Lenthall House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were not always protected from harm. Risks were identified and care plans were in place, however, staff did not always follow the care plan or have enough time to meet peoples needs. The environment and equipment was not decorated or cleaned to an acceptable standard. People were not protected from the risk of infection and did not always receive timely and effective support to manage known risks. This was a breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People had their medicines managed in a safe way. Staff understood their responsibilities to protect people from abuse. Where abuse was identified this was reported to the appropriate authorities such as the local authority safeguarding team.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Some people told us they did not feel safe. They said they had confidence in staff but didn't feel staff were always available when they needed them. Two people's relatives were concerned they were not always kept up to date about any changes or concerns. Everyone said staff were kind and knew how to protect people from abuse.

Staff had training and understood their responsibilities. However, staff did not always feel confident raising concerns, they told us senior managers were not approachable and they were afraid to speak up. We discussed these concerns with the provider who commenced an investigation into the culture at the service and across all of their services.

Staff practice throughout the day was appropriate with support and interactions positive and respectful.

The provider had an appropriate safeguarding policy for staff to follow which included making referrals to outside agencies such as the local authority and the CQC. We were given examples of referrals made to the local authority’s safeguarding team appropriately. However, the culture in the service did not support sharing and reporting concerns.

One person told us they were concerned about the amount of people in the lounge, they told us it was difficult to move around and they felt ‘blocked in’ at times. They had raised this with the manager but it had not improved. One person said " I've been here for two years now and it seems to be getting worse. I don't feel as safe as I used to". A relative told us about a broken wheelchair which could have resulted in an accident. Risk was identified within care records and this included positive behaviour care plans instructing staff about the best way to provide reassurance and keep people safe.

Senior leaders were confident their systems and processes identified and managed risks in the least restrictive way. Staff knew about people’s identified risks and what to do to keep people safe. They had training about using moving and handling equipment and had their competency assessed. However, we did observe staff using equipment in an unsafe way on 2 occasions during our visit. Some staff told us there were often delays taking action when equipment was broken such as washing machines, fire alarms and call bells.

Two people were supported by staff to use a stand aid for their mobility, however, they were not able to support their own body weight and this resulted in unsafe use of this equipment with risk of physical harm.

Staff had training and knew how to respond to accidents and incidents. Analysis was carried out following an accident or incident and changes made to reduce further risk. Health and safety audits took place but had not identified concerns we found in the environment such as broken blinds, rusting pipes in toilets and long grass in the garden. Only 77 % of staff had up to date moving and handling training. Equipment such as hoists and lifts had in date safety certificates.

The environment and equipment did not always support the delivery of safe care. People told us the blinds in the main lounge were broken and which made this room very hot during warm weather and people said the glare from the sun was blinding. Some people said they service required redecoration and a good clean. One person said, “The blinds are difficult, they can't close them, they look awful. We never seem to see any improvements though. It could do with a good clean." Relatives told us they had been promised improvements in the environment but they never materialised. A relative said, “We keep getting told that it's going to be decorated and that new furniture will be arriving. We have yet to see any changes take place inside the home”. Another relative said,“ The gardens are awful, the outside of the property is horrendous, the grass is up to the knees”. Shortly after our site visit we were told by the operations manager the grass had been cut.

Staff told us there were many recurring problems with the environment such as fire alarm, call bell systems and hot water, broken blinds and old furniture requiring replacement A number of issues had been reported to the CQC (the fire alarm, hot water and call bell systems were in working order at time of the site visit). The service had been without any industrial type washing machines for a period of more than 2 months and had only the use of 1 domestic washing machine to complete all the laundry for more than 38 people. New washing machines were installed shortly after our staff visit. The operations manager sent us information about planned redecoration to take place, however, there were no timescales for completion.

The premises and environment were in need of redecoration and refurbishment throughout. There was scratched paintwork, broken blinds, scratched flooring and stained carpet in the lounge. Some communal toilets and bathrooms were unpleasant in appearance. The garden was not maintained to a suitable standard, the grass had not been mowed and was long. This meant some parts of the garden were not accessible to people.

The provider’s processes were not always effective because equipment and facilities did not always support the delivery of safe care. The provider carried out health and safety audits and fire risk assessments, outstanding actions had not been recorded in the fire risk assessment such as replacing smoke seals and strips, staff told us this work had been carried out but this had not been recorded or updated within the risk assessment. Safety certificates for lifting equipment were in date. Risks in the environment were not always identified or responded to in a timely way.

People did not feel there was always enough staff. Two people said they had to wait for staff when they required support and when they used their call bell. People said most staff were well trained but there was just not enough of them. Relatives also told us there were not enough staff to meet people’s needs. A relative said "Lots of people's needs have changed (increased) but they haven't increased the staffing to ensure they can still meet their needs. Staff are over stretched and can't seem to get around everyone”. Another relative was concerned there were not enough senior staff on duty.

Managers told us they were actively recruiting care staff. They told us there were enough staff on each shift to meet people’s needs and keep them safe. Some staff told us there were not always enough staff and cover was not always arranged in time when there was short notice staff absences.

We observed staff supporting people and responding to their requests in an appropriate way.

They staffing numbers required on each shift were calculated based on people’s dependency needs. Staff rotas showed there were 6 or 7 care staff on duty during daytime hours and 3 or 4 at night. At least on care staff was a senior member of care staff. There were additional domestic, catering and laundry staff for some part of the day. Many people had complex needs including requiring support with their mobility with use of stand-aid or hoist, support with eating and drinking, position changes to prevent pressure sores and 2 people displayed distressed behaviour and required additional support. It was not clear if the staffing numbers provided were always sufficient to meet the needs described.

People and relatives did not feel the service and equipment was always clean.

Managers told us domestic staff followed daily and weekly cleaning schedules. Staff told us they had access to personal protective equipment such as aprons and gloves. When we gave feedback to leaders, they agreed they had not identified the concerns we identified regarding infection prevention and control we found during our site visit. They told us they would take action.

The environment and equipment was visibly unclean, this included hoists and stand aids, stairwells , windowsills, blinds, carpets, chairs. The laundry floor was stained and bags of contaminated waste plied on the floor because there was only 1 domestic size washing machine for the whole service. In communal bathrooms, toilets and wash basins were rusty and tarnished making them difficult to clean. The batteries for mobility hoists were stored within a sluice room causing a risk of cross contamination and infection. There were strong unpleasant odours in some parts of the service.

The provider had an infection prevention and control (IPC) policy and staff had training to reduce the risk of infection. However, processes did not always support effective IPC because some areas of the service were visibly unclean or damaged so could not be properly cleaned and there were unpleasant odours in some areas.

People told us they received their medicines in the right way and at the right time. One person said, "I always get my medication on time. The seniors are very good."

Staff told us they had training and had their competency to manage people’s medicines in a safe way assessed. Staff were knowledgeable and confident about medicine management.

The provider had policies and procedures for staff to follow regarding the safe management of medicines. Staff understood and followed these policies. The recording of medicines received, administered or returned were accurate and up to date. Medicines were stored correctly and securely. People had care plans in place about the medicines they were prescribed and people had their medicines reviewed by their doctor.