Archived: Lehmann House Residential and Nursing Home

About the service

Lehmann House Residential and Nursing Home is a residential care home providing personal and nursing care. The service can support up to 34 people. It is divided into four units over two floors. Two units were being used one upstairs and one downstairs. There were 16 people living in the service at the time of this inspection.

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

There was a lack of clear governance in the service and the provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant poor care was not identified and rectified by the provider. The provider had not effectively and consistently worked with professionals to ensure people's needs were met.

Risks to people's health and wellbeing were not consistently identified, managed or followed to keep people safe. Where advice had been received from health care professionals this was not always followed.

Improvements were needed to ensure incidents of suspected abuse were investigated and reported to the local authority when required. Improvements were needed to ensure people were consistently protected from the risk of infection and cross contamination.

The provider did not use a staffing tool to assess the number of staff required. There were not enough staff deployed effectively to provide care and support. Due to pressures on staff time, interactions with people were often task focussed. Staff told us the training was not of a high quality. We observed poor moving and handling practice during our inspection visit.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The service had obtained consent to people’s care and support arrangements from relatives who did not have the required legal authority.

The activities co-ordinator had left the service and no alternative arrangements had been put in place for people’s social engagement. We were told staff should be providing activities, but no extra staff had been employed to meet this requirement.

The service placed people at risk of physical harm and at the risk of significant emotional harm due to isolation, lack of engagement and the impact of poor care

Rating at last inspection

The last rating for this service was Requires Improvement (published 5 February 2019). At this inspection the service has deteriorated to Inadequate. Previous to the Requires Improvement rating the service was rated Inadequate at the inspection in July 2018.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lehmann House Residential and Nursing Home on our website at www.cqc.org.uk.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and care provided. A decision was made for us to inspect and examine those risks.

Enforcement

At this inspection, we identified breaches of regulation in relation to the management of risks, staffing levels and recruitment practices, people’s emotional and physical needs not being met and the overall governance of the service. We placed an urgent condition on the providers registration and issued a Notice of Decision to close the service

Follow up

This service has now closed.

Lehmann House Residential and Nursing Home is a residential care home providing personal and nursing care to 34 On the day of this inspection five people were being supported over two units.

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

Our previous inspection of 5 and 7 November 2019 had identified concerns regarding the governance of the service. At this inspection we found the provider had begun to make changes this this included the appointment of a new nominated individual to the management team.

We found ongoing concerns with the management of risks to people from receiving care and support. Individual issues relating to infection control had been addressed but we found further infection control concerns.

Due to action by the local authority there had been a large reduction in the number of people using the service between this inspection and our previous inspection of 5 and 7 November 2019. The provider had adjusted staffing numbers because of this. However, we were not fully assured that staffing levels at this inspection fully met the needs of those living in the service.

Our previous inspection found that medicines were not safely managed. At this inspection we found ongoing concerns with the administration of medicines.

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 report for the last inspection has not yet been published and is still subject to factual accuracy comments by the provider.

Why we inspected

We received concerns in relation to staffing and the overall management of the service. 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. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed. 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 Lehmann House Residential and Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s safety, the level of staffing, infection control and the overall management of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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 the 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.

This unannounced inspection took place on 3 December 2018.

Lehmann 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.

Lehmann House accommodates 34 people across three separate units on two floors. On the day of our inspection there were 11 people accommodated in two ground floor units. One unit specialising in dementia care and the other nursing care. Some people supported in the nursing unit were also living with dementia. The two first floor units were not being used.

At the last inspection in April 2018 we rated Lehmann House overall as Inadequate. This was because systems and processes were not in place to ensure that people received good quality of safe care. Following that inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve all of the key questions to at least good. We imposed conditions on the provider’s registration which required them to provide us with monthly updates regarding improvements. We also restricted new admissions to the service.

At this inspection we found that improvements had been made in all areas. Initial actions have been completed and further work is ongoing to embed the changes into the management of the service. The service will come out of special measures as it is no longer rated Inadequate overall.

