Archived: Leighswood

Leighswood is a residential care home providing personal care and accommodation to people aged 65 and over who may also be living with dementia. The care home is registered to provide support to 23 people in one adapted building, at the time of inspection 14 people lived at the home.

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

Enough improvements had been made to the home to meet the previous breaches of regulations. The environment had been redecorated in several areas and new bathrooms and toilets had been fitted. We found the environment to be safe for people to use. The garden had been cleared and was now accessible for people to enjoy. Further improvements were planned to make the environment more dementia friendly.

People told us they felt safe, and relatives had no concerns about their loved one’s safety. Staff had received refresher training about how to escalate concerns and were aware of potential risks when providing support. People received their medicines when they needed them. Staff were following current guidance and wearing the appropriate personal protective equipment.

Improvements were ongoing to ensure care records reflected people’s needs and preferences, and to provide meaningful activities that met individual needs. Systems were in place for people and relatives to raise any concerns.

People and relatives thought the management team were approachable and positive comments were received. People and relatives confirmed they had been consulted about the running of the home and the improvement’s that had been made. Audits were in place and these were used to check the standards in the home, to monitor the ongoing improvements, and to ensure people received safe care.

Rating at last inspection (and update) The last rating for this service was Inadequate (published 26 February 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve the breaches in relation to good governance, premises and equipment and person-centred care.

This service has been in Special Measures since February 2020. During this inspection the provider demonstrated that 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

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.

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

Leighswood is a care home which provides support for up to 23 people in one building. At the time of our visit, 20 people were using the service, one person was in hospital. These were older people, most of whom were living with dementia.

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

Some repairs had recently been undertaken at the service, however we identified further areas of the environment which required improvement, and some equipment was broken. The rear garden of the home was not accessible for people and not a pleasant environment for people to use with rubbish and equipment left in it.

There were enough staff to ensure people were safe and meet their basic care needs. However, most people were living with dementia and staff did always have time to support people in the way they would like to.

Where risks associated with people's health and wellbeing had been identified, plans were in place to manage some of those risks. However, some information in relation to risks was missing, so staff were not able to always support people safely.

People received care which was not always responsive to their individual needs. People were supported with minimal social activities to keep them stimulated.

Care records provided staff with some information in relation to people’s backgrounds, interests and individual health needs.

Staff understood their responsibility to safeguard people from harm and knew how to report concerns.

Medicines were stored and administered correctly, and staff had received some training in relation to this.

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; systems supported this practice.

People told us staff were caring in their approach and had good relationships with people.

Staff encouraged people to maintain a balanced diet and understood people’s special dietary needs. The provider and staff team worked with external health professionals to ensure people's health and wellbeing was maintained.

A registered manager was in post. Positive feedback was received in relation to the registered manager.

People and relatives had limited opportunities to feedback about the running of the service.

The registered manager was not aware of the Accessible Information Standard.

Some basic quality checks were carried out to monitor the service, however these had not identified where some improvements could be made to care or the environment.

The correct rating was not displayed. The registered manager had informed us of some significant events at the service however was not always clear of other events we should be notified of.

We received some mixed feedback about the provider in relation to the support they 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 service was rated as Requires Improvement (published 14 March 2019) and there was one breach of the regulation.

At this inspection, enough improvement had not been made and the provider was still in breach of this regulation and we found further breaches of the regulations.

Following our last inspection, a condition was placed on the provider’s registration for them to submit monthly reports to us to show actions taken to improve the service. We had not received all of these reports.

Why we inspected

This was a planned inspection based on the previous rating however was brought forward slightly following some feedback about some concerns received from the local authority.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified three breaches at this inspection:

Regulation 15 (1) Premises and equipment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Regulation 9 (1) Person – centred care of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Regulation 17 (1) Good Governance of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

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

Risks to people were not always managed consistently to ensure people’s safety. Staff had not always been recruited safely and some errors in the recording of medication was found. There were enough staff available to support people and there were effective infection control systems in place.

The registered manager had not consistently followed guidance in relation to Mental Capacity Act where people may require depriving of their liberty. Staff knowledge of Deprivation of Liberty safeguards varied. People were supported by staff who had received training in their role. People had access to sufficient amounts to eat and drink and were seen by healthcare services where needed.

