Archived: Lapstone House

We found the following examples of good practice.

Staff had received training in infection prevention and control and on using Personal Protective Equipment (PPE) safely. Staff had their infection prevention and control practices monitored to help ensure their competence and understanding. The provider had ensured sufficient quantities of PPE were available for all staff and visitors.

The staff and domestic team kept the home clean, uncluttered and hygienic. Audits were done on the environment and cleanliness. Frequently touched surfaces were cleaned regularly throughout the day to reduce the risk of infection.

The registered manager ensured clear information about maintaining social distancing and hygiene was prominently displayed to guide staff and visitors. Staff had staggered their breaks and rearranged communal areas in the home to support social distancing. The registered manager followed best practice around safe admissions when people moved into the home.

The registered manager had followed government guidance about visiting. People had been supported to stay in touch with relatives and families had been supported to spend time with people at the end of their lives in a safe manner.

Consent for testing and vaccination had been obtained from people, with appropriate support from their representatives, families and medical professionals if needed. The registered manager had arranged for regular COVID-19 testing for staff and people who lived in the home.

The manager reviewed staffing arrangements regularly to make sure people's personal and recreational needs could be met. Staff were allocated to consistently work in specific areas of the home to reduce the risk of transmission of infection.

The provider had robust contingency plans in place to ensure the safety of the service during the pandemic.

We last inspected the service in November 2015 where we found that there were not enough staff deployed at night. We judged the service to be in breach of Regulation 18: Staffing. This meant that the service was judged as requiring improvement in the safe outcome. The registered provider sent us an action plan and confirmed that staffing at night had been increased from two to three support workers. We saw evidence to support this at this inspection in March 2018. We judged the service was no longer in breach.

At our last inspection we rated the service as good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Lapstone House 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. The home provides care and support to mainly older adults, but may also take people living with dementia or those living with learning disabilities.

The home accommodates 25 people in one purpose built building. The home has three separate units, each of which have separate adapted facilities. At the time of our visit only two units were routinely used as there were only 21 people in residence.

The home is situated in the town of Millom and is within walking distance of the amenities of this small town. There are good transport connections in the town. It is operated by Cumbria County Council who run similar services across Cumbria.

The home had a suitably qualified and experienced 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.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and spoke to us about how they would identify any issues and report them appropriately. Risk assessments and risk management plans supported people well. Good arrangements were in place to ensure that new members of staff had been suitably vetted and that they were the right kind of people to work with vulnerable adults. There had been no accidents or incidents reported to the Care Quality Commission but the registered manager was aware of her responsibilities if there were any issues in the home.

The registered manager and her senior team kept staffing rosters under review as people's dependency changed. We judged that there were suitable care and support staffing levels in place by day and night. There were suitable numbers of ancillary staff employed in the home.

Staff were suitably inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. The team made sure that strong medicines and any sedation were kept under review with the local GPs.

Good assessments of need were in place and the staff team reviewed the delivery of care for effectiveness.

People were told us they were very happy with the food provided and we saw well prepared meals that staff supported and encouraged people to eat.

Lapstone House is a purpose built home that was refurbished over twenty years ago and has been updated by the provider since then. The house was warm, clean and comfortable on the day we visited. Suitable equipment was in place to help people with things like mobility.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People who lived in the home told us that the staff were very caring. We observed kind, patient and appropriate care being provided. Staff knew people and their families very well. They made sure that confidentiality, privacy and dignity were maintained. People were encouraged to be as independent as possible. Staff were trained in end of life care and we saw evidence to show that this kind of care had been done to good effect for many years.

Risk assessments and care plans provided detailed guidance for staff in the home. People in the service were aware of their care plans and were able to influence the content. The management team had ensured the plans reflected the person centred care that was being delivered.

Staff could access specialists if people needed communication tools. They had been able to offer people specialist support in the past.

We learned that the home had regular entertainers, activities and parties. Staff took people out locally and encouraged people to follow their own interests and hobbies. Staff in this home were active in raising money for these activities and for adding homely touches to the environment. Local people supported the home in this.

We noted that this home had good links to the community and had a locally based culture. The registered manager ensured that staff understood the vision and values of the County Council. Staff were able to discuss good practice, issues around equality and diversity and people's rights.

The service had a comprehensive quality monitoring system in place and people were asked their views in a number of different ways. Quality assurance was used to support future planning.

There had been no concerns or complaints received but the registered manager was aware of the protocols of Cumbria County Council.

Records were well organised, easy to access and stored securely.

Further information is in the detailed findings below.

Lapstone House is in the centre of the South Lakeland town of Millom and provides accommodation and personal care for up to 25 older people. The home is divided into three separate units, each with a sitting room, kitchenette, dining area and with bathing and showering facilities. There is a small quiet lounge, a hairdressing room for people living there and also a laundry for people's personal clothes. At the time of our visit there were 19 people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

We found at this inspection that there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not sufficient numbers of support staff at night time to meet the assessed needs of people living in the home.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with people who were living at Lapstone House and they made only positive comments about their care and about their home. People told us that it was a “safe” and “happy” place to live. They told us that staff they knew the staff supporting them well and that they were “kind” and “helpful” and helped them to do things for themselves.

We spent time with people on all the units. We saw that the staff offered people assistance and took the time to speak with people and take up the opportunities they had to interact with them and offer reassurance if needed. People living there told us that care staff respected their privacy and treated them with respect. We saw that the staff on duty approached people in a friendly and respectful way and people we spoke with who lived there told us that it was a “homely” and “comfortable” place to live.

The environment of the home was welcoming and the communal areas were decorated and arranged to make them homely and relaxing. We found that the home was clean and being kept tidy and fresh. The home was scheduled for refurbishment to improve and update the home for people living there.

The registered provider had systems in place to make sure people living there were protected from abuse and avoidable harm. The staff we spoke with were aware of their responsibilities in protecting people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of anyone.

They service had safe systems for the recruitment of staff to make sure the staff taken on were suited to working there. On the day of the visit there were sufficient care staff available to support the people living there during the day. We saw that care staff had received induction training and ongoing training and development and had supervision once employed.

Medicines were being safely, administered and stored and we saw that accurate records were being kept of medicines received and disposed of so all of them could be accounted for.

People knew how they could complain about the service they received and information on this was displayed in the home. People we spoke with were confident that action would be taken in response to any concerns they raised and told us they felt comfortable giving their views about the service and what they wanted in their home .