Since our last inspection the service had worked closely with the local authority to improve the content and quality of care plans. Care plans now contained more detailed information with regard to the assessment of risk and people’s care needs. However, further improvement was still required to the management of risk in relation to specific conditions and the management of some other risks such as the management of pressure ulcers. Risks from the environment were now managed effectively, for example with regular fire drills.

Care plans were regularly reviewed with the involvement of people and their relatives, where appropriate, to ensure they were up to date.

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.

Staff were now recruited safely with the appropriate checks carried out before staff began work.

Meals were nutritious and varied. People told us they enjoyed the meals at the service and confirmed they were given choices. Where people needed support with their meal this was provided. However, we did observe one occasion where this could have been improved.

There were sufficient staff to provide the care and support people required. Staff now received appropriate training to meet people’s needs. Some improvement was needed in staff understanding of how to support people living with dementia.

People were treated with care and kindness. People's wellbeing was protected and all interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity.

The service provided support for people to engage in activities. On the day of our inspection the activities manager was not at the service. We received mixed views from people about how they were supported to maintain their hobbies and interests. The manager has told us how they plan to improve this area.

People and relatives were aware of how to make a complaint. They told us they could approach

management and staff with any concerns and felt they would listen and take action.

Since our inspection in April 2018 the provider has made changes to the management structure in the service. This included the recruitment of a new manager who has applied to the Care Quality Commission to register and a compliance manager. The role of the compliance manager was to oversee the quality of the service provided. More robust management audits had been implemented. This included audits of care plans, medicines and health and safety matters. Where deficiencies were identified actions, plans were put in place to address these. These now needs to become embedded into the culture of the service.

Lehmann House is located in the Suffolk village of Wickham Market and accommodates up to 34 people. There were 14 people accommodated at the time of our inspection.

There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This was the first inspection of Lehmann House since the new provider; De Vere Care Ltd took over Lehmann House and registered it in October 2017.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There had been a lack of oversight of the service by the provider, poor management and leadership with no clinical governance, which had led to people’s safety and welfare being compromised.

Provider governance systems were not operated effectively in order for them to provide an accurate overview of the service and ensure proper monitoring and review, identify shortfalls and inform an ongoing plan for improvement. The provider’s systems had failed to identify the issues we found during our inspection.

Thorough risk assessments were not carried out routinely to identify and mitigate risks in relation to people's healthcare and support needs, and fire safety. Necessary health and safety precautions had not been taken within the home to protect people from harm.

An effective system was not in place to ensure there were sufficient numbers of staff on duty to support people and meet their individual care needs. There were not sufficient numbers of skilled, trained and experienced staff to meet people’s needs effectively at all times.

The culture within the home did not promote a holistic approach to people's care to ensure their physical, mental and emotional needs were being met. Audit and monitoring systems had either not been sustained or were ineffective to ensure that the quality of care was consistently assessed, monitored and improved.

People’s care was not co-ordinated or managed to ensure their specific needs were being met. Records were incomplete and not reviewed. Where people were found to have significant weight loss this was not identified, managed promptly and effectively.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.

Care records did not provide enough information for staff around safe care and supporting people’s wellbeing. Improvements were needed in staff’s understanding of dementia care to enable them to support people in providing care that was effective and person centred. This included staff’s knowledge in managing high levels of anxiety and supporting people to have access to meaningful stimulus, tailored to their level of dementia/needs.

Training for staff was not managed effectively. The majority of the care staff employed had not worked in care before. The provider had not made arrangements to support staff through training and supervision. Recruitment practices were insufficient and did not fully explore people's background. New staff where not supported in their role.

Given the level and seriousness of our concerns following this inspection we shared the information we had with the local authority safeguarding and contracts team. We sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they were going to do immediately to address them. The action plan submitted to us by the provider was not satisfactory. We took immediate enforcement action to restrict admissions and force improvement.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling 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 inadequate for any of the key questions it will no longer be in special measures.