People were supported by staff who were kind and caring to them. People were treated with dignity and their independence was encouraged. People were supported to be involved in decisions regarding their care.

People were supported in ways that met their needs and their individual preferences. There was a complaints system in place that ensured complaints were investigated and resolved. People’s end of life wishes were discussed and recorded.

There were systems in place to monitor the quality of the service but these were not always effective. People had not been asked to provide feedback on their experience of the service. The registered manager had plans in place to improve the quality of the service.

Rating at last inspection: Requires Improvement (08 March 2018)

About the service: Leighswood is a residential care home that is registered to provider support to up to 23 people. At the time of the inspection, the provider was providing personal care to 17 people aged 65 and over.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

This inspection took place on 23, 24 January, and 07 February 2018 and was unannounced. Leighswood provides accommodation for up to 23 people who require personal care. At the time of our inspection there were 14 people living there.

Leighswood 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. Leighswood accommodates up to 23 people in one adapted building.

Following our Inspection in January 2017 the registered manager left the service. At the time of this inspection, the provider had appointed a new manager who had not at the time registered with CQC. At this inspection the manager had registered with the Care Quality Commission. 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.

People who lived in the service were now safe and their relatives confirmed they thought this was the case. Improvements were required in the fire procedures and monitoring of equipment in the home. The recruitment system operated by the provider meant that new staff employed were suitable to work with people in Leighswood. Staff were knowledgeable about people’s risks and we saw staff knew how to support them to minimize the risk, but this was not always in line with their risk assessments. Improvements in the system meant that people now got their medicines as prescribed and when needed. People and their relatives told us, and we saw, there were enough staff to support people to meet their needs. People lived in a clean environment.

People’s needs were assessed when they came to live at Leighswood. People and their relatives told us they were happy with the care they received. Staff told us and we saw they received training and support from the registered manager to provide effective care for people. People told us they had choices and enjoyed the food. We saw staff offered people hot and cold drinks throughout the day. The cook was knowledgeable about people’s nutritional needs, which meant special diets were catered for. Health professionals when required met people’s health needs. Staff supported people to have maximum choice and control of their lives in the least restrictive way possible; the policies and systems in the service support this practice.

People told us the staff at Leighswood were kind and caring. We saw staff treated people with kindness and compassion. We saw staff respected people’s privacy and dignity. Staff understood the importance of maintaining people’s independence where possible. We saw positive relationships had developed between staff and people and people were encouraged to maintain relationships that were important to them.

There was now a complaints system in place should people or their relatives wish to complain. Where complaints had been received, they had been investigated and responses sent in line with their complaints procedure. People told us they were bored and there was not a lot to do. We saw activities were not designed around people’s individual needs. People told us and we saw they had choices about their daily care needs and staff respected their routines which meant people had the care they required in line with their individual preferences. There was a system in place should people reach the end of their lives.

Although there had been significant improvements in the care people received, the governance system operated by the provider still required some improvements to be made to ensure people got safe and responsive care. People and their relatives told us the home was managed well and improvements had been made. Staff were happy working at Leighswood because the registered manager supported them. This meant people were happier living in Leighswood because there was a much improved ambience.

This inspection took place on 26 and 28 July 2017 and was unanounced. Leighswood provides accommodation for people who require personal care for up to 23 people. At the time of our inspection there were 18 people living there.

We last inspected this service on 31 January 2017 and again on 01 June 2017. At our Inspection in January we found the provider was not meeting the requirements of the law in six areas and we rated the provider as inadequate in each of the five key questions. We spoke with the provider’s representative and the registered manager following our inspection in January 2017. We asked them to send us an action plan detailing what actions they would take to improve the service. We issued a warning notice due to the failure in the governance system at Leighswood.

Following our Inspection in January 2017 the registered manager left the service. At the time of this inspection the provider had appointed a new manager who had not at the time registered with CQC. 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.

We completed a focused inspected on 01 June 2017 to see if improvements had been made. At this inspection we found improvements had been made, but we did not change the rating as we only inspected under one key question ‘Is the service safe?’ We completed a comprehensive inspection in July 2017 which looked at all five key questions. At this inspection we found improvements had been made in some areas. We found people were now treated with dignity and respect by staff and we found there were sufficient staff to meet people’s needs. We found people’s rights were protected through effective use of the Mental Capacity Act and people were now receiving care which met their individual needs. However, we also found the provider was not now meeting the requirements of the law in two new areas. We found the provider was not providing safe care because we could not be assured people got their medicines as prescribed and the recruitment system operated by the provider had not ensured people were cared for by staff who were appropriate to provide care to people who used the service. The governance system operated by the provider had not improved sufficiently which meant the terms of the warning notice had not been met and they were still not meeting the requirements of the law.

