• Care Home
  • Care home

Lighthouse

Overall: Good read more about inspection ratings

44 Farrant Road, Manchester, Lancashire, M12 4PF (0161) 225 2777

Provided and run by:
Wellington Healthcare Limited

All Inspections

13 April 2022

During an inspection looking at part of the service

About the service

Lighthouse is a residential care home and provides accommodation and support to adults with a substance misuse and associated needs, including mental health. The service provides support for up to 44 people and at the time of our inspection there were 37 people living at the home.

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

People were positive about the home and the support they received. People told us they received their medicines safely and when they needed them. Staff had received training in safeguarding and knew how to identify and report concerns. Accidents, incidents had been documented and lessons were learned where required. Staff received training and guidance to manage infection control effectively.

People had been involved in a very impressive refurbishment of the home and were pleased with the results. There was an established staff team that was motivated and trained to carry out their roles effectively. People found the staff supportive and care assessments were person centred and met their needs.

People and staff were positive about the culture in the home and we observed this during the inspection. Effective management systems were in place to improve the service and staff received good support and told us they enjoyed working at Lighthouse.

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 15 October 2020) 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 been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider reviewed their risk management policies, their approach to the recovery model and considered a programme of refurbishment. At this inspection we found the provider had acted on each recommendation and made noticeable improvements. This included an impressive refurbishment of the premises.

Why we inspected

We carried out a focused inspection of this service in September 2020 where breaches of legal requirement were found. The provider completed an action plan after the last inspection to show what they would do to improve staffing levels and governance within the service. We undertook this focused inspection to check they 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, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lighthouse on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

16 September 2020

During an inspection looking at part of the service

About the service

Lighthouse is a residential care home and provides accommodation and support to adults with a substance misuse need and associated needs, including mental health. The service provides support for up to 44 people and at the time of our inspection there were 22 people living at the home. In April 2020 the provider made changes to their registration. This meant the service changed from CQC’s hospital directorate to the adult social care directorate.

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

The service was not always safe and there was a lack of understanding regarding safe infection control procedures. Staff and the registered manager were not following government guidance issued as part of the COVID-19 pandemic, regarding wearing the appropriate protective equipment, such as face masks.

The environment was not always safe, as key risks in relation to the home’s electrics were not fully mitigated. Outstanding tasks had not been completed from the home’s electrical conditions report. The provider's approach to fire safety drills was inconsistent, which meant some staff had not undertaken a mock fire drill.

We made a recommendation that the provider reviews their risk management processes, so they are service specific and in line with best practice, as we noted the current policy and procedure was not fit for purpose.

We found there were enough staff on duty to keep people safe, however, we received a negative comment regarding the night staffing levels. The registered manager was confident the night staff deployment was safe and would discuss this area further with the night staff to establish whether the concerns around staffing at night was an isolated case.

We noted some areas of the home would benefit with being refurbished or re-decorated. We have made a recommendation in this area.

People told us that they were happy with the support they received, and the staff were caring. Staff knew the people they were supporting well and understood their care needs.

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. However, the provider's approach to mental capacity assessments did not always document this practice.

The service needed to review their approach to people’s recovery from addiction. There was no framework in place to clearly track people’s progress. We have made a recommendation in this area.

Improvements had been made to aspects of the providers risk management procedures following our last inspection. However, the service needed to implement new quality systems to ensure there was a better oversight of performance and quality at provider level. Despite our findings, people we spoke with were happy with the care provided and staff felt supported by the registered manager.

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

Rating at last inspection

The last rating for this service was requires improvement (published 10 July 2019). We also inspected the service on 24 September 2019 and 8 October 2019. At that inspection we did not change the ratings.

Why we inspected

This was a planned focused inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lighthouse on our website at www.cqc.org.uk.

Enforcement

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.

We have identified breaches in relation to safe care and treatment, staffing and good governance.

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. We notified the Local Authority Quality Improvement Team of the areas of concern we identified, and we also contacted the local infection control team.

24 September 2019 and 8 October 2019

During an inspection looking at part of the service

We did not rate Lighthouse at this inspection as it was a focused inspection of the safe key question. We carried out this inspection after receiving information of concern about how the service was managing a mixed gender environment and the assessment and management of risks associated with individual clients supported by Lighthouse.

