Archived: The Laleham

Updated 5 July 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection was carried out by two inspectors.

Service and service type:

The Laleham is a care home. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Although the service had a manager registered with the Care Quality Commission they had been absent from the service since May 2018. Between May 2018 up until this inspection there had been one temporary manager and another manager who had left in April 2019. A new manager had been appointed but was not present throughout the inspection. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The first day of the inspection was unannounced. We told the management team we would be returning for the second day.

What we did:

Because this was a responsive inspection brought forward due to concerns, the provider had not been asked to complete a Provider Information Return. Providers are required to send us key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We gathered this information throughout the inspection. We reviewed the information we held about the service including previous inspection reports. We also looked at notifications about important events that had taken place in the service, which the provider is required to tell us by law. We used all this information to plan our inspection.

We spoke with nine staff including; the head of care, the administrator, care staff, activity staff, senior care staff, and the provider. We spoke with two people’s relatives and received feedback from eight people. Some people were unable to verbally express their experiences of living at the service. We observed staff interactions with people and observed care and support in communal areas.

We looked at seven people’s personal records, support plans and people’s medicines charts, risk assessments, staff rotas, staff schedules, four staff recruitment records, staff training records, records in relation to how the service is run and policies and procedures.

We asked the provider to send us additional information after the inspection which we received.

Updated 5 July 2019

About the service:

The Laleham provides accommodation and personal care for up to 60 people. Some people may be living with dementia. Bedrooms are on three separate floors and are accessed by a passenger lift. There are various communal rooms, including lounges and dining rooms. The service faces the sea and has parking at the front. There were 45 people using the service when we inspected.

People’s experience of using this service:

The provider had not referred all incidents to the local safeguarding team as required.

There were inconsistencies in the recording of incidents. Further analysis was required to ensure consistency in management oversight and to identify patterns and trends in all areas to prevent or reduce repeated incidents.

The provider used a dependency tool to establish how many staff were required. Although there were enough staff to meet people’s needs during the day, staffing was reduced through the night and the provider was unable to tell us how they calculated the number of staff required at night. The provider had not taken into consideration the layout of the service of specific needs of people.

Staff had not always been recruited safely. Staff files contained unexplained gaps in their employment history and missing information.

Risk management was not consistent. For example, behaviour guidance was missing for people who could display behaviours that could challenge others and there were no risk assessments about the use or storage of an oxygen cylinder a person used. Other risks had been identified and action taken to reduce any potential harm, for example environmental risks.

Most medicines were safely received, stored and administered and regularly audited to check for any errors. We found some opened undated liquid medicines and unclear guidance for the administration of medicines which had strict protocols around administration. The provider acted to improve this after the inspection.

The environment was clean, however, chipped paint, especially to lower areas of doors and door frames, exposed bare wood. Bare wood is absorbent of fluids and therefore difficult to clean. Staff had enough personal protective equipment to carry out cleaning duties safely.

Staff had not always received training to enable them to meet people’s specific needs.

The service was an older large property with a complex layout. Although some thought had been put in to making areas of the service more identifiable, more was required. Some people living with dementia may find it difficult to find their way around the building.

There had been numerous management changes which had impacted on the consistency, development and continuous oversight of the service. Although auditing processes were in place to analyse risk and the delivery of care, audits had failed to identify the issues we found during our visit.

The registered persons had not submitting safeguarding notifications to the Care Quality Commission in an appropriate and timely manner in line with our guidelines.

People, visitors and relatives had been asked to complete feedback forms about the quality of the care provided. Analyses and action to improve from the feedback provided had not always been acted on in a timely way.

The service was compliant with the Mental Capacity Act 2005. People needs were assessed before being offered placements at the service. People needs were re-assessed and action taken where required so staff could continue to support people to meet any changed needs.

People were offered a variety of meal choices and alternatives were prepared if people did not like what was offered on the daily menu.

Staff were responsive to people’s health needs. People had been supported to access healthcare resources such as dieticians, SALT, psychiatrists, mental health teams, consultants and specialist nurses.

Staff spoke with people with kindness and respect, people were asked for permission before being supported with any care needs.

People were offered different activities. Throughout the inspection we observed people taking part in various activities such as quizzes and crafts. Staff made sure people who preferred to stay in their bedrooms had one to one time to avoid isolation.

The complaints procedure had not been written in an easy to read format for people living with dementia. The policy was not available in large print or any other formats for people.

Each person had their own individual care plan which detailed the support they required. Some information was missing from the care plans which the head of care was in the process of updating.

Rating at last inspection:

The service was rated Good at the last inspection on 15 & 17 August 2017 (the report was published on 18 September 2017). At this inspection we found overall the service met the characteristics of requires improvement.

Why we inspected:

This inspection was brought forward due to information of concern we received in relation to the building and environment of the service.

Enforcement:

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

Follow up:

We will ask the registered provider to send us their action plan to tell us how they will improve the service. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk