We carried out a review of the data available to us about Lezayre Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Lezayre Nursing Home, you can give feedback on this service.
Lezayre Nursing Home is a care home providing residential and nursing care to 35 people at the time of the inspection. The service can support up to 36 people.
People’s experience of using this service and what we found
Risks to people had been assessed and measures put in place to minimise risks and maximise people’s safety. Staff knew people’s needs and how to meet them and this information was reflected within detailed plans of care. Regular internal and external checks were also made of the building and equipment to ensure they remained safe.
Procedures were in place to prevent the spread of infections and the home appeared to be clean. Staff had access to personal protective equipment and families were supported to visit the home in line with guidance. Accidents were reviewed and opportunities taken to learn lessons to help prevent further incidents.
We found that there were enough staff available, to support people in a timely way, although feedback received was mixed. Staff had been recruited safely, were aware of people’s needs and knew how to report any safeguarding concerns they had. People and their relatives told us they were safe living at Lezayre. Medicines were managed safely by staff who had undertaken training and had their competency assessed. However, some records required further clarity and the registered manager actioned 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; the policies and systems in the service supported this practice.
The provider had systems in place to monitor the quality and safety of the service and the registered manager was committed to ensuring their regulatory responsibilities were met. Systems were in place to gather feedback from people and their relatives, to help shape the service and people told us the home was well managed and staff provided good care.
Staff worked closely with the local GP and made referrals to other health and social care professionals when required, for specialist advice and support, to ensure people’s needs were met effectively.
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 6 July 2022). At the last inspection the provider was in breach of regulations in relation to medicines and risk management. We also recommended that the provider reviewed its systems to ensure effective procedures were in place to monitor the quality and safety of the service.
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 and the recommendation had been met.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements.
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.
This report only covers our findings in relation to the Key Questions 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 changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lezayre Nursing Home 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.
Lezayre Nursing Home is a care home providing personal and nursing care for up to 36 people. At the time of the inspection there were 33 people living in the home, some of whom were living with dementia.
People’s experience of using this service and what we found
Risks to people were not always monitored and mitigated to maximise people’s health and wellbeing. Records showed people did not always receive the care they needed and not all care plans reflected people’s current needs. Other individual risks, such as smoking and use of bed rails, had been assessed and regular checks were made on the building and equipment to help ensure safety.
Medicines were administered by staff assessed as competent. However, they were not all stored safely as temperatures were not monitored in all areas where they were stored. When people required medicines to be administered covertly (hidden in food or drink), staff lacked clear guidance on how to administer these safely.
We made a recommendation regarding the systems in place to monitor the quality and safety of the service. Although there was a range of audits and checks in place, we found that these were not always effective. Not all of the issues we identified during the inspection had been highlighted through the audit systems and where areas for improvement had been identified, action had not always been taken to address them.
The home appeared generally clean and people and their relatives told us this had greatly improved recently. Cleaning schedules were in place, but these could be further improved to include cleaning of frequently touched areas. Staff had access to relevant PPE, and we observed this to be used appropriately. There was a system in place for staff COVID-19 testing, but the oversight of these procedures required further development.
People’s friends and relatives were supported to visit in line with government guidance. Relatives told us they were kept updated and informed of any changes in their family members wellbeing.
There were sufficient numbers of safely recruited staff to support people. People and their relatives told us the home was a safe place to live. There were systems in place to report accidents and incidents and safeguarding referrals were made appropriately. Referrals were made to other health professionals for specialist advice when required and people could access a GP at any time if they were unwell.
Although staff told us they had completed relevant training, it was difficult to establish which staff had completed what training, as the training matrix did not clearly reflect the eLearning and practical training each staff member had undertaken.
People’s nutritional risks had been assessed and people told us they had enough to eat and drink and enjoyed the meals available. However, records did not always provide consistent information regarding people’s nutritional needs.
