Leabrook House Nursing Home

About the service

Leabrook House Nursing Home is a care home providing personal and nursing care to up to 40 people, including people with physical disabilities or learning disabilities. At the time of the inspection there were 34 people using the service.

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

Right Support

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 were assessed so any potential risks were identified, and steps taken to keep them safe. Systems in place safeguarded people from abuse and staff were knowledgeable about how to support people safely.

People were protected from harm, for example through infection control measures and safe management of medicines.

Right Care

People did not always experience caring, person-centred care. Whilst some staff interacted positively with people, staff members were sometimes task orientated in their approach due to staffing pressures. People sometimes spent long periods of time without meaningful interaction with others.

The service promoted people’s independence and scheduled activities were organised for people. People's health needs were well managed and the service worked in partnership with other agencies to promote people's health and wellbeing.

Right Culture

Systems and processes were in place to promote a positive culture at the home. However, further improvements were required to boost staff morale, which would positively impact people’s experiences.

Practices at the service were audited to monitor quality of the care people received and areas of improvement were identified. There was good communication with other agencies to ensure people’s needs were met.

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 1 July 2022) and there were breaches of regulation. 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

The inspection was prompted in part due to concerns received about alleged abuse and neglect of people and allegations about the cleanliness of the home. A decision was made for us to inspect and examine those risks.

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.

We found no evidence during this inspection that people were at risk of harm from this concerns. However, we have found evidence that the provider needs to make improvements. Please see the effective, caring, responsive and well-led sections of this full report.

Follow up

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

Leabrook House is a care home providing personal and nursing care to 38 older and younger people at the time of the inspection. The service can support up to 41 people.

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

Some diabetic care records contained gaps and inconsistences. Percutaneous endoscopic gastrostomy (PEG) feeds were stored in a separate room. The temperature of the room was not being monitored. Systems were in place to protect people from the risk of abuse and harm. Staff recruitment records did not always contain enough information to demonstrate all required pre-employment checks had taken place. Mental capacity assessments were not routinely carried out for decisions regarding people’s care and treatment, including decisions about the use of restraint or restrictive practices.

Staff understood who to report concerns to as well as the risks to people's health. People's support needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. Staff followed the infection control procedures the provider had in place. People received their prescribed medications and in accordance with their specific guidance. People were comfortable, relaxed and happy around care staff and staff understood how to keep people safe.

People's individual communication needs were considered to support them to be involved in their care. Staff had the necessary skills to carry out their role. Staff had regular training opportunities and training specific to people's individual needs was provided. Staff had very good knowledge and understood people's health conditions and the support they required.

Systems and processes in place promoted a positive culture in the home. Staff worked with a wide range of stakeholders involved in people's care. These included occupational therapists, health professionals and safeguarding authorities. Staff understood their responsibility to be open and honest when things had gone wrong. The acting manager operated an ‘open door’ policy which enabled people, their relatives and staff to approach management to discuss any concerns they had.

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 06 November 2019

Why we inspected

The inspection was prompted in part due to concerns received about care delivery. A decision was made for us to inspect and examine those risks.

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.

Enforcement

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 a breach in relation to the need for consent. Please see the action we have told the provider to take at the end of this report.

We also identified and a continued breach in relation to the governance of the service being provided. 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 until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Leabrook House is a care home providing personal and nursing care to 38 older and younger people at the time of the inspection. The service can support up to 41 people.

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

There was a lack of systems and processes in place that would provide the registered manager with oversight of the service. The few audits that were in place had failed to highlight a number of areas for action that were identified on inspection.

People’s opinions were not consistently sought and any feedback that was gathered about the service was not analysed for any lessons learnt, or information sharing.

People knew how to raise complaints and raised issues directly with the registered manager. However, people were frustrated with the lack of communication regarding how their complaint was being dealt with and what actions were being taken in response to the concerns raised.

People were supported by a group of staff who had been trained to recognise signs of abuse, but not everyone at the service who we spoke with, felt safe. One person raised a safeguarding concern with us during the inspection and the registered manager acted promptly and appropriately to this.

Staff were aware of the risks to the people they supported and how to manage those risks. Staff were observed to support people safely in line with their risk assessments.

