Lucerne House

Lucerne House a residential care home providing accommodation and personal care for 10 people with learning disabilities and autism. There were 10 people living at the home when we inspected. Some people have specialist needs associated with dementia, autism, mental health and epilepsy.

In addition to Lucerne House, the provider also runs a separate supported living service for 42 people living with learning disabilities and or mental health who lived in their own homes. Only one person received support with personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Although a large service, the model of care took people’s individual needs and risks into account. Communal areas were used to ensure people had space and some people enjoyed spending time in their rooms. There were plans to refurbish the garden office to create additional space for people to spend their time. Processes to assess and monitor risks were consistently implemented across the different areas of the home and supported living service.

People told us they felt safe living at Lucerne House we observed people in both settings were relaxed in the company of staff. Safeguarding concerns had been responded to promptly.

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.

Right Care:

People’s received their medicines safely and where appropriate, people were supported to manage, or part manage their own medicines.

There were enough staff to meet people’s needs and wishes. Some people went to day centres and others were supported to participate in activities of their choice. People told us they enjoyed what they did and had regular opportunities to attend church, some went swimming and some enjoyed theatre, shopping and restaurants.

A health professional told us, “I feel the clients are safe and staff are very confident when supporting clients. The home is well managed, and the manager and deputy will always seek advice at any time when needed. The staff are very caring and yes, they understand the clients’ needs.”

Right Culture:

There were effective systems to monitor the quality of the service. Audits were comprehensive and were effective in identifying any shortfalls which were then promptly addressed. The home had identified some improvements needed in relation to developing some areas of record keeping and work was underway to address this.

There was a positive staff culture and ethos in the way people were supported which led to people developing independence and doing things they enjoyed. Local links had been established which further enhanced people’s lives within the area the lived. People’s relatives felt that there was good communication and they were kept informed and equally could contact the service if they had any concerns.

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 16 March 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains good.

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

Follow up

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

We found the following examples of good practice.

The home was following government guidance in relation to visitors. We were told essential maintenance visits were safely implemented in line with government guidance. For example, all visitors wore personal protective equipment (PPE) and were advised to remain socially distant from people and staff. All essential visitors had their temperature taken on arrival and they were asked to carry out a Lateral Flow Device (LFD) Covid 19 test before they could enter the home. The result was recorded.

There were plans to make alterations to the conservatory in the week after the inspection to enable visitors to see their relatives in a safe and socially distanced way. A new fogging machine had also been bought, staff had received training on its use, and the home was awaiting delivery. Some people met with a relative for a socially distanced walk and one person was taken to their relative’s house to do window visits.

The registered manager followed current guidance in relation to infection prevention and control. Alongside regular cleaning routines, additional cleaning was scheduled throughout the day and night. A new cleaner had been appointed and regular deep cleaning was carried out. The home had remained Covid free but had contingency plans in place should any person or staff come into contact with anyone with Covid 19 or test positive. All staff wore PPE and had received training on infection control, the putting on and taking off of PPE and hand washing. Individual risk assessments had been written for people and staff to consider specific risks for each in relation to any underlying health conditions or specific considerations.

A couple of months ago there had been an occasion when one person had received what they now believe to have been a false positive test for Covid 19. The registered manager told us the actions they took to ensure people and staff safety. The person concerned was isolated to their bedroom and received meals there. Laundry facilities were changed to minimise the spread of any possible infection. The person had recently learned how to use their mobile phone and was able to phone and receive calls from relatives independently. The person told us, “I wouldn’t want to do it again, but I enjoyed having my meals in my room and chatting to staff.” The registered manager told us this had been a helpful exercise to see what worked and did not work and what would need to be changed if they had an outbreak.

The registered manager told us they met virtually and in the garden with the providers who were very supportive. In addition, they had joined a What’s App group for registered mangers and found this incredibly supportive. They were able to see questions and answers from other managers who had to deal with outbreaks, and this had helped to shape their contingency plans. The main office had been moved to a new office in the garden. The old office was now a quiet lounge but could be used in the event of an outbreak as a donning and doffing area for staff.

We asked one person what they were looking forward to doing after lockdown and they said, “Seeing my family.” Staff supported to maintain contact with relatives by social media or telephone. Before our inspection we received positive feedback from a relative thanking the staff for their support and care during the lockdown. This information was shared with the manager who put it on the home’s closed Facebook page. Following this the home received five further responses from relatives echoing their thanks and praise for the staff team. At the time of our visit a few people were doing jigsaws, one person was doing sand art, another was using a laptop and others were listening to music. Three people continued to go out independently for walks and others were supported to have daily exercise outside of the home.