Systems were in place to seek and record people’s consent to their care. When people had been assessed as lacking the capacity to consent to a decision, best interest decisions were made on their behalf appropriately. Applications had been made to deprive people of their liberty, but mental capacity assessments were not always completed prior to the application, to ensure it was necessary.
People living in the home, their relatives and staff, all told us the home was managed well. Staff told us they enjoyed working in the home and were well supported by the registered manager. Feedback was also sought on the quality of care provided to people and this feedback was positive.
The registered manager responded in a timely way to address issues identified during the inspection.
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 15 December 2021) and there was a breach of Regulation 12 (safe care and treatment) with regards to the management of medicines. 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 that although some improvements had been made, the provider remained in breach of regulation.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We received concerns in relation to people’s care and treatment, staff recruitment, consent and the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
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.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
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 monitor the service and will take further action if needed.
We have identified breaches of Regulation 12 (safe care and treatment) in relation to the management of risk and medications 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
Lezayre Nursing Home is a care home providing personal and nursing care to up to 36 people. At the time of the inspection there were 26 people living in the home, some of whom were living with dementia.
People’s experience of using this service and what we found
At the last inspection we identified a breach in regulation regarding the management of medicines. During this inspection we found that although some improvements had been made, further changes were needed, and the provider was still in breach of regulation regarding this. Staff who administered medicines had undertaken training and had their competency assessed.
Records showed that some risks to people had not been fully assessed, such as those regarding smoking, emergency evacuation, COVID-19 and use of flammable creams. However, the manager addressed these concerns straight away to ensure risk was assessed and mitigated.
Although internal and external checks were completed regularly to help ensure the building and equipment remained safe, not all areas of the home had been adequately cleaned to minimise the spread of infection. Action was taken before the end of the inspection to address the issues. Systems were in place to ensure everybody completed COVID-19 testing in line with current government guidance and all relevant people had received COVID-19 vaccinations as required.
People and their relatives told us they felt safe living in the home. There were enough staff available to support people, who had been recruited safely and undertaken training to ensure they had the knowledge and skills to support people well. Staff understood their role in the safeguarding process and knew how to raise concerns.
A range of audits had been completed, which had identified some of the issues we highlighted during the inspection. An action plan had been created and we found that steps had been taken to begin making the required improvements to ensure regulations were met.
The manager was very responsive during the inspection and took quick action to address any issues raised. Feedback from staff, people living in the home and their relatives was positive and showed that despite only being in post a few weeks, the manager had already started to create effective relationships with people. Relatives told us they were kept well informed and staff had regular meetings to ensure they were kept up to date.
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 2 December 2020). At the last inspection a breach of regulation was identified in relation to the management of medicines. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to make improvements. At this inspection, we found that enough improvement had not been made/sustained, and the provider was still in breach of regulations.
The last rating for this service was requires improvement (published 2 December 2020). The service remains rated requires improvement for the second consecutive inspection.
Why we inspected
This was a planned inspection based on the previous rating. However, concerns had also been received about infection control and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remains requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lezayre Nursing Home on our website at www.cqc.org.uk.
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 have identified a breach of regulation in relation to the management of medicines. Please see the action we have told the provider to take at the end of this report.
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.
Lezayre Nursing Home is a care home providing personal and nursing care to up to 36 people. At the time of the inspection there was 23 people living in the home.
People’s experience of using this service and what we found
Medicines were not always managed safely. There were inconsistencies in the recording of stock balances. Not all staff had had their competency assessed to ensure they safely administered medicines and they did not have information to support them when administering as required medications. This is a breach in regulation.
The systems in place to monitor the quality and safety of the service were not always effective in identifying areas of the service that required development and improvement, such as the areas of concern we highlighted during the inspection.
