The inspection took place over two separate dates 27 February 2018 and 15 March 2018. A second day was scheduled, as severe weather meant not all the inspection team could be present on the first day of inspection. The first day of inspection was unannounced the second day was announced. The service was last inspected 17 January 2017 and was found to be providing a good service and meeting all of the associated regulations. We brought forward a planned inspection to this service because of concerns raised by the local authority. We also received a higher number of safeguarding concerns and incidents between people using the service than expected for a service of this size. We wrote to the provider last year after concerns were raised with us about staffing levels, insufficient activities and whether the registered manager was being adequately supported. The provider sent us a suitable response and the local authority quality improvement team have been working with the service to help them identify and carry out improvements.
At our inspection, 27 February and 15 March 2018, we found the service had made some improvement and was addressing the concerns raised since our last inspection. We have rated the service as Requires improvement in responsive and well led because people have not always received good outcomes of care and at times had not been safe in the service.
Lancaster 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. The service does not offer nursing care. Lancaster House is a service registered for 31 people following an application last year to extend the service from 17 to 31 people. The homes registration includes caring for people with dementia, mental health, older people, and younger adults. At our inspection on the 27 February there were 27 people using the service. Whenever possible the service considered where people’s needs could best be met. The annex was predominantly for younger adults with mental health needs. The other unit was mainly but not predominantly for older people with mental health or living with dementia. Some people had a dual diagnosis of mental health and dementia.
The home is situated in the town of Watton within easy reach of amenities and had adequate parking.
The service has a registered manager who had a background in mental health. They have been registered since 2015. 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 our most recent inspection on 27 February and 15 March 2018, we found improvements were being made but not firmly embedded. Undoubtedly, there had been a number of concerns with this service since the change of their registration to increase their bed numbers. The increase in numbers is likely to have had an impact on the stability of the service and we found some people’s needs were not compatible with others. This was being addressed by the service and some people had moved on or were being supported to find an alternative service. Effectively the registered manager’s workload had increased and they did not have any administrative support or a deputy manager. They were working long hours including being permanently on call for this service with insufficient support from the registered provider. This put a strain on the service. This situation has since improved. The registered manager is supported informally by the registered provider and has extended networks of support. They have in place two senior staff who they have sufficient confident in and able to share some of the responsibilities and on-call so they can have some time off. This needs to be developed further to ensure staff are competent and can work independently and carry increased responsibilities. Staffing levels should also be kept under review as the needs and likely input each person requires could vary significantly particularly when some people receive a transitional service.
The safety of people using the service is paramount and this at times had been compromised by people living together who did not always get on and had incompatible needs. The registered manager had been proactive in meeting with health care professionals and local authority to ensure where needs could not be met they were supported to find somewhere else to live which was more appropriate. Safeguarding concerns had not always been dealt with effectively but lessons have been learnt and we found staff had sufficient knowledge and confidence in the registered manager to report concerns. The registered manager had worked closely with the local authority developing and working towards action plans to improve the service for people using it.
We found the service was not yet sufficiently responsive to people’s needs both in terms of providing enough social stimulation or demonstrating individualised care and support. Some of which could be attributed to staffing levels. We found records although reviewed did not always clearly demonstrate how risks had been monitored or reflective of the care provided.
There were safe systems in place to ensure people received their medicines as required and staff had the necessary training and skill to do this. Staff monitored people’s health care needs and sought advice and guidance when necessary. People received appropriate end of life care.
Staff recruitment processes were sufficiently robust and new staff were clearly supported throughout their induction period. There was a regular programme of training and support for all staff.
The Commission is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found people’s rights were being upheld and staff supported people in lawfully and in line with legislation around mental capacity and deprivation of liberties.
People were supported to eat and drink in sufficient quantities for their needs and any concern about this was monitored to help ensure risks were managed. However, records did not always clearly reflect this.
Staff demonstrated good interpersonal skills and communicated with people effectively. They adopted a calm approach with people and exercised tolerance and understanding. People’s independence was facilitated and staff respected their dignity.
Feedback from people was asked for but this needs to be developed further to ensure everyone’s views was known and taken into account when planning the service.
The service had an adequate complaints procedure and gave people opportunity to raise concerns/suggestions about the service.
The premises were being refurbished and were suitable for purpose but lacked sufficient space to help ensure people’s privacy.
The registered manager had worked hard to bring about stability and improvement. They kept their practices up to date and provided effective leadership. They were knowledgeable and supportive. The service had effective quality assurance systems and improvements were being made to the service.