We carried out a review of the data available to us about Lever Edge Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Lever Edge Care Home, you can give feedback on this service.
Lever Edge is a residential care home which can accommodate up to 81 people. The home provides accommodation within three units spread over two floors. The Bungalow unit on the ground floor and the Turton unit on the first floor provide accommodation and support for people living with dementia. The Rivington unit on the ground floor provides accommodation for people who require support with their care. At the time of the inspection 71 people were living at the home.
People’s experience of using this service and what we found
People told us they felt safe living at Lever Edge Care Home, receiving care and support from staff who knew them well. Staff were knowledgeable about how to identify and report safeguarding concerns and had reported any issues appropriately. Staffing levels were based on people’s needs and enough staff were deployed to support people safely. Accidents, incidents and falls had been documented and reviewed to look for trends and help prevent a reoccurrence. The home was clean, with effective cleaning and infection control processes in place. People received their medicines safely by staff who were trained and assessed as competent.
People and relatives felt staff had the necessary skills and knowledge to carry out their roles. Staff completed a mixture of online and classroom-based training sessions, received regular supervisions and an annual appraisal. 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. People’s health and welfare needs were being met, with access to professionals as required. Equipment was in place to support people to stay well. Referrals had been made timely to professionals when any issues had been noted or concerns raised. People spoke positively about food and drinks provided, with choices available at each mealtime, along with snacks should they want them.
Staff were described as kind, caring and supportive. A relative told us, “The care mum gets is fantastic. We are very, very grateful that she is safe, loved and being looked after.’’ People were treated with dignity and respect and encouraged to do as much for themselves as they could.
Care files provided information about people’s life history, likes, dislikes and how they wanted to be cared for. People and relatives had been involved in the care planning process and updated about any required changes. Peoples’ social and recreational needs were met through a weekly activities programme, facilitated by activity co-ordinators and staff members. The complaints process was clearly displayed within the home, people told us they knew how to raise concerns, but had not needed to.
The home used a range of systems and processes to monitor the quality and effectiveness of the service provided. Actions had been identified and added to the home’s improvement plan, which was regularly reviewed. Staff spoke positively about the management team and the support they provided. People and relatives were also complimentary. One relative stated, “[Registered manager] is very approachable and level headed; they listen to everything which is extremely important.”
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 November 2020). No breaches of regulation were identified at that inspection and improvements were noted, however, as it was a focussed inspection, which looked only at the safe, caring and well-led key questions, the overall rating could not be changed, as we did not inspect all key questions. At this inspection we found improvements had been made in all key questions.
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels, staff support and oversight, management of falls and incidents, medicines management, management of deprivation of liberty safeguards (DoLS) and care and support provided to people. A decision was made for us to inspect and examine those risks.
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 coronavirus and other infection outbreaks effectively.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring and well-led sections of this full report.
You can read the reports from both the focussed inspection and our last comprehensive inspection, by selecting the ‘all reports’ link for Lever Edge Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Lever Edge is a residential care home providing personal and nursing care for up to 81 people. At the time of the inspection 69 people were living at the home. The Bungalow unit on the ground floor and the Turnton unit on the first floor provide accommodation and support for people living with dementia. The Rivington unit on the ground floor provides accommodation for people who require support with their care.
People’s experience of using this service and what we found
People were kept safe from the risk of abuse and safeguarding concerns were responded to appropriately. Care plans identified risks for people and how these could be reduced. Medicines were managed safely. Effective infection control was promoted throughout the home.
People told us they felt safe and spoke highly of the staff team and care they received. Staff were described as being attentive and responsive. One person said, “They’re fantastic people, I couldn’t care for people like they do. They work tremendously hard, all you have to do is ask.”
The registered manager and wider management team received praise from people, relatives and staff. The registered manager was praised for implementing an organised structure for staff to follow; this meant that care needs were met and emotional wellbeing was promoted. Staff felt well supported and received ongoing training, with plans in place to address any shortfalls. Auditing systems were robust and were used to identify improvements.
