Lannock Manor

Lannock Manor is a small residential care home registered to provide accommodation and personal care without nursing. The service accommodates up to 10 adults with mental health needs in one building. There were seven people using the service at the time of this inspection.

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

People felt safe and were protected from avoidable harm by a staff team trained to recognise and report any concerns. Staff reviewed their practise when things went wrong to learn lessons and adapt their practise. Risks to people’s health and safety were identified and safely managed. People received their medicines at the right times, and these were managed safely. People lived in a clean, hygienic environment.

People were supported by sufficient numbers of staff. Staff were employed following appropriate references and disclosure and barring checks being carried out.

Staff were supported to develop their skills and worked well together. Staff worked with external care professionals to ensure people received the care and support they needed.

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. People were involved in making decisions about their care and support. Staff supported people to express their views and consulted them about their care.

The management team and staff were caring and supported people in a person-centred way. Staff were friendly, and treated people with respect. People’s were supported and encouraged to engage in meaningful activities that supported their personal interests. People felt able to raise concerns to the management team when they wanted.

The provider and registered manager understood their role and legal responsibilities. The provider and registered manager's vision and ethos for the service was now fully understood and embraced by the staff team. Regular audits and quality monitoring helped drive forward improvements in the service. The registered manager and staff were approachable. Team morale was positive and staff were proud to work for the service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 March 2019).

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lannock Manor on our website at www.cqc.org.uk.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Rating at last inspection: At the last inspection in March 2018 the service was rated as, ‘Requires Improvement’. This was because the provider had not always maintained robust governance of the service and improvements were needed in record keeping, management of medicines and assessment of risk. We also found that staff had lacked training, their competencies were not assessed and there was a lack of engagement and involvement of people who used the service.

Why we inspected: This was a scheduled inspection based on the previous rating to assess improvements the provider had made.

People’s experience of using this service:

• Whilst significant improvements had been made since our previous inspection in March 2018 the management team acknowledged that further work was still needed to embed their values and philosophy into day to day life at Lannock Manor.

• There was a range of activities on offer at the home. However, these were not always meaningful and failed to support people in their quest to move on to more independent living.

• People had care plans that detailed the care and support they needed. However, these plans did not help support people with their rehabilitation or to move into independent living.

• People told us they felt the care and support they received was safe. Staff received training in safeguarding and they knew how to report their concerns internally and externally to safeguarding authorities.

• People’s medicines were managed safely.

• People enjoyed their meals and their dietary needs had been catered for. Staff supported people to prepare meals to help them when living independently.

• Staff received training to help them support people safely and their practical knowledge and competencies were assessed by the manager.

• There had been significant changes in the staff and management team at Lannock Manor. People, relatives and staff said this had been positive.

• People had good health care support from external professionals. When people were unwell, staff liaised with health professionals to address their health care needs.

• People felt well cared for by staff who treated them with respect and dignity.

• People and relatives told us they were confident to raise a concern if they needed to.

• People and relatives told us staff were kind and caring. People`s dignity and privacy was protected.

• The manager worked in partnership with health and care professionals and the local community.

• When required notifications had been completed to inform us of events and incidents that happened in the home. This helped us the monitor the action the provider had taken.

• The manager continuously monitored the quality of the service through audits and feedback received from people, their relatives, staff and external agencies.

Follow up: 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.

Lannock Manor 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.

Lannock Manor is a small residential centre registered to provide accommodation without nursing and accommodates up to 10 Adults with mental health needs in one adapted building.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last inspected Lannock Manor on 15 August 2017 we found breaches of regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to maintain robust governance of the service, record keeping was poor, management of medicines was not safe and risks to people’s safety and wellbeing were not appropriately assessed or managed. We had also found that staff lacked training, their competencies were not assessed and there was a lack of engagement and involvement of people who used the service. This was the first time the service had been rated as ‘Requires Improvement’.

Following the comprehensive inspection on 15 August 2017, the provider wrote to us to tell us how they would make the necessary improvements to meet the legal requirements. At this inspection we found that the provider had introduced many improvements to help promote people’s safety and wellbeing however, further development was needed to embed improved practice and processes and this remained ‘work in progress’ at this time.

People felt safe living at Lannock Manor. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calmer than we had found previously and people's needs were met by sufficient numbers of staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Since the previous inspection some improvements had been made to the staff training provision however, further improvements were still needed to help ensure the staff team had the skills necessary to support people who used the service effectively. People received support from staff members who had regular supervision from line management however, this had not been rolled out to bank staff members. Permanently recruited staff understood their roles in protecting people's rights in accordance with the Mental Capacity Act 2005 (MCA). However, bank staff were not always clear about how people’s mental capacity affected their ability to make informed decisions or the processes around assessing this. People told us they enjoyed the food at Lannock Manor and those who were able to plan, prepare and shop for their meals did so with minimal support from staff. People's day to day health needs were met when needed and they had access to health care and social care professionals when necessary.

