Archived: Lambert House

Lambert House is a residential care home providing personal care to up to 11 people. The service provides support to autistic people. At the time of our inspection there were 11 people using the service. The care home is a large two-storey building, with a communal bathroom and toilet on each floor. A communal lounge, dining room, recreation room and sensory room were located on the ground floor.

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.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

The model of care did not maximise people's choice, control and independence. People were subject to restrictive practices without proper due regard to legal processes and requirements. 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; the policies and systems in the service did not support this practice. People were not supported to engage in activities that met all their needs. Some people living in the service had sensory loss but were not supported to engage in activities that met these needs. People were not always supported to communicate their wishes and feelings as there was limited use of communicate strategies.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

People were not supported in a manner which promoted their dignity, privacy and human rights. Some practices dehumanised people living in the service which was of significant concern. People were living in a poorly maintained and dirty environment which did not uphold their dignity. Safeguarding concerns had not always been shared in a timely manner. The support provided was not person-centred because staff did not follow risk assessments or care plans. This placed people at risk of harm. People were not supported by staff who knew them well due to the high use of agency staff and ineffective systems ensuring staff understood how to support people.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

We identified a closed culture in the service. A closed culture is 'a poor culture that can lead to harm, including human rights breaches such as abuse'. In these services, people are more likely to be at risk of deliberate or unintentional harm. The provider had not taken effective action to identify and address the poor culture in the service. Leadership was weak and did not hold staff to high standards. Governance systems in the service were ineffective as they had failed to ensure regulatory requirements 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

The last rating for this service was good (published 15 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staff conduct in relation to people using the service, restrictive practices and governance. 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.

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

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from risk of harm, safe care and treatment, person-centred care, safe use of medicines, premises and equipment and good governance.

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 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.

Lambert House is a residential care home that provides care and support for up to 11 people with a learning disability and a primary diagnosis of autism. Nine people were living in the home at the time of this inspection, plus two people were staying for respite care.

People’s experience of using this service:

¿ The service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. Risks to people who used the service were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Risk assessments were thorough and personalised.

¿ The service ensured there were sufficient numbers of suitable staff to meet people’s needs and support them to stay safe. The registered manager confirmed that robust recruitment procedures were followed.

¿ Medicines were stored, managed and administered safely. Staff were trained, and their competency checked, in respect of administering and managing medicines.

¿ People who used the service were supported to have sufficient amounts to eat and drink and maintain a balanced diet. People enjoyed their meals and were supported to choose what they wanted from the menus and other options available.

¿ Staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff understood the importance of helping people to make their own choices regarding their care and support. People who used the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

¿ Staff treated people with kindness, respect and compassion. People also received emotional support when needed. People were involved in planning the care and support they received and were supported to make choices and decisions and maintain their independence as much as possible. Information was provided to people in formats they could understand.

¿ Care plans were personalised and described the holistic care and support each person required, together with details of their strengths and aspirations. Information also explained how people could be supported to maintain and enhance their independence and what could help ensure they consistently had a good quality of life. People’s comments and concerns were listened to and taken seriously. The service also used any comments or complaints to help drive improvement within the service.

Rating at last inspection:

At our last inspection (report published 26 August 2016) all the key questions were rated Good and the service was rated as Good overall. This rating has not changed and the service remains Good.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information that we receive.

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

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. There was not a registered manager in post as they are due to start in the home in September. The current manager overseeing Lambert House was the registered manager from one of the other homes within the organisation. The new manager was due to start in September 2016, and would apply for registration once they start.

The home was safe and staff understood their responsibilities to protect people from harm or abuse and had received relevant safeguarding training. Staff were confident in reporting incidents and accidents should they occur.

There were effective processes in place to minimise risk to individuals. Assessments had taken place regarding people’s individual risks and clear guidance was in place for staff to follow in order to reduce risk. Staff were knowledgeable about how to protect people from harm and reporting concerns. People received support to take their medicines safely and risk assessments were in place to minimise avoidable harm. The environment in which people lived was safely maintained.

Staff were trained in supporting the people who lived at the home. Staff were supported with supervisions and obtaining further care qualifications. Staff had knowledge of gaining consent from people and sought this before providing care.

There was a limited choice of food in the evenings, however improvements were planned to increase this to two options. People were supported effectively to eat and drink appropriate and sufficient amounts. They had regular on-going access to healthcare.

People were supported by compassionate staff who were passionate about people’s wellbeing. Staff had built strong relationships with people and always respected people’s dignity and privacy. People were supported to maintain their relationships with their loved ones.

There were many opportunities available to people to go out to do activities and access the community. Their health needs were responded to in a timely manner and the records contained a great deal of detail about people’s needs.

The manager was supportive to the staff in the home, who worked well together as a strong team. The service had experienced recent difficulties with staffing, and this had improved. There were many systems in place to assure quality of care through the auditing and monitoring of specific areas.

We were unable to talk with the people who used the service but spoke with a person's relatives and a number of staff from all staff groups. We reviewed the care records for three people. We also reviewed a selection of other records including training schedules, staff files, audit results and the provider's policies and procedures.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

The management team had been trained and understood their obligation to apply the principles of the MCA and DoLS. People who used the service had a number of 'best interest' decisions recorded. These included decisions about restricting the person to leave the home, their personal hygiene and the administration of their medicines. The management team had appropriately assessed people's capacity, and sought the agreement of the person's health professionals and relatives/ representatives, before putting these decisions into practice.