Although people told us they felt safe we found improvements were still required in how people received their medicines and how staff recorded when people were offered their medicine. The provider did not operate a safe recruitment system which meant people were at risk of receiving care from staff who were not suitable to provide care to the people living in Leighswood. We saw safe techniques were used to move people. Staff understood the risks to people’s health and safety and how to manage them; however these were not always recorded in their care records. There was sufficient staff to meet people’s needs. Staff understood their responsibility to raise concerns regarding potential abuse.

Although people told us staff had received training to support them we found improvements were still required in some areas. Staff we spoke to told us they had received training which helped them to support people with safe care but there were gaps in staff knowledge with regards to the Mental Capacity Act (MCA) as staff had not received any training in this area. Staff understood the need to ask for consent and we saw they sought consent before providing any care. The manager had applied the principles on the Mental Capacity Act. People’s nutritional needs were being met. People had access to other health professionals when their health needs changed.

Although people told us they were supported by kind and considerate staff, we found the provider was not always caring in their approach to the care people received. People had choices about their care and staff listened to them and respected their choice. People were treated with dignity and respect by staff. Staff encouraged people’s independence where possible.

People and their relatives told us they felt comfortable raising complaints with the manager, however there was not a formal complaints process in place. People received care which was responsive to their individual needs and had choices about the care they received. Some improvements were required to ensure people’s care records contained up to date and accurate information about the care they received.

The governance system in place was not effective as it did not highlight the areas where we found concerns during our inspection. Although people told us they were happy with the care they now received and recognised there had been marked improvements since our previous inspection we could not be assured this was sustainable as there was no oversight of the service by the provider and there was no registered manager at the service. Staff told us they were supported in their role.

During this inspection we found 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.

At the last comprehensive inspection on 31 January 2017 this service was placed in special measures by CQC. At that inspection we had found breaches of six regulations in which two of these were in relation to the key question, ‘Is the service safe?’ The rating of inadequate was given to this key question. This was because risks to people’s health and safety were not being managed safely, people did not get their medicines as prescribed, people’s freedom of movement was restricted and there was insufficient staff to meet people’s needs. The overall rating for this service was ‘Inadequate’.

This report only covers our findings in relation to the breaches we found under the key question, ‘Safe’. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Leighswood on our website at www.cqc.org.uk.

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.

Since our last inspection on 31 January 2017 the registered manager had left and the provider had recruited a new manager but they had not yet registered with the Care Quality Commission. 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.

At this inspection we found some improvements had been made but further improvements were still required. The provider was no longer in breach of the two regulations in relation to the key question we reviewed. The overall rating for the service remains ‘Inadequate’.

People and their relatives told us there had been improvements and said they now felt safe. Staff told us following our last inspection they had received training in how to move people safely. We saw people were now being moved using safe techniques. However, the provider was unable to demonstrate the hoist used to transfer people was safe and action was taken to address this.

People told us they got their medicines when they needed them. We found improvements were still needed to record when people had skin patches or prescribed creams applied. Records did not demonstrate what action staff took when people regularly refused their medicine. We found when people were prescribed their medicine ‘as and when’ some people were given it on a regular basis, and further guidance had not been sought. Although some improvements had been made we found further improvements were required to ensure people got their medicine as prescribed.

People told us there were sufficient staff to meet their needs. We saw staff were available when people required any support and staff were available to spend time with people. The manager told us they had now considered the staffing levels on a night time and told us there were sufficient staff to meet people’s needs due to staffing being deployed appropriately.

We will review our rating for 'safe' at the next comprehensive inspection to make sure the improvements made continue to be implemented and embedded in to practice.

Leighswood provides accommodation for people who require personal care for up to 23 people. At the time of our inspection there were 22 people living there.

There was a registered manager in post at the time of our inspection. 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.