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 in 5 June 2019) and there was one breach 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 been made and the provider was no longer in breach of regulations.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Caring and Well-Led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.
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 the service can respond to coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lever Edge Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Lever Edge Care Home is a residential care home that is registered to provide personal care and support for 81 people and is divided into three units. On the day of the inspection there were 68 people living at the home. On Turton unit there were 26 people living with dementia and on Smithills unit there were 18 people also living with dementia. Rivington unit cared for people who required help and support with care and 24 people were living on this unit.
Since our last inspection the registered manager had left the service in February 2019. The home is currently being managed by the regional manager with the support of the regional director.
People’s experience of using this service:
Staff knew how to keep people safe from abuse and policies and procedures were in place to identify, investigate and report suspicions of abuse. People told us they felt safe.
Some areas of potential risk were identified, assessed and planned for to help keep people safe. We found some environmental risk assessments were in place. However, some minor concerns were raised about fire safety issues following an inspection by Greater Manchester Fire and Rescue service. This was found to be a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These are detailed in the safe domain on this report.
Staff recruitment was satisfactory and staff rotas looked at on the day of the inspection accurately reflected the numbers of staff on duty. From our observations and from comments made by people who used the service, staff and relatives we recommend that staffing levels and the deployment of staff be reviewed. It was clear that the deployment of staff was raised as a concern.
We recommend that staffing levels and the deployment of staff be reviewed.
Staff training was ongoing, and staff confirmed they had recently attended some training in medication and dementia care.
The majority of people spoken with said they were well cared for. People were supported to have choice and control of their lives and staff supported this in the least restrictive way possible. Policies and procedures were in place to support this practice. People received a healthy diet in line with their assessed needs. People had access to health care as required.
Care plans and assessments were in place which identified the areas of support people wanted and needed. However, we found the initial assessment were at times contradictory in parts. This meant that staff may struggle to understand people’s needs. Suitable arrangements were in place to respond to any complaints and concerns.
People’s views and opinions were sought on the service and staff and resident/relatives’ meetings were held. The service had a complaints policy and people we spoke with knew how to make a complaint.
Systems and procedures were in place to monitor the quality and effectiveness of the service. The regional manager had already completed some audits to identify areas of good practice and issues for improvement.
Rating at last inspection: Inadequate and the last report was published 16 November 2018. For more information details, please see the full report which is on the CQC website at www.cqc.org.uk
The last inspection of Lever Edge took place on 04 September 2018. There were four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified. These were in relation to failure to provide person centred care, dignity and respect, medication and governance. The overall rating for this service was ‘Inadequate’ and the service was placed in ‘Special measures’.
Why we inspected:
Services in special measures are kept under review are required to inspected again within six months. A comprehensive inspection was undertaken on 06 March 2019 to ensure that improvements had been made by the provider.
The service was currently without a registered manager. People confirmed that the interim managerial arrangements were working well. People and their relatives were encouraged to provide feedback on the service and staff worked well as a team.
Follow up:
At this inspection we found improvements had been made. The service is now out of special measures. However, we will continue to monitor information and intelligence about this service to ensure these are sustained. We will return to re-inspect the home in line with our inspection timescales for services that Require Improvement, however if we receive any information of concern, we may inspect sooner.
Further information is in the detailed information below.
Lever Edge (Lever Edge) Care Home is a residential care home located in the Great Lever area of Bolton. Lever Edge is a 'care home'. People in care homes receive accommodation and nursing or 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.
Lever Edge, Bolton is a purpose built two storey care home. The home is close to Bolton town centre and close to a bus route and the motorway network. The home provides residential and personal care for 81 people. On the day of the inspection there were 76 people living at the home.
There was a registered manager in place. A registered manager is a person who had registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At this inspection we found the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, medicines, infection control person-centred care good governance.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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 so that 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.