Lucerne House is a residential care home for up to ten people living with a learning disability and/or autism. The organisation also supports two people who live in their own home, (known as Flat 6). At the time of our inspection these people were not in receipt of personal care so we did not carry out an inspection of the support they received. People living at Lucerne House had learning disabilities and their needs were varied. Some people needed support with living with autism, diabetes, dementia and epilepsy. Some people displayed behaviours that challenged others.

People’s experience of using this service:

Lucerne House was registered before Registering the Right Support (RRS) had been published. Nevertheless, we found the care service reflected the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. ‘People with learning disabilities and autism using the service can live as ordinary a life as any citizen’ – Registering the Right Support Policy.

¿ There were good recruitment procedures and enough staff to meet people’s individual needs. People told us they felt safe. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed.

¿ People’s medicines were managed safely and the registered manager worked with health professionals to make sure people were only prescribed medicines that were needed.

¿ People’s needs were effectively met because staff had the training and skills to fulfil their role. This included training to meet people’s complex needs in relation to epilepsy, diabetes and behaviours that challenged.

¿ Staff attended regular supervision meetings and received an annual appraisal of their performance.

¿ Staff supported people in the least restrictive way possible. People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

¿ People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them.

¿ People were supported to attend health appointments, such as the GP or dentist. If assessed as appropriate and in line with individual needs, appointments were held at Lucerne House.

¿ People told us they had enough to eat and drink and menus were varied and well balanced. People’s meals were served in a way that respected their specific needs and beliefs.

¿ People were supported to take part in a range of activities to meet their individual needs and wishes. Some attended college courses and day centres and others preferred to choose a daily plan of activities arranged with the support of staff. People also told us they enjoyed visiting their friends and inviting friends and their family members to their house. A social care professional told us, “In my experience (staff) have been very supportive of the relationships the people who live at Lucerne House have with their family members.”

¿ The environment was clean and well maintained. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks were all up to date.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis.

¿ People and relatives were given information on how to make a complaint and said they would be comfortable raising a concern or complaint if they needed to.

Rating at last inspection:

This service met the characteristics of Good. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection:

Good. The last inspection report was published on 27 April 2017.

Why we inspected:

This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up:

We will review the service in line with our methodology for 'Good' services.

At the last inspection in June 2016 we found the 'well led' question in relation to the flat required improvement. There was no effective system to regularly monitor the quality of care provided at the flat. There was no environmental risk assessment or systems to support people to raise any problems they might have had with the building. The provider sent us an action plan that told us how they were to meet the breach of regulation by October 2016.

This unannounced focused inspection on the 24 February 2017 was to check that the provider had followed their plan and to confirm they now met legal requirements. We looked specifically at the 'well led' question in relation to the flat and we found that that they had now met the specific breach of regulation previously found. However, we continued to find areas of practice that require improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Lucerne House) on our website at www.cqc.org.uk.

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

Although the provider visited regularly to review the running of the service and to provide supervision to the registered manager there were no records of these visits or any actions taken. These areas of record keeping were identified at the last inspection and remain an area for improvement.

There were improved systems in place to oversee care provision. For example as people’s needs changed the care and support provided had been increased or decreased in line with their wishes and needs. When there were concerns about people’s health or well-being additional advice had been sought to ensure people’s needs could be met. An environmental risk assessment had been carried out and reviewed to ensure that the building was safe. Equipment was serviced regularly. Support was provided as and when needed to ensure the building was kept clean and in a way that met the needs of the people who lived there.

There were regular audits carried out in relation to the management of medicines and staff had received training to enable them to meet the needs of the people they supported. There were opportunities for people to share their views about the care and support they received. It was evident that when shortfalls occurred, for example, in relation to light bulbs not working or a problem with the boiler, people knew how to raise the issues and records showed they were addressed promptly.

Whilst the breach of regulation has been met we could not improve the rating for well led from requires improvement because there remained an area of record keeping that had not improved. We will check this during our next planned comprehensive inspection.

Whilst the majority of people had good communication skills, a small number of people needed support with communication and were not able to tell us their experiences, so we observed that they were happy and relaxed with staff. At the time of our inspection there were eight people living at the home.

There was no 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. An acting manager was appointed in March 2016 and since the inspection they have submitted their application for registration.

We carried out an unannounced inspection on 28 November and 03 December 2014 of both services where we rated the home as ‘Requires Improvement’ in all areas. We issues specific requirement notices in relation to safe care and treatment, person centred care, consent, independence and dignity and governance. We received no action plan from the provider to tell us how they would make improvements. We carried out this comprehensive unannounced inspection of both the care home and Flat 6 on 29 and 30 June 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that overall significant improvements had been made in the running of the home.

Oversight of Flat 6 was less thorough than that of Lucerne House. There was no environmental risk assessment in place and one person’s risk assessment documentation was not up to date.