We inspected Lighthouse on two dates: 24 September 2019 and 8 October 2019.

After the initial visit we issued a letter of intent to the service on 27 September 2019. We did this under Section 31 of the Health and Social Care Act 2008 to notify the provider of the serious concerns that had been identified during the inspection. The letter of intent detailed that we would take enforcement action if the provider did not take immediate action to address concerns raised. We then returned to check the actions had taken place.

By the end of this inspection the provider had taken most of the steps needed to ensure the risks posed by mixed gender care had been mitigated. However, some further work was needed including the completion of environmental risk assessments. At the inspection on 24 September 2019, we found the service was not safe. Staff were not assessing and managing the risk posed by the service being mixed gender. Staff were not doing all that was possible to mitigate the risk. On the ground floor, there were three males who passed two female’s bedrooms to access the toilet, bath or shower. There had been an incident where a male and a female client had spent time in each other’s bedrooms. However, by the time we revisited the service on the 8 October 2019 clients had moved bedrooms and there was a female only corridor, with two female’s bedrooms on it and another female was moving to this corridor during the inspection. The service confirmed that the further two females had moved to the female only corridor by 10 October 2019. The female only corridor had a different keycode which only females and staff had the access code. All female clients had a documented risk assessment considering their potential risks of staying in a mixed gender environment and how these could be mitigated. However, environmental risk assessments needed further work to ensure they clarified how staff should promote the client's safety throughout the whole building and mitigate potential risks.

The provider still had further work to complete to ensure client risks were appropriately assessed and managed. At the inspection on 24 September 2019, we found records did not reflect the risks posed by clients to themselves and others, including historic risks and staff were not provided with information on how to mitigate the risks. The documentation had changed since the last inspection and was more suitable for services caring for older people. When we returned on 8 October 2019, one client's risks had been carefully considered and this person was on one to one observation. In addition staff working at night as waking nights had increased from two to three to allow for the increased observations, eight out of 14 of these shifts included male members of staff. Mitigation was in place for the shifts when there was three female members of staff, including the use of personal safety alarms and carrying a mobile phone with them to summon assistance if required. However, further work was needed to ensure all clients had comprehensive risk assessments in place.

However, the environment was clean and well maintained. Clients we spoke with, told us they were happy in the service and felt safe there.

Staff had a good understanding in safeguarding and had received training. Incidents were reported, and actions taken were shared with staff via team meetings.

There were still requirement notices from the previous inspection, that will be followed up at a later date.

8 and 9 May 2019

During a routine inspection

The provider has made progress since the previous inspection and we recommend the service be removed from special measures.

We rated the Lighthouse as requires improvement because:

  • The service had not assessed and mitigated environmental risk to clients. Following the change in medicine administration the manager had stopped clients progressing with the self administration process. Support plans, risk assessments and risk management plans were not reviewed following incidents.
  • Staff did not follow the Mental Capacity Act. Client records were not complete, current and contemporaneous. Group therapy activities in relation to addiction and lifestyle were not taking place as marketed. Lighthouse did not consider blood borne viruses of clients and staff did not have training in this area.
  • Although the governance procedures and oversight had progressed, there were areas that the manager did not have oversight of. There was no risk register in place. Staff were not receiving supervision in line with the providers policy. Clients were not involved in the running and development of the service.

However:

  • We observed, and clients told us, that staff at all levels were respectful approachable and responsive to the clients’ needs. Clients were involved in the local community. Residents meetings took place and change happened following these meetings.
  • Lighthouse was accessible for people with mobility needs and had a variety of rooms and facilities to pursue activities or have access to a quiet environment, dependant on client preference. Clients spoke positively about the new chef; saying that they provided tasty and varied food. Clients knew how to complain, information was displayed, and the manager was following the complaints policy.

13 and 14 November 2018

During a routine inspection

We are placing the service into special measures.