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.
We found a definite distinction between the ground and first floor with regard to infection prevention and control. The malodour on the first floor was unacceptable.
We found that not all medicines were managed safely and that improvements must be made to ensure people’s health was not placed at risk of harm.
Staff recruitment was satisfactory. Staffing levels needed reviewing to ensure that there were enough staff on duty at all times to ensure people’s need could be met.
There was an appropriate, up to date safeguarding policy and procedure in place. Safeguarding issues had been suitably logged with responses and actions.
The service was working with the legal requirements of the Mental Health Act 200 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Care files included a range of information relating to health and well-being. However, some specific information and monitoring had not been completed.
There was a staff induction and staff training was ongoing. Staff confirmed they received supervision meetings with senior staff.
People we spoke with had mixed views about the care provided at the home. Some were satisfied with the care they received.
On the day of the inspection there was a lack of activities or stimulation for people living at the home. There was little staff interaction with people. At times, some staff were overheard by visitors speaking in a derogatory manner to people in their care, and to each other. Some people did not look well-presented and well groomed.
Health and safety certificates were in place. The overall maintenance records for the environment were up to date.
People we spoke with were happy with the quality of the food. However the presentation of the pureed diet required attention.
There was an up to date complaints procedure. Details of how to make a complaint were displayed within the home.
Staff had access to a range of policies and procedures to refer to as required.
Lever Edge Care Home is a residential care home situated in Great Lever, Bolton and is registered with the Care Quality Commission to provide residential care for up to 81 people. At the time of the inspection there were 57 people living at the home. The home is divided into three areas; part of the ground floor provides residential care and support. There were 17 people living in that area. The area known as The Bungalow is also on the ground floor and cared for people living with dementia. There were 19 people being supported in The Bungalow. The upstairs floor had 21 people living with dementia being supported. The home is located on a main road and is close to local shops and transport routes.
At our previous inspection on 12 November 2015 and 09 February 2016, we found a total of 11 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found four breaches in relation to safe care and treatment, two breaches in relation to staffing and training, one breach in relation in safeguarding, two breaches in relation to person-centred care, one breach in relation to receiving and acting on complaints and one breach in relation to good governance.
The home was also placed into special measures meaning significant improvements were required, or further enforcement action could be taken. Following this inspection, the home sent us an action plan, detailing the improvements they intended to make. Until the home could demonstrate improvement and sustainability the local authority suspended placing people at the home.
At the time of our inspection of 04 August 2016, the service had an acting manager who was in the process of applying to become the 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.
At the previous inspections we identified concerns in relation to medication, staffing levels, staff training, safeguarding, responding to complaints and monitoring. During this inspection, we saw improvements across all areas had been made.
We found there were enough staff available meet people's needs in a timely manner and we saw lounge areas were not left unattended when in use.
We undertook a tour of the building and found it to be clean and tidy, with domestic staff carrying out their duties during the day.
We saw people who used the service were transferred safely into their chairs by staff, with appropriate moving and handling assessments having been undertaken.
People who lived at the home told us they felt safe. The relatives we spoke with also said they felt their family members were safe living at the home as a result of the care provided.
Staff had a good understanding of safeguarding procedures and how to report concerns.
We found appropriate recruitment checks were undertaken before staff started working at the home. These included ensuring references from previous employers were sought and either a Disclosure Barring Service (DBS) or a Criminal Records Bureau (CRB) check was undertaken.
Medication was given to people by staff that had completed relevant training. Regular audits of medication were also undertaken to ensure this was being done safely.
At our previous inspection, we had concerns in relation to staffing levels and staff training. During this inspection we saw staff had now received appropriate training to support them in their roles and staff told us they felt well supported.
We saw people received appropriate support at meal times and saw that staff encouraged and prompted people with eating as well as possible to ensure a good nutritional intake.
We saw areas of the home included adequate signage around the building and the use of sensory objects people could touch and use as they walked around the building.