There were enough staff who had been appropriately recruited, to meet the needs of people. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. Staff understood what they needed to do to protect people from the risk of abuse. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

The acting manager and staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed that restrictions were required to keep some people safe and where this was the case referrals had been made to the local authority for authorisations.

Staff had a good understanding of people as individuals, their needs and interests. Some people attended day centres and work placements and staff also made sure that those who did not had the opportunity to go out every day. People’s spiritual needs were met.

People had access to healthcare professionals when they needed specific support. This included GP’s, dentists and opticians. Some people had specific fears in relation to their healthcare needs and the home went the ‘extra mile’ to make sure that their needs could be met in a way that suited them. This included obtaining easy read information that explained procedures and arranging for professional visits to be carried out in their home.

People were asked for their permission before staff assisted them with care or support. Staff had the skills and knowledge necessary to provide people with safe and effective care. Regular training was provided specific to meeting people’s needs and if staff identified additional training that they would like to receive, arrangements were made for this to happen. Staff received regular supervision and support from management which made them feel valued.

The acting manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately. Staff and people spoke positively about the way the service was managed and the open style of management.

We found one breach 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 this report.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The home had changed to a new pharmacy supplier and new systems were still being put in place. They systems for the management of medicines were not robust. When shortfalls were found there was not always evidence that actions had been taken to resolve them.

A number of staff personnel files did not contain all required pre-employment checks. Criminal records checks were obtained for staff. However, systems were not in place that ensured that matters raised through this process had been discussed with prospective staff and where appropriate, potential risks had been minimised. This meant that the provider could not demonstrate that staff employed to work at the home were suitable.

Records were not always sufficiently detailed to determine how staff dealt with situations. For example, a verbal complaint had been made to the home but there were no records of the investigation or actions taken.

Is the service well led?

There was no effective system in place to regularly assess and monitor all areas of the home and to ensure that when shortfalls were identified appropriate actions were taken.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had not needed to make any applications but there were policies and procedures in place and the manager had been trained to understand when an application should be made and, how to submit one. We were told that arrangements would be made for the staff team to receive training on this subject. There were shortfalls in record keeping in relation to the management of some medicines.

A number of staff personnel files did not contain all required pre-employment checks. This meant that the provider could not demonstrate that staff employed to work at the home were suitable. There was no system in place to demonstrate that all staff received regular supervision. A number of records were misplaced, some were found over the course of the day and others could not be located. This meant that the home was unable to demonstrate that they were meeting the standards in these areas.

Is the service effective?

People told us they were happy living at Lucerne House and that their needs had been met. Staff had a good understanding of people's needs and it was evident that they knew people well. If people had complex needs, specialist advice and support had been sought to assist staff. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were treated with respect and staff were courteous. They explained to people what they were doing and offered them a choice of a variety of activities. We saw that staff supported people to achieve their wishes. For example, one person in supported living told us, 'I swapped my bedroom and lounge around so that I have a bigger bedroom and a smaller lounge. We don't use the lounge much and I needed more space so we had a meeting and agreed to do it. We like the way it is now.'

Is the service responsive?

Records confirmed that people's preferences, interests and diverse needs had been recorded and that care and support had been provided that met their wishes. People had access to activities that were important to them. For example, some people had work placements; some went to college and some, day centres. People were supported to attend religious services, to go to clubs and a disco. They visited friends and invited their friends to visit them.

Is the service well led?

The organisation had arranged for a consultant to support them with addressing shortfalls identified at the last inspection. It was evident that progress had been made in some areas and that systems needed time to be embedded fully. However, there was still no effective system in place to regularly assess and monitor all areas of the home.

We spoke with four of the nine people living at Lucerne House and with one person from the domiciliary service. People told us that they liked living at Lucerne House. They said that their keyworkers helped them to make plans to do the things they wanted to do.

One person in the domiciliary service told us, 'I love living in my own home. I decide what to do each day and have a busy timetable.' They said, 'I have a mobile phone so I can get help if I need it in an emergency.'

People living at Lucerne House told us, 'My keyworker discusses my care plan with me.' Another person said, 'I talk to my keyworker if I need any support.'

We observed that staff ensured that consent was obtained prior to providing care and support. We found that care plans were detailed and documented the needs of people and how they should be met. However, some of those seen had not been reviewed for several years.

There was inadequate monitoring of the systems in place for the safe management of medicines and this meant that some of the information available to staff was not up to date.

Staff told us that they received training to perform the duties of their various roles within the home. However, the home was unable to demonstrate that this had taken place. There were no systems in place to ensure that staff attended supervision meetings.

The systems in place to regularly assess and monitor the quality of the care provided were not effective.

We saw that people were very involved in their support plans and all knew who their key worker was. The home was clean and comfortable. We found that staffing levels were appropriate and that the service provided extra staff to support people in outside activities. The staff had received training and regular supervision sessions.