The Lombrand Limited

The Lombrand is a residential care home providing accommodation and personal care for up to 21 people who need support with their mental health. At the time of our inspection 14 people were living at the home.

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

People received kind and compassionate care from staff who knew them well. People were happy and relaxed being supported by staff, and staff supported people to be independent and respected their privacy and dignity.

Staff were skilled, experienced, and had the training to support people effectively.

People were supported safely with food and drink, and to see health and social care professionals if this support was necessary.

The environment was suitable to people's needs.

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.

People received personalised care which met their support needs and their preferences. People were encouraged and supported to do things that they enjoyed.

The registered manager and staff team promoted a positive culture at the home. The registered manager completed audits to monitor the quality of the service and put actions in place to continually improve the service. People, and the staff team were regularly asked to give their feedback about the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 requires improvement (published 24 May 2023).

Why we inspected

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

This report only covers our findings in relation to the key questions of effective, caring, responsive and well led which contain those requirements.

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 has changed from requires improvement to good based on the findings of this inspection.

Please see the effective, caring, responsive and well led sections of this report.

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.

You can read the report from our last inspection, by selecting the 'all reports' link for The Lombrand on our website at www.cqc.org.uk.

Follow up

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

The Lombrand is a residential care home providing accommodation and personal care for up to 21 people living with mental health conditions. At the time of our inspection 14 people were living at the home.

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

The provider, management team and staff had worked hard to make improvements since the last inspection to people’s outcomes, and to the governance systems at the home. These processes required further time to embed and be sustained to drive continuous improvement.

People who lived at the home told us they felt safe and well cared for. One person said, "I am happy living here. There is always someone to help me if I need it."

Overall the environment was clean and tidy, however we spoke with the management team regarding some areas of the home that required attention.

Peoples care plans and risk assessments continued to be improved to ensure these reflected their changing needs and gave staff clear guidance on how to meet these. Accidents and incidents were documented, investigated and reviewed to identify any patterns and trends.

People were supported by sufficient numbers of safely recruited staff. People appeared relaxed and comfortable in the company of staff, and we observed warm and caring interactions.

Staff had received training in safeguarding and knew how to identify and report concerns. Any safeguarding issues had been reported in line with guidance.

People’s medicines were managed safely.

Staff felt supported in their role and enjoyed working at The Lombrand. Staff were positive about the management and felt valued and listened to.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 last rating for this service was requires improvement (published 20 January 2023) and there were breaches of regulations. 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.

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the key questions of safe and well led which contain those requirements. 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 has remained requires improvement based on the findings of this inspection. Please see the safe and well led sections of this full report.

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.

You can read the report from our last inspection, by selecting the 'all reports' link for The Lombrand on our website at www.cqc.org.uk.

Follow up

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

The Lombrand is a residential care home providing accommodation and personal care. The service accommodates up to 21 people living with mental health conditions. At the time of our inspection 16 people were living at the service. The Lombrand is one building with 3 floors.

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

The service had made significant improvements and changes since our last inspection, but these practices were not yet embedded. The manager acknowledged, “There was further work to be done”.

Improvements to governance systems had been made since the last inspection, however, these were not always fully effective and had failed to identify issues raised during the inspection. Further improvements were required to ensure documentation was consistently accurate. Care plans were not always reflective of people’s current needs.

There was not enough staff to ensure people received personalised care. Staff had received training and were clear about their role. Staff had good knowledge of safeguarding and told us they felt confident raising concerns.

People told us the food was good and people had enough food and drink provided.

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.

People who used the service told us they felt safe. One person said, “It’s a lovely home”.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 last rating for this service was inadequate (published 8 April 2022) and there were breaches of regulations. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 8 April 2022. During this inspection the provider demonstrated some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

We have identified continued breaches in relation to governance and oversight of the service and in relation to the deployment of staff.

At our last inspection we recommended the provider review their systems and processes to ensure access to healthcare services are consistent. At this inspection we found the provider had acted upon this recommendation and some improvements had been made.

At our last inspection we recommended the provider review their systems and practice relating to complaints. At this inspection we found the provider had acted upon this recommendation and improvements had been made.

At this inspection, we have made recommendations relating to achieving better outcomes for people.

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

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, which will help inform when we next inspect.

The Lombrand is a residential care home providing accommodation and personal care. The home accommodates up to 21 people living with mental health conditions. At the time of our inspection 16 people were living at the home.

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

People did not receive a safe, person-centred and well led service.

