Lenthall House

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

People were protected from the risk of harm as care records provided detailed guidance and the measures staff needed to take. Staff demonstrated they knew how to keep people safe and raise any concerns. People were protected from abuse, systems and processes were in place to identify and report any abuse or harm.

Significant improvements had been made to ensure medicines were stored and managed safely and people received their medicines as prescribed. People were supported by enough staff to meet their needs. The care and support was person centred and people did not have to wait for assistance or feel rushed.

People were protected from infection. Staff wore appropriate personal protective equipment and the home appeared clean and odour free.

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.

There was effective oversight and leadership of the service. People, relatives and staff were unanimous in their praise of the registered manager and the improvements they had made to the service. The registered manager monitored the service to ensure the care provided achieved the best possible outcomes for people.

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 inadequate (published 01 February 2022).

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.

This service has been in Special Measures since 31 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focussed inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

Follow up

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

Lenthall House is a residential care home providing accommodation and personal care to 35 people aged 65 and over at the time of the inspection. The service can support up to 40 people accommodated over two floors.

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

Risk was not always safely managed. As a result, people were left at increased risk of not receiving the care and support they required in a safe way.

Environmental safety concerns were found in people’s bedrooms and communal areas. Alcohol based hand sanitiser and paraffin based topical creams had been left in people’s bedrooms and communal areas. This increased the risk of harm to people.

Accidents, incidents and falls were dealt with appropriately. However, themes and trends were not always identified, and lessons were not always learnt when things went wrong.

Medicines were not always safely managed. People were not always receiving their medicines as prescribed. Medicines were not always being stored appropriately or administrated safely. This placed people at increased risk of harm.

There were not always enough staff to meet people’s needs and to ensure care records were accurate and up-to-date. The provider was unable to evidence appropriate recording of up-to-date information within care records, care plans and risk assessments to ensure people’s care was person-centred and achieved good outcomes for people.

Effective systems and processes were not always in place to maintain oversight of the service, or effective in identifying areas of concern. Achievable action plans were not always developed, and when action plans were developed there were not always clearly set priorities, timescales and ownership of each issue.

There was a distinct lack of lessons learnt at provider level. Several of the issues identified had previously been raised at other locations under the provider’s registration and the same issues were found at Lenthall House.

People’s relatives and staff provided mixed feedback about the support provided by the management team and the quality of communication.

People’s relatives were not always involved in developing and reviewing their family member’s care.

People were supported by staff who had been recruited safely and who knew people well.

Staff demonstrated a good understanding of safeguarding and the signs of abuse and were able to describe how and who to report concerns to.

Effective infection prevention and control (IPC) policies and procedures were in place and the service was following best practice and Government guidance in relation to the management of COVID-19 and other infections.

The provider and management team had good links with the local communities within which people lived.

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 good (published 14 June 2018).

Why we inspected

We received concerns in relation to staffing levels, staff training, recurrent falls and a lack of management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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 that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lenthall House 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 as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, staffing, medicines, the environment and management oversight at this inspection.

We issued a Warning Notice requiring the provider to be compliant by 31 March 2022.

Please see the action we have told the provider to take at the end of this report.

Follow up

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 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.

We found the following examples of good practice:

¿ The service had a designated visiting area with a separate entrance, so visits took place as safely as possible.

¿ Visitors followed the provider’s infection prevention and control procedures which included temperature checks and completing a COVID-19 questionnaire.

¿ Staff contacted relatives weekly to report on their family member’s well-being and update them on visiting arrangements. Some visits took place virtually using video phone calls.

¿ People using the service socially distanced. Communal areas were re-designed, so people could sit at a safe distance from each other.

¿ People were safely admitted to the service in line with government guidance.

¿ Systems were in place to shield and isolate people where necessary, taking into account their rights and best interests.

¿ Staff wore the correct PPE (personal protective equipment). They were trained in infection prevention and control and knew how to protect people from the spread of infection.

¿ The service put on extra socially-distanced activities to support people’s well-being and prevent them becoming isolated. For example, a brass band played in an outdoor courtyard to entertain people who were indoors.

¿ People and staff were regularly tested for COVID-19.

¿ The premises were clean and hygienic throughout. The provider increased cleaning hours by 30 per week to ensure infection control guidance was followed. The premises was well-ventilated throughout.

¿ Care workers had regular one-to-one support from senior staff and access to mental well-being resources. There was a mental health first aider on site.

¿ The registered manager carried out checks and audits to ensure people received the care they needed and were kept safe. These were regularly reviewed.

Further information is in the detailed findings below.

Lenthall House is registered to accommodate and personal care to 40 people; at the time of our inspection there were 37 people living in the home. Lethall House provides care and support to older adults and has an area of the building that is specifically tailored to meet the needs of people living with dementia.

There was a registered manager in post at the time of our inspection. 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 last inspection in February 2016, Lenthall House was rated overall good. At this inspection we found that there had been continuous innovation and improvement and is rated overall good.

The registered manager and senior management team at Lenthall House were visible, approachable and acted as a role model for staff within the service. There was a clearly articulated person centred culture.