We found appropriate Deprivations of Liberty Safeguards (DoLS) applications had been made by the acting manager, where people had been deemed to lack capacity to make decisions. Staff had also received training in this area and had an understanding of the legislation.
We found people were treated with dignity and respect by staff. We saw staff knocked and waiting for a response before entering people’s bedrooms.
We saw that people’s preferences were taken in to account with times of rising and retiring. People were able to get up at times they wanted to and ate breakfast at a time that was suitable to them.
We observed pleasant and friendly interactions between staff and people who used the service.
The people with whom we spoke told us they were happy with the care they received and were complimentary about the staff.
The staff and relatives with whom we spoke told us they had noticed improvements at the home in recent months.
We found that there was a varied plan of activities and stimulation for people. The home was preparing for a garden party to be held on 21 August 2016.
Where people had been referred to other agencies for advice such as the falls service or to a dietician, their advice was followed by staff.
People had care plans in place which provided relevant guidance for staff about how to care for and support people. These were reviewed at regular intervals and updated where necessary.
We saw complaints were dealt with and responded to appropriately,
Following our previous inspection we had concerns with the general leadership and management of the home. A management team had been put in place to oversee the day to day running of the home until the appointment of a registered manager.
We found there were effective systems in place to monitor the quality of the service provided. Regular checks were undertaken in all aspects of running the home and there were opportunities such as residents and relatives meetings for people to comment of the facilities of the service and the quality of the care provided.
We saw the ratings from the previous inspection were displayed near the front door of the home, which is a legal requirement.
This inspection took place on 12 November 2015 and an inspection report was initially published with a ‘good rating’. This report was suppressed following an incident involving a police investigation that raised concerns about documentation falsification. This meant the information relied upon on the previous inspection day was inaccurate. We therefore returned to the home on 09 February 2016.
This report includes information from the inspection in November 2015 and a further inspection day in February 2016, at which we reviewed certain aspects of the care provided in detail in response to the information that had been brought to our attention. We had previously carried out an inspection on 15 October 2013 when we found the service had complied with all the regulations reviewed at that time.
Lever Edge Care Home is a two storey purpose built care home. It is situated in the Great Lever area of Bolton and is close to local amenities and public transport. There is car parking to the front of the building and parking on the road is permissible. The home is registered to provide care for 81 adults. On the first day of our inspection there were 75 people using the service. On the 2nd day of the inspection there were 72 people using the service.
The home is divided into three areas; part of the ground floor provides residential care and support. The area known as The Bungalow also on the ground floor provides care for people living with dementia as does the first floor.
The home had a registered manager in place. 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. The registered manager was present on the first inspection day. On the second inspection day there was an acting manager overseeing the service.
We found that regulations had been breached in eleven instances with regard to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the safe administration of medicines, having sufficient numbers of suitably qualified staff, staff receiving the appropriate level of training and support to ensure they had the skills to care for people effectively, person centred care, complaints and good governance.
The environment was spacious to allow people to move safely around the home with the use of walking aids and wheelchair. The home was well maintained, clean, warm and well lit. There was an internal courtyard with appropriate seating for people to sit outside.
The service had a robust recruitment and selection process to protect vulnerable people from staff who were unsuitable.
There were a significant number of occasions when there were not sufficient numbers of experienced and suitably trained staff on duty to support people safely and effectively.
A significant number of training records had been falsified, meaning that many staff did not have the correct skills and knowledge to carry out their duties effectively.
Systems were in place in relation to the medication practices, but people did not always receive their medicines in a correct and timely way.
We saw how staff worked in cooperation with other health and social care professionals. However some issues were not followed up to ensure that people received appropriate care and support. This placed people’s health and well-being at risk.
We saw risk assessments were in place for the safety of the premises and procedures were in place to prevent and control the spread of infection.
Contingency plans were in place in the event of any emergency that could affect the running of the service and the provision of care.