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 overall or for any key question or core service, 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 rated Lighthouse as inadequate because:

  • Managers had not ensured that the building that accommodated the clients was safe. Staff did not risk assess the environment in relation to risks to clients, especially in relation to managing a mixed sex environment. Staff had not identified repairs that required to be made to the building to keep clients safe.
  • Staff did not follow basic procedures to protect clients from risk. The service did not have a system for checking clients as they entered or left the building. This meant that, if there was a fire, staff would have no way of knowing who was still in the building. Managers had not ensured that staff had all the training required for their role, in relation to drug misuse, overdose awareness and how to administer emergency medicine. Records did not contain the completed documentation to keep clients safe. In the records we reviewed we found staff had not completed fully, physical identity forms and health action plans. This meant staff would not have the necessary information to share if a client went missing or to meet their healthcare needs. They did not have any risk management plans in the records we reviewed.
  • The governance arrangements for the service were not effective. The service could not be assured that the oversight was in place to provide high quality services and keep clients safe. Lighthouse did not have a system to identify the number of staff required for each shift. There was no way of knowing if the service was under or over staffed. There was no system to monitor the compliance with health and safety checks of the environment. Policies did not comply with legislation and there was no system to review the policies and ensure they were relevant to the client group. There were policies from three different services in use. The provision of the therapy in relation to addictive behaviours was not being provided as marketed in the services literature and information to commissioners and clients.
  • The registered manager was not following policies in relation to Duty of Candour, complaints and CCTV. The risk register did not capture current risks to the service in relation to governance and how staff would mitigate risks.
  • Lighthouse breached Regulations 12 Safe care and treatment and 17 Good Governance of the Health and Social Care Act 2008, we have issued warning notices for these breaches. Lighthouse also breached Regulation 18 Staffing of the Health and Social Care Act 2018, we will issue a requirement notice in relation to this.

However:

  • Feedback from clients, carers and care coordinators was positive. Clients were supported and encouraged to participate in activities within the local community.
  • Staff received a comprehensive induction, regular supervision and annual appraisal.
  • Staff worked in a person-centred way. They demonstrated an understanding of equality and diversity issues and working with clients belonging to vulnerable groups. Staff had developed a therapeutic programme tailored to the needs of clients with a dual diagnosis of substance misuse and mental health needs.

06 September 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • We found the environment at the Lighthouse to be clean, safe and well maintained, and that there was adequate staffing for the service. Staff recruitment was based on the number of clients admitted to the Lighthouse, and extra staff from the provider could be accessed if needed. All clients had risk management plans in place. Environmental health checks, fire safety checks and legionella risk assessments were in place and up to date. There were enough staff to ensure that activities were not cancelled. Medication was monitored and dispensed safely. A safeguarding policy was in place, but no alerts had been raised in the 12 months prior to the inspection.

  • The Lighthouse had clear and comprehensive admission criteria. Care plans were seen to be holistic, person centred and considered the views of clients. Clients were given a full assessment prior to admission, in conjunction with the assessments of referring agencies. Consideration was clearly given as to whether the service could manage existing physical health problems. An unannounced medication audit was carried out in July 2016 by the pharmacy used by the Lighthouse, issues that were identified were dealt with. Staff appraisals were taking place.

  • Both clients we spoke to told us that the staff were caring, approachable and were always available to speak to if they needed further support. Most of the staff had personal experience of substance misuse issues, and this led to an understanding of client issues. Staff were caring and respectful and their interactions were person-centred, friendly, and recovery focused. Relatives and carers were also offered support by the service, as well as in their local area.

  • Lighthouse staff maintained close links with care coordinators and care managers to ensure all services were planned, developed and delivered in accordance with the referral recommendations. The Lighthouse directed clients towards a variety of services that it could not provide, but this was only done in partnership with the referral body or their representative. The Lighthouse had a full range of rooms and equipment to ensure care needs were met. Activities available at the Lighthouse included swimming, a cycling group a gardening group, woodcraft, and cooking and baking. There had been no formal complaints in the 12 months prior to the inspection.

  • The Lighthouse aimed to offer practical and goal-focussed support to clients, with access to services that would promote independence, give choices about the way services were delivered, maximise privacy and dignity, and safeguard welfare. This aim was evident in staff attitudes and behaviour. Staff sickness was monitored, at the time of the inspection there was only one staff member on long-term sickness. There were no bullying or harassment cases reported at the Lighthouse for the 12 months prior to the inspection. There was a whistleblowing policy in the employee handbook and staff were aware of it.

However, we also found the following issues that the service provider needs to improve:

  • Diversity and equality training figures were less than 75%, as were manual handling practical, and effective behaviour management.

  • Key performance indicators were not fully utilised to gauge the performance of the service, although the impact on the service was not noticeable at the time of inspection.