No person living in Lambert House had a DoLS authorisation. The manager told us that they were in liaison with the DoLS team at the local authority to determine whether they should apply for DoLS authorisations due to the number of 'best interests' decisions made for each person.

We saw evidence that staff had received training and education in relation to mental capacity and safeguarding. The staff we spoke with showed a good understanding of both of these safeguards.

Medicines were stored correctly in locked cupboards and we noted that people's Medication Administration Records (MARs) contained all of the required information for the safe administration of medicines and had no gaps. We saw evidence that all of the staff who administered medicines had received the appropriate medicines management training.

We reviewed the mandatory training schedule for the service and noted that staff were up to date with their training with dates highlighted for when refresher training was due.

We found that the provider had effective recruitment and selection procedures in place and undertook the necessary checks to ensure that employees were of good character, and had the skills and qualifications needed to provide safe and effective care to people.

We saw evidence that the provider's audit schedule was effective. This included regular auditing of the quality of the service, as well as accidents and incidents and environmental risks.

Is the service safe?

The care records we reviewed were outstanding. There was ample evidence to demonstrate that the care and support people received reflected their needs. Care plans were evidence-based and reflected nationally recognised standards of caring for people with autism. People's care plans and risk assessments were reviewed and updated on a regular basis in order to reflect any changes in people's needs.

Each person who used the service had a key worker. People's goals were documented in their care records and we saw evidence that people were adequately supported and equipped to help achieve their goals. The staff supported people to develop 'life skills' to help them increase their independence.

We saw evidence that the provider had systems in place to ensure competent staff. Staff received regular supervisions and an annual appraisal. All of the staff we spoke with told us that their supervisions were meaningful and facilitated their competence and confidence to undertake their roles and responsibilities. Staff were encouraged and supported to access further training and education and we noted that this included training in relation to caring for people with autism, person-centred care and ethical care and control.

Is the service caring?

One of the relatives we spoke with said, 'We couldn't want anything more. The service is fabulous. Our (relative) gets everything they need. The staff are great and really understand the needs of people with autism. We get constant feedback about how our (relative) is progressing and the service has helped us understand about autism. We wouldn't change a single thing about Lambert House.'

The staff had received training in person-centred care and this was evident during our review of people's care plans and by observing the interaction between staff and the people who used the service. It was evident that staff thoroughly understood the needs of the people that they were caring for and treated people with compassion and respect. Different communication techniques were used to help facilitate effective communication and this was done in an appropriate and dignified manner.

Is the service responsive?

The environment was planned to help meet the needs of the people who used the service. This included different areas where people could choose to spend their time. We noted that there were secure gardens, a recreation room, a music/sensory room and numerous communal lounge areas.

It was evident that the care and support people received met their individual needs. People's care plans included all aspects of the person's activities of daily living and there were support plans in place for staff to follow to help ensure they responded to people's needs in an effective way. We observed staff interacting with people in a positive way and this included encouraging people to develop certain skills to help them become more independent.

During our inspection a clinic was being undertaken for people's relatives to meet with the person's psychologist and the registered manager. The relatives we spoke with told us that the clinics gave them the opportunity to ask any questions they had in relation to their family member's care and support, as well as responding to any concerns or anxieties that they had.

The provider had a complaints policy and procedure and we saw evidence that they took account of complaints and comments to improve the service.

Is the service well-led?

All of the staff we spoke with were positive about the management team at Lambert House. Staff told us that they felt well supported and were confident to raise any issues or concerns. They told us that the registered manager actively listened to what they had to say and responded in an appropriate manner. The non-care staff we spoke with told us that they felt part of the team and said that they felt the service was well-led.

There was a positive culture within the service and we noted that staff supported each other in a meaningful and productive manner. The relationship between the management team and the care and non-care staff was encouraging. We noted that the management team regularly worked alongside staff while they carried out their duties in order to support them.

The service had quality assurance systems in place to assess and monitor the quality of the service people received. We noted that the governance arrangements within the service promoted a learning environment.

The individual care records reviewed demonstrated that people's therapeutic needs were recorded in detail and that they were being met by the service. This meant that people experienced care, treatment and support that met their needs and protected their rights.

Staff told us that they were confident that they would recognise potential safeguarding concerns and knew what action to take if this was identified. This showed us that the provider had taken reasonable steps to identify and prevent abuse from happening.

We did not see evidence of any therapeutic programmes having to be cancelled due to staff shortages and we noted that additional staff were on duty at the weekend and at other busy periods;.to ensure that people received the required levels of support. This showed us that there were enough qualified, skilled and experienced staff to meet people's needs.

The service was being audited monthly by senior managers on behalf of the provider. We noted that any actions arising had been addressed. This demonstrated to us that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We reviewed three care records in detail and noted that each person had an individual care record including assessments of need and how these should be met by staff to help to support health and personal care needs.This showed us that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that people were enjoying their lunch and could choose what they would like to eat and drink. This showed us that people were supported to be able to eat and drink sufficient amounts to meet their needs.

Environmental risks assessments were linked to the assessed needs of the people who were using the service. This demonstrated to us that the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. Staff told us that there were good opportunities for training. This showed us that staff received appropriate professional development. Staff informed us that they were aware of how to address any complaints that they received and could outline how they would address these. This showed us that people had their comments and complaints listened to and acted on.