People were not always aware of the content of their support plan, or how they could be supported to achieve independence and individual goals. Reviews of people’s support needs were completed monthly but did not always involve people. People told us that staff were kind and caring towards them and people were relaxed in the company of staff. Staff were calm and friendly with people and listened when they tried to verbalise how they were feeling. People told us that staff treated them in a dignified manner and respected their privacy. People were encouraged to maintain relationships with family members or those people important to them.

Some improvements had been made to identify the support people needed to gain the skills and experience to give them the opportunity to move on to independent living. However, further improvements were needed to develop a meaningful plan to support people to identify and achieve meaningful goals. Improvements had also been made in supporting people to access meaningful engagement both inside and outside the home, however, this needed to be more embedded into daily practice in the home. People told us they knew how to make a complaint and would raise any concern with staff or management team.

Improvements had been made in respect of record keeping, staff training, staff supervision, governance and leadership. However further work was needed across all areas to continue to develop and to embed the improvements into daily practice. The provider had sourced a suite of policies and procedures and developed an employee handbook to clearly set out staff and management responsibilities. A range of audits were undertaken, areas of shortfall were identified and documented with the actions required to remedy these.

Staff attended regular team meetings with the registered manager. Staff told us these meetings were useful and they felt able to raise any issues or ideas they may have had in relation to the running of the home. Satisfaction surveys were distributed annually to relatives of people who used the service and relevant professionals. All the people we spoke with along with staff members told us the management team were visible and supportive throughout the home. The provider had become a member of an external care provider’s association. This membership gave them access to up-to-date information, support and advice, training courses and qualifications, support with recruiting experienced and qualified staff and a host of business services.

Lannock Manor is a residential care home providing a rehabilitation service for up to 10 people with mental health needs. On the day of our inspection nine people were living at Lannock Manor.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This is the first inspection of this service since initial registration in January 2016.

People told us they felt safe living at Lannock Manor. However, risks to people’s safety and wellbeing were not consistently managed. The staff team did not have the necessary skills and knowledge to manage people’s behaviours. People’s medicines were not always managed safely. Staff had received training in safeguarding matters however, were not able to demonstrate good knowledge in this area. Safe and effective recruitment practices were followed to help make sure that all staff were of good character and suitable for the roles they performed at the service.

Staff had received training to help them to provide safe support for people however, this was primarily by means of e-learning and there had been no assessments undertaken to assess the knowledge and competencies of the staff team. Staff did not always feel supported by the management team. Staff had completed training in relation to the Mental Capacity Act 2005 (MCA) but were not clear on their responsibilities and people’s rights under the Act. People’s relatives told us that the care and support provided at Lannock Manor was appropriate to meet people’s needs. People were provided with a good choice of food and were supported to choose where and when they wanted to eat their meals. People were supported to access healthcare services to monitor and maintain their health where appropriate.

People’s support plans failed to detail the individual support people required in order to further their independence and did not identify goals or measure any achievements towards independence.

People did not always receive the support they needed to access or engage in meaningful engagement outside the home. Staff told us that there were not enough staff available to support people to meet their individual social and engagement needs. Some activities had been provided on a planned and individual basis, such as a day trip to Cambridge and going to a concert.

Record keeping was not always robust. For example, support plan reviews were not always completed in a timely manner, a support plan for a person recently admitted had not been completed and there were no audit trails of how decisions had been reached in relation to people’s support and actions taken to address shortfalls. Policies and procedures were not robust and did not cover all aspects of the service provided. The provider’s quality auditing systems were not robust and had not identified shortfalls found during our inspection. The registered manager had not always informed the CQC of significant events in a timely way which meant we could not check that appropriate action had been taken.

The registered manager worked closely together with the provider on a day to day basis to run the service and the registered manager reported that consequently they did not have anyone provide them with formal supervision. There was no process in place to capture any verbal dissatisfaction of people who used the service. Staff did not feel the culture in the home promoted team work and empowerment.

Relatives of people who used the service told us that they felt the home was well run. The registered manager demonstrated an in-depth knowledge of the people who used the service. The provider had a system in place to capture the views and opinions of people who used the service, their relatives and external professionals.

You can see what action we have told the provider to take in relation to the areas that they were not meeting the standards at the back of the full version of the report.