Lampton House

Lampton House is a residential care home providing personal care to people. The service provides support to up to 30 people. At the time of our inspection there were 26 people using the service.

People’s experiences of using the service and what we found.

During our first day of our inspection we identified improvements were required to the front door had various locks that could cause a delay if trying to exit in the event of a fire. Four walking frames had missing ferrules. The provider’s quality assurance system had failed to identify these shortfalls found during our inspection. We fedback our concerns to the registered manager and the provider who took action to rectify these shortfalls prior to our visit on the second day.

We also found quality assurance systems had failed to identify shortfalls relating to missing risk assessments where people had creams containing paraffin. Along with grab and go files requiring updating and the provider was not ensuring the rating for the service was being displayed as required.

The provider had a fire risk assessment in place and people had individual personal evacuation plans in place. However, we were not assured during our inspection that the building was safe in the event of a fire. We made a referral to the fire safety team so they could review the building in line with fire safety regulations.

People felt supported by staff who were caring and who knew them well. Staff felt able to raise concerns with the registered manager and the provider through the provider’s whistleblowing procedures. All people, relatives and staff felt the service was a nice place to live.

People, relatives and staff felt the provider and the registered manager were approachable and accessible. The provider undertook regular visits within the service and the registered manager helped when staffing was short.

People were supported to access a GP when required. Staff meetings supported staff with updates and information. Staff had received safeguarding training and the provider and registered manager had recently undertaken level 3 training.

Staff wore personal protective equipment to prevent the risk of cross infection. Improvements were identified on the first day of the inspection with staff not using tongs to offer people biscuits and one person putting their hand into the biscuit tin. This posed an infection control risk, People told us they wanted access to the TV remote so they could change the channel themselves.

Following our inspection, we asked the provider to send an updated statement of purpose for the service. The providers statement of purpose describes what they will do, where they will do it and who they will do it for. We will monitor this action is taken.

Rating at last inspection and update

The last rating for this service was Good (published 5 September 2019).

Why we inspected

We decided to inspect due to concerns raised in relation to safeguarding people from abuse and if people were receiving safe care. As a result, we undertook a focused inspection to review the key questions of Safe and well-led only.

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.

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 Good to Requires Improvement based on the findings of this inspection.

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 Lampton House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach as the provider’s governance arrangements were not robust and had failed to identify shortfalls in the safe domain of 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 the local authority to monitor the service.

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

The provider had an outbreak of corona virus within in the home. At the time of the inspection 26 out of 27 residents, and 41% of staff had tested positive. However, they were through the isolation period and the provider had processes in place to keep people safe. We found the following examples of good practice.

Staff had received training in infection control, including how to safely put on and take off personal protective equipment, (PPE) such as gloves, aprons, and face coverings. The registered manager also told us; they were getting additional training as part of the support offered through Public Health England.

We saw staff wearing appropriate PPE and changing their PPE when moving from room to room, except for one staff member who entered the building without putting their PPE on immediately. We spoke to the registered manager about this and they assured us they would remind all staff about the importance of following the providers policy to wear full PPE as soon as they enter the building.

Due to the recent outbreak the provider had stopped all visitors coming into the home, this was to help contain the virus. One staff member told us, “We support people to use phones and other technology to keep in touch”.

The registered manager told us about the process they used when visiting is allowed. They showed us the form visitors entering the home would be asked to complete. This was a declaration that included recording of temperatures. The registered manager also assured us visitors were asked to wash their hands and wear PPE when entering the home.

When staff came on shift they were expected to record their temperatures and gel their hands before entering the building. Staff who used shared transport to work were asked on arrival to change their clothes in the staff room to avoid any cross contamination. However, the staff had to walk through the home to reach the staff room.

We discussed this with the provider, they told us this had been raised at the recent meeting with Public Health England and they were considering how they could implement a dedicated donning and doffing (putting on and taking off PPE), room for staff that was nearer to the entrance of the home.

The home was split into three floors and staff could isolate each floor, but the registered manager told us they had not implemented zoning as 26 residents had tested negative in the home. They told us the focus was on supporting people to isolate in their rooms for the 14-day isolation period instead. Staff told us how they closed all communal areas including the dining area and the lounges to prevent any further outbreak.

The registered manager had regular contact with Public Health England and the local commissioning team to monitor the outbreak. The provider sent us their action plan and the registered manager told us they were having weekly meetings with their clinical support team.

The provider was not admitting people to the home currently because of the outbreak. The registered manager told us they have do have vacancies, but no one would be admitted without a negative test first.

The registered manager ensured regular testing was carried out, weekly for staff and monthly for people living in the home although no one was having further tests for 90 days in line with Covid-19 testing guidance following a positive result. The registered manager told us they gained consent from relatives for people who were not able to consent to testing, this information should be recorded in line with the Mental Capacity Act.

