report. A third breach about failing to notify the Care Quality Commission of events in the service is being dealt with separately.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. The provider will continue providing regular updates to their action plan. 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

This inspection took place on 31 July 2018 and was unannounced.

At the last inspection in June 2017 we rated this service ‘requires improvement’. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were regulation 15 (premises and equipment) and regulation 17 (good governance). These were continued breaches from a previous inspection in April 2016. During this inspection we have identified continued breaches in regulation 15 and 17 and identified new breaches in regulations 9 (person-centred care), 10 (dignity and respect), 11 (need for consent), 12 (safe care and treatment) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 18 (notifications) of the Care Quality Commission (Registration) Regulations 2009. This is the third-time breaches of regulation 15 and 17 have been identified and the overall rating of this service is ‘Inadequate’.

The service is required to have a registered manager in post. A registered manager is a person who has registered with 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 the inspection there was no registered manager in place. We met with a newly appointed acting manager and the registered provider during the inspection.

Maintenance of the building was poor and not completed in a timely manner. A garden area for people to access was unsafe; building materials, rubbish and broken equipment surrounded the service and created a risk to people, staff and visitors to the service. Ceilings were stained and a bathroom had tiles missing on walls. People were left with broken lights, toilets and window chains for weeks before repairs were completed.

Infection control measures continued to be insufficient to prevent the risk of inspections spreading. Bathroom floors were not sealed at the edges to allow adequate cleaning. We found dust and dirt throughout the building. This is the third consecutive time infection control concerns have been raised with the provider during an inspection.

The systems which the provider had in place to assess the experience of people receiving care had not identified the extent of concerns we observed during our inspection. There had been a failure to rectify the failings identified during our last two inspections and this meant people received inadequate care and support in line with our regulations.

Measures required to reduce the risk of harm to people were in place but they were not always completed accurately or were up-to-date. Medicines procedures and systems were in place; however, some improvement was required to ensure medicine practices were safe.

People’s care plan reviews were not always effective at recognising a change in people’s needs. Relatives told us they had not been invited to be part of reviews. As a result, care plans failed to reflect people’s person-centred needs. Daily notes were found to be repetitive and failed to accurately reflect how care was provided in line with the person’s care plan.

Some interaction with people using the service was observed to be 'task' focused. The staff were very busy during the inspection and the newly appointed manager was still delivering care. This had impacted on people’s dignity. People felt the provision of activities could be improved to meet the wider needs of people.

The provider failed to understand their duty under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and were depriving people of their liberty without the legal authorisation to do so.

The provider had failed to notify CQC of all incidents within the service. We are looking at this matter outside of the inspection process.

Recruitment processes were in place. Staff had received training which provided them with the skills to meet the needs of the people. Staff had an understanding of how to safeguard people from abuse. Records of incidents and accidents were maintained. People’s nutrition and hydration needs were catered for and the meal time experience was observed to be calm.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate enforcement action, 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 and 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 cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We saw that some of the improvements had been made but found continuing breaches of Regulation 15 and Regulation 17 of the Health and Social Care Act 2008(Regulated Activities) 2014. This was because the environment was not properly maintained and had no secure outdoor space for people. This was important as the service was positioned close to a busy main road and some people were living with dementia. In addition record keeping was not consistent and areas for improvement had not been identified which meant that the service was not learning from past issues and making improvements. We have asked the provider to send us a risk assessment of the environment and an action plan to show us how they are going to address these matters using our powers under section 64 of the Health and Social Care Act 2008.

Lavender House is a care home in the centre of Brough which provides accommodation for up to 32 older people, some of whom are living with dementia. At the front of the house there is a grassed area and car parking. An extension to the service is in progress.

There was a registered manager employed at this 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Throughout this report we will refer to the registered manager as ‘the manager’.

There were safeguarding policies and procedures in place which staff were aware of. Staff had received training to support those procedures.

Risks to people's safety had not always been identified. There were areas such as the outside of the building that were not safe. Accidents and incidents had been recorded in detail and analysed with trends identified.

Staffing levels were sufficient to meet people's needs. Recruitment procedures were robust. Staff had the skills and knowledge to meet people's needs. They were supported through one to one supervisions.

Medicines were managed safely.

The staff worked within the principles of the Mental Capacity Act and requested that deprivation of liberty safeguards be put in place where appropriate.

People's nutritional and hydration needs were met.

People were familiar with the building but it was not adapted for those people living with dementia. This would have more of an impact for new people to the service.

We observed many positive interactions between staff and people who used the service. People told us that staff treated them with respect.

Care plans were focused on the person but were not always fully updated following reviews.

Activities took place at the service but there were few meaningful activities for people living with dementia.

There had been no complaints about this service since the last inspection. There was a poster displayed telling people how to complain if they wished to do so.

The home was friendly and close knit. Staff were happy working at the service. There was clear evidence of partnership working particularly with healthcare professionals.

This inspection was carried out on 27 April 2016 and was unannounced. One Adult Social Care (ASC) inspector carried out the inspection. The service was last inspected in December 2013 and the service was found to be compliant in all of the standards apart from requirements relating to infection control. This was followed up in March 2014 and the service was found to be compliant.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

We found that the services premises and equipment were not always safely maintained. A bath chair was found to be in an unsafe condition and annual maintenance checks had not been completed for the fire alarm, emergency lighting and the bath chair. This was a breach of Regulation 12. You can see what action we told the provider to take at the back of the full version of the report.

We found that the premises were not properly maintained and did not have an adequate outdoor space that people using the service could safely use. This was a breach of a Regulation 15. You can see what action we told the provider to take at the back of the full version of the report

We found the registered provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support. However, we found it had failed to detect that several maintenance certificates had expired, that equipment was broken and that parts of the premises were not adequately maintained. This was a breach of a Regulation 17. You can see what action we told the provider to take at the back of the full version of the report

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people's assessed needs. Staff had been employed following appropriate recruitment and selection processes and we found that the recording and administration of medicines was being managed appropriately at the service.

We found assessments of risk had been completed for each person and plans had been put in place to minimise risk. Apart from the services only bathroom, other areas were clean, tidy and free from odour and cleaning schedules were in place.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the home deemed essential, such as, safeguarding, moving and handling and infection control and also service specific training such oral care, person centred care and end of life care.

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act 2005 (MCA) guidelines had been followed. The home did not use restraint, and this was confirmed during conversations with staff.

People's nutritional needs were met. People told us they enjoyed the food and that they had enough to eat and drink. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day.

People told us they were well cared for and we saw people were supported to maintain good health and had access to services from healthcare professionals. We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living in the home. People were able to make choices and decisions regarding their care.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported.

People were offered a variety of different activities and were also supported to go out of the home to access facilities in the local community; although people did indicate they would like more outings.

People's comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were recorded; however, any actions taken were not always accurately recorded.

We saw that there had been improvements in the cleanliness of the general environment and in the care practices of the staff. This meant people had experienced improvements in reducing the risks of infection from cross contamination or poor hygiene practices.

People were satisfied with the standards of cleanliness and the service of care they received.

We found that peoples' health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in cooperation with others and shared information in the form of specific documentation.

We found that people were not properly protected against the risk of infection from poor hygiene and cleanliness within the service because the provider had not ensured good infection control practices were carried out. We had some concerns about cleanliness of the premises and staffing resources to enable good infection control practices to be followed.

We found that although there was sufficient care staff to meet peoples' needs there was poor deployment of care staff so that staff worked excessive hours. There was insufficient cleaning staff to ensure the service was tidy, organised, clean and meeting infection control standards.

We found from viewing documentation and speaking to people that used the service that the provider had an effective system to regularly assess and monitor the quality of service that people received.

We did not speak with people that used the service about receiving their medication and we were unable to observe medication being administered. However, we looked at medication storage, systems for administering, disposing of and recording of medication and we assessed the secure handling of controlled drugs. We found systems to be very well managed and recorded.

We found that staff had received updated training in medication handling and there had been a major re-organisation of the medication room. This resulted in people having their medication reviewed by their GP, all medication being stored in locked facilities, all excessive medication stocks being returned to the pharmacist and a complete clearance of unnecessary items from the medication room. Staff told us they had found the management of medication much easier and more organised since the clearance of the medication room and the reviewing of peoples' medication needs.

We found that people were satisfied with the support and care they received, enjoyed the meal provision, interacted well with each other and staff and were treated with respect. People said, "The staff are lovely, they always help us when we need it and they do work so hard" and "I have lived here for quite a while now and I like it very much, I have some friends and the staff are very helpful." They said, "We are well looked after" and "I am given as much help as I need." A district nurse told us that the service took their advice and cared well for people.

We found, through use of the SOFI, that staff were caring and considerate. We found that there were some concerns regarding the handling and storage of medication, and we concluded that medication was not being administered safely and records did not account for when they had been administered or refused.

We found that staff had been safely recruited and that there was an appropriate system in place to address and resolve complaints.