We found that people’s care records contained detailed information to guide staff on the care and support people required. The records showed that risks to people’s health and wellbeing had been identified, but some records were incomplete and did not demonstrate a commitment to person-centred care.
We saw that people who used the service and/or their family (where appropriate) had been consulted about the care plan. This helped to ensure that people’s preferences were considered.
We found that the provider was not meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. In some cases applications should have been made for DoLS authorisations and these had not been done.
Appropriate arrangements were in place to assess whether people could consent to their care and treatment.
People were offered a variety of nutritious food and adequate hydration. We saw the food was home cooked and the presentation of food was appealing.
We observed that the relationship between people who used the service and staff was respectful, kind and friendly. However, staff at the home did not have the specialist training and skills required to help ensure people who were poorly and needed end of life care were supported appropriately.
The home had an activities coordinator. On the first day of the inspection we discussed with the registered manager that people who used the service may benefit from a more varied programme of activities.
Systems were in place to monitor the quality of the service provided and regular checks were undertaken on all aspects of running the home. However, evidence found during the process of the inspection indicated that records were not always complete and accurate.
There were opportunities, such as residents/relative meetings, satisfaction questionnaires for people to comment on the facilities and the quality of the care provided. It came to light following the first day of inspection that people’s concerns were not always addressed in a satisfactory way.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
We are considering our enforcement actions in relation to the regulatory breaches identified. We will report further when any enforcement action is concluded.
We found the home to be warm, clean and tidy. We looked on all three units and found the home to be sufficiently staffed. Staff we spoke with told us it was important to maintain good staffing levels to ensure continuity of care for people who used the service.
We saw people who used the service were well presented and we observed staff interacting with them in a friendly, polite manner and respecting their dignity and privacy.
We spoke with four people who used the service and two relatives. One person told us, 'I never thought I would have to move in to a home, but it's very nice here'. Another said, 'The staff are good'. We spoke with two relatives, one told us, 'I am happy with the care my X receives' another said, 'It's great, no complaints at all'.
We saw staff had access to relevant policies and procedures including safeguarding procedures and contact details. We spoke with four members of staff who told us they had undertaken lots of training which was relevant to their role.
We saw a number of compliment cards from relatives displayed on the units. Comments included: 'As a family we can't thank you enough for all the love, care and support you gave our X'. Another read, 'To all the staff at Lever Edge we wish to express our heartfelt gratitude' and 'Thank you, our X felt loved and cared for by your delightful team'.
Care plans were in place and of a satisfactory standard. The care records seen were person centred and informative. They showed how the person wanted their care delivered.
Lever Edge care home was comfortable and homely and safe. People said they were encouraged to bring their personal mementoes from home. Old photographs decorated the corridors with nostalgic images. LP covers from the fifties and sixties and interactive items were placed on the walls along with other items of interest to encourage discussions. Seats were placed strategically along the corridors for people to rest on. One person said about the pictures, 'They are great aren't they; they bring back so many memories.'
Staff had regular training to keep their skills up to date. They had all completed national qualifications in care. They felt this provided them with the skills and knowledge to support people well.
People said they were happy and had no complaints. They knew they could tell the manager if they had any worries. One person told us 'I would just tell the manager and she would sort it for me, no problem.' Another person said, 'What would we have to complain about here? They couldn't do more for you.'
'It's lovely here and the food is really good'.
'The staff are very kind and they look after us really well'.
One visitor was very complementary about the staff saying, 'The home is very well run and all the staff make you welcome. It's always clean and it never smells, they look after people well, they really care'.
A visiting health professional was also pleased with the way the home was managed and with the care given to her client.
The staff said the manager of the home was very supportive and approachable. In turn the manager said, 'There is a good staff team that work well together'.
We spoke with the relatives of a person who had only been at the home for a few days, they said, 'So far we are very pleased with what we have seen. We were provided with information about the home before accepting a place here'.