The service was not safe. Appropriate standards of hygiene had not been maintained in all areas. Effective infection prevention and control (IPC) measures were not always followed by staff and management. Risks in relation to infection control, people and the environment had not been fully considered and managed and there was limited action to prevent reoccurrence when things went wrong. Medicines were not always managed safely. This placed people at risk of harm.

The service was not always caring. People told us they were not always treated with kindness, dignity and respect. Independence was not always considered and promoted. People were not always involved in making decisions about their care and support.

The service was not always responsive to people’s needs. Care was not person centred or delivered in line with people’s preferences and wishes. This put people at risk of harm or poor care. Relatives told us communication was poor and they were not consulted or involved in their relatives’ care when people required support to make decisions. Government guidance in relation to visiting had not been followed. People told us they experienced isolation.

The service was not well-led. We found widespread and systemic failings throughout the service. Audits were not effective in driving forward improvements within the home. Policies and procedures were not consistently followed to maintain safety. Good practice guidance was not always considered and implemented. Records were not always accurate, up to date and reflective of people's needs.

Staff were not always provided with training and support to complete their role. We identified gaps in training and staff knowledge. Supervision systems were in place, were not robust and not all staff received regular supervision in line with the provider’s policy.

The principles of the Mental Capacity Act were not always followed. 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; policies and systems in the service did not support this practice.

Staff did not feel supported in their roles and described a culture of blame and bullying. Staffing levels within the service were not sufficient to enable staff to engage with people, support people with activities or to access their local community.

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

Rating at last inspection

The last rating for this service was good (published 15 May 2020).

Why we inspected

We carried out a targeted inspection on 07 January 2022 to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about COVID-19. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the provider following COVID-19 guidance, so we widened the scope of the inspection to become a comprehensive inspection which included all the key questions of safe, effective, caring responsive and well-led.

We looked at IPC 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. This included checking the provider was meeting COVID-19 vaccination requirements.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified multiple breaches in relation to person centred care, safe care and treatment, safeguarding, consent, dignity and respect, staffing and good governance 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

The Lombrand is a residential care home providing accommodation with personal care. The home accommodates up to 21 people in one house. At the time of our inspection 16 people were living at the home who had mental health conditions.

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

People were kept safe from the risk of abuse and avoidable harm. Staff were recruited safely and there were enough staff to keep people safe. People received their medicines as prescribed and staff followed good infection control practices.

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.

People told us the care they received was effective. We saw people's needs and choices were assessed in line with standards, guidance and the law. Staff worked proactively to ensure people were supported to live healthier lives and have control within their lives. Staff told us they had access to training and felt supported in their roles. People's nutritional needs were met.

People received care from staff who knew them well as they had worked with them for several years. People liked staff and had developed good relationships with them. Staff treated people with dignity and respect.

People were involved people in their care and their plans were based on their needs and preferences. Staff engaged people in activities they were interested in. The provider had a suitable process to respond to any concerns or complaints.

The provider, registered manager and staff team were open, approachable and focussed on providing person centred care. Systems were in place to monitor the quality of care provided.

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 (report published 7 August 2017).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.

At the last inspection in March 2015 the service was rated Good. At this inspection we found the service remained Good.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks to people and the environment were assessed and plans put in place to mitigate any identified risks. Policies and procedures were in place to manage medicines. The provider had safe recruitment procedures in place and ensured there were sufficient numbers of staff on duty to support people’s needs. Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The provider had a plan of training in place to ensure staff had the correct skills to meet the needs of the people using the service. Staff were supported through supervision and received an annual appraisal. People were provided with a balanced and varied menu to meet their nutritional needs.

Staff provided care and support in a meaningful and caring way. They knew the people who used the service well. People were involved in the planning of their care and support.

People's care and support needs were detailed, reviewed and met by staff who had a good understanding of how and when to provide people's care. Staff respected people's choices and independence.

There was a complaints procedure in place and people told us they knew how to complain.

Further information is in the detailed findings below.

We saw that the system for administering medication was robust although some improvements in managing and recording boxed medication were needed. The environment was well maintained and suited to the needs of the people who used the service.

There was a comprehensive system in place for the supervision and training of staff. Staff reported that they felt supported by management. The service had an audit system in place that was used effectively by staff and management and action planning was monitored and carried out well. People who used the service and staff were given various opportunities to feed back and be involved in the development of the service.

We found the atmosphere in the home was relaxed and friendly and people who lived there were interacting positively with each other and with the members of staff supporting them.

However, when we visited on 23 August 2012 we found that robust recruitment procedures and record keeping were not in place. People were not protected from the risk of unsafe or inappropriate care. The provider had taken action to remedy this and we found improvements in staff recruitment and record keeping when we visited the service again on 31 August 2012.