People and their relatives told us Lezayre was a safe place to live. There were sufficient numbers of staff available to support people in a timely way and staff were knowledgeable about safeguarding procedures. Risks to people had been assessed and measures taken to reduce any identified risks. Infection control arrangements were in place to prevent and mitigate the risk of Coronavirus. Appropriate personal protective equipment (PPE) was available and staff used this appropriately in the day to day delivery of care.
Feedback regarding the management and quality of service people received was very positive from both people receiving support and their relatives. Staff said they enjoyed their jobs and were well supported. The manager and staff were clear about their responsibilities and told us they all worked well together as a team.
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 18 December 2018).
Why we inspected
The inspection was prompted in part due to concerns received about infection control procedures. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have identified breaches in relation to the safe management of medicines at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lezayre Nursing Home on our website at www.cqc.org.uk.
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 had a manager who was 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.
The home is a converted three-storey property set in its own grounds in a residential area. It is registered to provide accommodation and nursing or personal care for up to 36 people, however a number of these places were in double rooms which are no longer shared and the manager told us that the maximum number of people accommodated would be 32. Twenty-three people were living there when we visited.
Our last inspection of Lezayre was on 9 October 2017 and we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider had not made sure that the premises were safe or that arrangements were in place to prevent and control the spread of infection, and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider did not have effective governance arrangements in place.
During this inspection we found that improvements had been made to the safety and cleanliness of the environment and the service was no longer in breach of Regulation 12. The manager completed regular quality monitoring audits which identified any areas needing improvement. Action plans were agreed and implemented by the manager and the staff team. The service was no longer in breach of Regulation 17.
There were enough qualified and experienced staff to meet people’s needs and keep them safe. New staff were recruited safely. Staff were supported in their role through induction, supervisions and an annual appraisal. Training was provided to ensure staff had the knowledge and skills to work safely and effectively.
People told us they felt safe in the home and that they had no concerns regarding their care. They told us the staff were kind and caring and protected their dignity and privacy.
People’s medicines were managed safely.
Records showed that consent was sought in line with the principles of the Mental Capacity Act 2005 and applications to deprive people of their liberty had been made appropriately..
People were satisfied with their meals and with the choice of food available.
A range of social activities was provided to keep people stimulated and occupied.
The care plans we looked at were written in a sensitive and person-centred style and gave details of people’s care needs and how their needs were met.
People spoke highly of the registered manager and told us she provided excellent support for the staff team and was always looking for ways to improve the service for the people who used it.
The home is a converted three-storey property set in its own grounds in a residential area. It is registered to provide accommodation and nursing or personal care for up to 36 people, however a number of these places were in double rooms which are no longer shared and the nurse on duty told us that the maximum number of people accommodated would be 30. Twenty eight people were living there when we visited. The people accommodated were older people who required 24 hour support from staff.
Our last inspection of Lezayre was on 18 November 2015 and we found the service to be Good in all areas.
The home had a manager who was 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. Before this inspection we had been notified that the manager would not be present in the home for a period of time.
During the inspection we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider had not made sure that the premises were safe or that arrangements were in place to prevent and control the spread of infection and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the provider did not have effective governance arrangements in place.
The home is an old building and requires continuous maintenance work to ensure people are safe. Flooring in one area needed urgent attention and floor-covering in other areas was damaged. Before the inspection we received concerns regarding infection prevention and control at the home. We found that the laundry, sluices and storerooms required improvements and a number of areas were dusty.
There were enough qualified and experienced staff to meet people’s needs and keep them safe. During the course of the day we observed staff being alert and responsive to people’s needs. Safe recruitment processes had not always been followed in full.
People we spoke with said they felt safe living at Lezayre. Staff received training about safeguarding and this was updated every year.
The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home and had attended relevant training. The staff we met had a cheerful and caring manner and they treated people with respect. Visitors we spoke with expressed their satisfaction with the care provided.
Overall, we found that medicines were managed safely but some improvements were needed.
People we spoke with were happy with their meals and with the social activities provided. People were registered with local GP practices and had visits from health practitioners as needed.