People were supported by a group of safely recruited staff. The majority of staff had worked at the service for many years and knew people well. A recruitment programme was ongoing to recruit more staff and increase staffing levels.

People received their medicines as prescribed, administered by trained staff. Medicines were regularly audited, but audits had failed to identify some protocols were missing for ‘as required medicines’. Audits had identified a number of missed signatures on medication administration charts but there was no evidence available to demonstrate what actions were being taken in response to this.

Staff felt well trained and supported in their role. New staff benefitted from an induction that included shadowing more experience members of staff. Staff supported people to access a variety of healthcare services to help them maintain good health but did not consistently act on issues identified.

People enjoyed the food on offer and assistance was offered at mealtimes for those who needed it.

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.

Staff were seen as kind, caring and compassionate and had positive relationships with the people they supported. Staff knew people well and what was important to them, however, there was little evidence to demonstrate that people had been involved in the development and review of their care plans.

People were supported to take part in a variety of activities that were of interest to them. Staff knew people well, what was important to them and how they wished to be supported.

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 6 June 2017).

Why we inspected

The inspection was prompted in part due to concerns received about care delivery and some allegations regarding thefts at the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Well Led section of this full report.

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

We found no evidence during this inspection that people were at risk of harm from this concern.

Enforcement

We have identified a breach in relation to good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is registered to provide accommodation, nursing or personal care to a maximum of 41 people. People also access the service for short term respite care. On the day of our inspection 39 people were using the service. A high number of people who live there have needs associated with brain injury, illness or disability.

The previous ratings inspection of the service took place on16 and 20 March 2015 and at that inspection we found the service to require improvement in the area of Safe. This was because we found issues with the management of some medicines, which required improvement to prevent people being placed at risk of possible ill health. At this inspection we found that some improvements had been made to ensure the safe management of medicines.

The service had a registered manager. 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. The registered manager was available on the day of the inspection.

People living in the home felt safe. Staff were aware of the processes they should follow to minimise risk to people. Systems were in place to protect people from the risk of harm and abuse. Staffing levels and skill mix ensured that people’s needs would be met. Staff had been trained to manage medicines safely and people received their medicines as and when they should.

Staff had the skills and knowledge required to support people effectively. Staff received an induction prior to them working for the service and they felt prepared to do their job. Staff could access on-going training and regular supervision to assist them in their role. Staff knew how to support people in line with the Mental Capacity Act 2005 and gained their consent before assisting or supporting them. Staff assisted people to access food and drink.

Where possible people were involved in making their own decisions about their care and their specific needs. Staff provided dignified care and showed respect to people. People were encouraged to retain their independence with staff there ready to support them if they needed help.

Staff understood people’s needs and provided specific care. People’s preferences had been noted and acted upon where possible. People were given the opportunity to become involved in activities. People knew how to raise complaints or concerns and felt that they would be listened to and the appropriate action would be taken.

People were happy with the service they received and felt the service was led in an appropriate way. Staff were supported in their roles. Quality assurance audits were carried out, so that it was clear to see if any patterns or trends were developing which may impact upon the service provided to people. We received notifications of accidents or incidents that had occurred, which the provider is required to do so by law.

All of the people we spoke with were satisfied with the care and overall service provided. One person said, 'It is a good place'. Another person told us,' They are good and look after me'. Relatives were very complimentary they used words such as, 'Marvellous' and 'Wonderful' to describe the service provided. One relative said, 'It is an amazing place. It was recommended to us. They have come on so well since they have been here'.

People's needs had been assessed which ensured that their health, personal care, and safety needs could be monitored and met.

Recruitment processes were adequate which gave people living at the home assurance that only suitable staff had been employed which had decreased the risk of them being harmed in any way.

People and staff we spoke with highlighted that there were enough staff to meet people's needs and keep them safe. One person told us, 'There are always enough staff around. We do not have to wait for anything'. We found that staff had been given training and support which had helped them to meet people's needs and keep them safe.

Records we looked at and people we spoke with confirmed that systems had been used to monitor how the service had been run to benefit the people who lived at the home.