Staff were encouraged and enabled to work creatively which achieved consistently good outcomes for the people receiving care and support. There was a strong system of quality assurance led by the provider and manager that ensured people consistently received good care and support.

The people living at Lenthall House had an enhanced sense of well-being and quality of life because staff worked innovatively to enable people to have meaningful experiences and to become active members of the local community. People were consistently treated with dignity and respect and the staff team consistently showed empathy for people.

People were safeguarded from harm as the provider had effective systems in place to prevent, recognise and report concerns to the relevant authorities. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately. Staff understood the importance of obtaining people's consent when supporting them with their daily living needs.

People experienced caring relationships with staff and good interaction was evident, as staff took time to listen and understand what people needed.

There were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role.

People's care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People or their representative had been involved in planning and reviewing their care and plans of care were in place to guide staff in delivering their care and support.

People's health and well-being was monitored by staff and they were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People's needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people's care was tailored to their individual needs.

Staff responded to complaints promptly and in line with the provider's policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to and acted upon.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored through the regular audits carried out by the management team and provider.

The service was well run by a registered manager who had the skills and experience to run the home so people received high quality person-centred care. The registered manager led a team of staff who shared their commitment to high standards of care and clear vision of the type of home they hoped to create for people.

We spoke with the registered manager, regional manager, the deputy, two cooks and five care staff, this included an agency care worker. We looked at some of the records held in the service, including the care files for four people who used the service. We observed the support people received from the staff, and carried out a tour of the building.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

People who used the service and relatives we spoke with, told us they felt safe and that their needs were met appropriately. Comments included, 'Yes, I feel safe and well cared for.' And, 'I have no concerns my mother is not cared for appropriately, I know she is safe here and well looked after.'

The provider assessed and reviewed people's needs to ensure care plans and risk assessments, were up to date and reflected people's needs. This ensured people were cared for safely by staff who knew how to meet their needs.

We saw what action the provider had taken to support people who were at risk of falls. Assisted technology was used as an additional safety measure for those at highest risk. There were emergency procedures in place, including personal evacuation plans that instructed staff how to keep people safe in an emergency situation.

We found the maintenance of records had improved since our last inspection. People could be assured their needs were met safely due to accurate recording.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, the manager was able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

The provider had reviewed systems in place that ensured people's needs were reviewed. This meant people's needs were monitored effectively.

We saw the provider had started to implement further documentation that would identify in more detail a person's life history. This demonstrated the provider was committed in developing a more effective, and person centred approach to service delivery.

We found the provider had effective systems in place for the monitoring of people's dietary and nutritional needs. People received a well-balanced and nutritious diet, and regular fluids kept people well hydrated.

People who used the service and relatives spoke highly of the staff. Comments included, 'The carers (staff) are all very good, on the whole also very caring.' And, 'I have no complaints, I'm very happy and well cared for.'

We found the provider supported staff effectively. Staff received appropriate training to meet the needs of people they cared for, and were supported to review and develop their practice.

Is the service caring?

People who used the service and relatives we spoke with, told us they found the staff showed dignity and respect when providing care and support. Comments included, 'The care staff are good, they listen to me and treat me well.'

We found the service to have a warm, welcoming and relaxed atmosphere. Staff were observed to of engaged with people in a caring manner, showing dignity and respect at all times. We also saw that staff showed patience and gave encouragement when supporting people.

We found staff to be knowledgeable about the needs, routines, likes and dislikes of people they cared for. This showed that staff were attentive, caring and aware of the importance of equality and diversity.

Is the service responsive?

We found the provider responded well to people's needs. We saw examples where the provider had made appropriate referrals to health professionals, as a response to a change of need in a person. A visiting district nurse told us the staff were quick to respond to concerns relating to people's needs, and made appropriate and timely referrals.

From records seen, and comments received from people who used the service and relatives, concerns had been raised with the provider about the lack of activities available. We saw what action the staff had taken in response to these issues. We were shown a 12 month activities and entertainment plan.

Is the service well-led?

People's personal care records, and other records kept in the home, were accurate and complete.

The provider worked well with other agencies and services such as health professionals. This showed a coordinated and person centred approach to care delivery was provided.

We found the provider had quality assurance and monitoring procedures in place. The manager had worked well with the local authority to improve the quality and shortfalls in the

As part of our inspection we looked at the care and welfare of the people who lived in the home and how their care and support needs were assessed and met. We reviewed some care plans and saw that the Provider was in the process of changing the system of recording information. The files we reviewed had some information missing or contained inaccuracies.

We found that people felt welcome and happy in the home. We saw that the staff treated the people who lived in the home with respect.

One person who lived at the home told us, “I have some good days and some not so good, but I like it here.”

We spoke to family members of some of the people who lived in the home. One person told us, “I don’t have any problems with Lenthall House. Care is exemplary.”

We found that some of the Provider's policy documents would benefit from review and updating. We saw appropriate measures were in place to ensure information and records were stored securely. However, the incomplete nature of the care files, with missing and inaccurate information presented a minor risk to the appropriate care and support being provided to the people who live in the home. A compliance action has been set against this Regulation.