The care plans we looked at gave details of people’s care needs and how their needs were met, however they were not easy to read or follow. Charts in people’s bedrooms were completed well to show the care that had been provided.
In the absence of the manager, the quality and effectiveness of the service had not been monitored for the last two months and the standard of record keeping had deteriorated.
The inspection took place on 18 November 2015 and was unannounced. The home is a converted three-storey property set in its own grounds in a residential area. There were bedrooms on each floor, some of which had en-suite toilet and wash basin. Communal areas were all on the ground floor.
The service is registered to provide accommodation and nursing or personal care for up to 36 people and 30 people were living there when we visited. The people accommodated were older people who required 24 hour support from staff.
The home had a new manager who had applied to be 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 we spoke with said they felt safe living at Lezayre. All staff had received training about safeguarding and this was updated every year. There were enough qualified and experienced staff to meet people’s needs and keep them safe. The required checks had been carried out when new staff were recruited.
The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home and had attended relevant training. The staff we met had a cheerful and caring manner and they treated people with respect. Visitors who we spoke with expressed their satisfaction with the care provided.
We found that the home was adequately maintained and records we looked at showed that the required health and safety checks were carried out. We found that medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.
People we spoke with confirmed that they had choices in all aspects of daily living. They were happy with the standard of their meals and the social activities provided.
People were registered with local GP practices and had visits from health practitioners as needed. The care plans we looked at gave details of people’s care needs and how their needs were met, however a new care plan format was being introduced which was designed to improve the recording of information about the person’s life and their preferences.
There was a friendly, open and inclusive culture in the home and people we met during our visit spoke highly of the home manager. Some quality audits had been carried out and these were being further developed.
When we visited Lezayre on 30 April 2014, we were concerned that the premises had not been adequately maintained to provide a suitable home for people to live in. We also found that the required checks had not always been carried out before new staff were employed. We went back to the home on 16 September 2014 to check whether improvements had been made.
We saw that significant improvements had been made to the environment and maintenance work was continuing to improve bedrooms and communal areas. We saw records to show that the required checks had been carried out before a new member of staff started working at the home.
Is the service safe?
The premises had not been adequately maintained to provide a suitable home for people to live in.
Effective recruitment procedures had not been followed when employing new staff to check that they were of good character and had the necessary qualifications. New staff had not completed induction training.
Is the service effective?
People told us that they were happy with the care and their needs were met. Staff had a good understanding of people's care and support needs.
Is the service caring?
Staff were kind and patient to the people who lived at the home and we observed positive interaction between staff, visitors and people who lived at the home.
Is the service responsive?
People's needs were assessed before they moved into the home. Care plans recorded people's personal preferences and interests, and care was provided in accordance with people's wishes. People were asked to give their views of the service.
Is the service well led?
The manager was new to the service and had been registered with CQC. She had considerable previous experience in a similar role. An operations manager provided support in all areas of the service.
We looked at a number of letters that had been written by family members of people who had lived at Lezayre. One person had written:
'We would like to pay tribute to Lezayre Nursing Home. From the management team down they created a homely, happy, caring and above all an extremely professional atmosphere especially when [our relative] became poorly. Not only did they cater for her every need, but towards the end of her life, our needs too, ensuring we ate their wonderful food and allowing us to sleep there, thus enabling us to share her last precious moments.'
People we spoke with were happy with the care that they received from the home's staff and said that they were able to have a visit from their doctor as needed and received other community services for example ear syringing and flu vaccination. We saw that people's weights were recorded every month and plans were written for those who were identified as being at risk.
We observed that everywhere was clean and there were no unpleasant smells. A visitor told us 'they clean beautifully'. The home's kitchen was awarded a five star rating by the environmental health officer.
People we spoke with said that they were happy with the care that they receive. They said that they felt safe living at Lezayre. People told us 'the staff are smashing' and 'the staff are very nice'.