People were not protected from the risk of harm because staff did not use safe techniques to transfer them around the home. People did not get their medicines as prescribed. Medicines were not always available to people. People were not always protected from harm because the registered manager had failed to take appropriate action when people sustained injuries. People’s freedom of movement was restricted because people were directed to one room so staff could monitor them. There was insufficient staff to ensure people got safe care, particularly at night time..

Staff had received some training but it was ineffective as staff were not providing people with safe or effective care. Principles of the Mental Capacity act had not been followed because the registered manager and staff did not have the knowledge or understanding of how to apply the principles to people who lacked capacity to make decisions about their care. Staff did not ask for consent before providing care. Although people told us and we saw they enjoyed the food we could not be sure people had support to maintain their nutritional needs. People did not always have access to health professionals when their needs changed.

Staff did not support people in a dignified way and people’s right to privacy was not always respected by staff. People did not have meaningful relationships with staff. Staff did not have the time to spend with people. We saw some staff spoke to people in a disrespectful way.

People did not receive care which was responsive to their individual needs. Staff knew about people’s preferred choices but did not always have them time to deliver care in a way which people preferred. People spent long periods of time with nothing to occupy them as they did not have the opportunity to engage with any activities or hobbies or interests. Relatives told us they knew they could complain but when people did make formal complaints we saw action had been taken.

People were not supported by a management team who ensured the care they were receiving was safe. The provider had failed to monitor the quality of the care people received and to take action when needed. Staff had mixed views about whether they were supported in their role.

During this inspection we identified six breaches of the Health and Social Care Act 2008 relating to safe care and treatment, safeguarding people from harm, staffing, consent, respecting people’s privacy and dignity person centred care, and good governance. You can see what action we told the provider to take at the back of the full version of the report.

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 the 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 be 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 we will 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.

Leighswood is a residential home that provides accommodation and personal care for up to 23 older people who are living with dementia. At the time of the inspection there were 21 people living at the service. 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.

People told us that they felt safe living at the service. They were protected by a staff team who could recognise signs of potential abuse and knew how to report any concerns. People were protected by sufficient numbers of staff to ensure their needs were met. People received their medicines as required. Risk management processes did not always identify and manage all risks to people.

People’s rights were not always protected by the effective application of the Mental Capacity Act 2005 (MCA). Where people did not have the capacity to make decisions about or consent to their own care, principles of the MCA had not been followed. People were happy with the food and drink they received and had access to healthcare professionals when required. People were supported by a staff team who had received regular training and were supported by their line manager.

People were supported by a staff team who were kind and caring. Staff knew people well and understood people’s preferences. People were enabled to make choices about their day to day care. People’s privacy and dignity was upheld and they were supported to maintain relationships that were important to them.

People’s care plans and the care they received mostly reflected their needs and preferences. People had access to limited leisure opportunities. They told us that they had not had a need to make a complaint, however they felt confident in doing so if it was required.

People were not protected by robust quality assurance systems that ensured the areas of improvement within the service were identified and actioned. People and staff felt that the registered manager was approachable and supportive.

We spoke with people who used the service, their relatives and staff who were working on the day of the inspection. Some people were unable to talk to us due to their complex needs; we observed their care throughout the day.

At a previous inspection in January 2012 we had concerns that the service did not have systems in place to ensure the safe administration of medication. At this inspection we found that the manager had implemented systems.

We looked to see if people had consented to their care, treatment and support. We found that where possible people gave consent to their care, but where they were unable to due to their needs the appropriate support had been given.

We found that people's care and welfare needs were being met. Two relatives told us that they were happy with the care their relative received.

Staff told us and we saw that there was adequate staffing to meet the needs of the people that used the service.

We found that there was a complaints procedure which was available to people who used the service and their relatives.

We found that Leighswood was compliant in the five outcome areas we looked at.

We looked to see how people's care and welfare needs were being met and found people received appropriate care in a timely manner.

People who used the service had complex needs and limited communication skills. We saw that where possible people who used the service were involved in the planning of their care. We spoke with relatives of people who used the service and they told us that they were happy with the care their relative received and that they were kept fully informed of any changes to their relatives care plans.

We found that the service followed the appropriate safeguarding procedures to keep people who used the service safe from abuse or the risk of abuse.

We spoke with staff who told us they enjoyed working at Leighswood Care Home and felt they had sufficient training to fulfil their role competently.

The service had quality monitoring systems in place to monitor the quality of the service being delivered and to ensure continuous improvement.