The environment looked clean but three staff members we spoke with told us touch points were not cleaned regularly. The registered manager told us they were scheduled to be cleaned as least four times a day, but they would review this.

Further information is in the detailed findings below.

Lampton House is a residential care home providing personal and nursing care to 28 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

Lampton House is a period home that has been extended and is laid out over three floors. There are 30 single rooms available, all have toilet, handwashing facilities and telephone. The ground floor accommodates a large dining room, lounge, kitchen, laundry room and bedrooms. The middle floor consists of further bedrooms, manager’s office, communal toilet and bathroom, there is level access to a large garden, including a seating area and green house. All floors are accessible via stairs and a lift. Parking is available outside.

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

People told us they received support from staff who were kind and caring, we saw many kind and caring interactions between people and staff during our inspection. Staff told us they felt people received good care and were treated with dignity and respect.

People told us they felt safe. The provider took steps to ensure people were safe, these included assessing and managing risk and taking appropriate steps to protect people from potential harm and abuse. All staff we spoke with were confident about how they would identify potential abuse and actions they would take if abuse was witnessed or suspected. There were sufficient numbers of suitably qualified staff to meet the needs of people. People told us their medicines and creams were managed safely, guidance about the safe management of medicines was available for staff. The registered manager reviewed accidents and incidents to identify themes and trends and prevent a recurrence.

People received care that was personalised to meet their needs. When complaints and concerns were raised, these were dealt with appropriately and the provider acted to resolve them. End of life preferences and choices were explored when people moved into the home. People were well supported towards the end of their lives, care plans included guidance for staff about the person’s care and emotional needs.

People, staff and relatives spoke positively about the management team and told us they felt well supported. There was a positive team culture with staff across the service working together. The provider maintained oversight of the service and there was an effective governance system used to identify errors, omissions and shortfalls. There were good links with organisations in the local community and the provider used different ways to engage with stakeholders.

Care plans reflected peoples’ needs, choices and preferences. Staff told us they received ongoing training relevant to their roles and to people living in the home. People told us the food was good quality and a choice of food and drink was available. People were supported to access healthcare services and the provider told us they had good links with local healthcare professionals. The home was pleasant and free from malodours. Where people lacked the capacity to make a particular decision, capacity assessments were not completed appropriately. However, in practice the provider and staff were working in line with the principles of the Mental Capacity Act 2005 (MCA).

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.

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 February 2017)

Why we inspected This was a planned inspection based on the previous rating.

Lampton House care home provides accommodation and personal care for up to 30 older people, some of whom are living with dementia. The service has 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.

People were relaxed and comfortable with staff that were attuned to their needs. Staff treated people with dignity and respected their privacy, they were discreet when supporting people with personal care. Staff developed positive, kind, and compassionate relationships with people.

People's care was individualised. Staff spoke with pride about the people they cared for and celebrated their achievements. They knew people well, there was a relaxed, calm and happy atmosphere at the home with lots of smiles, good humour, fun and gestures of affection.

Staff understood the signs of abuse and knew how to report concerns, including to external agencies. They completed safeguarding training and had regular updates. Personalised risk assessments balanced risks with minimising restrictions to people's freedom. Accidents and incidents were reported and included measures to continually improve practice and reduce the risks of recurrence.

People appeared happy and content in their surroundings. The service had enough staff to support people's care flexibly around their wishes and preferences.

People experienced effective care and support that promoted their health and wellbeing. Staff had the knowledge and skills needed to carry out their role. Each person had a comprehensive assessment of their health and care needs and care plans had instructions for staff about how to meet those needs. Staff worked closely with local healthcare professionals such as the GP, community nurses and mental health team to improve people's health. People had access to healthcare services for ongoing healthcare support. Staff recognised when a person's health deteriorated and sought medical advice promptly when they were feeling unwell. Health professionals said staff were proactive, sought their advice and implemented it. People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely.

People praised the quality of food and were supported to improve their health through good nutrition. Staff encouraged people to eat a well-balanced diet, make healthy eating choices and to exercise and maintain their mobility.

People and relatives were happy with the service provided at Lampton House. The culture of the home was open, friendly and welcoming. Care was holistic and person centred, staff knew about each person, their lives before they came to live at the home. They understood people's needs well and cared for them as individuals.

People's rights and choices were promoted and respected. Staff understood the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards and involved person, family members and other professionals in 'best interest' decision making.

People pursued a range of hobbies, activities and individual interests. For example, reading, arts and crafts and organised quizzes and games such as Bingo and Scrabble. Where people chose to remain in their rooms, volunteers and staff spent time with them to chat and keep them company.

People received a good standard of care because the staff team were led by the provider and registered manager who set high expectations of standards of care expected. There was a clear management structure in place, staff understood their roles and responsibilities, and felt valued for their contribution. Staff were motivated and committed to ensuring each person had a good quality of life. The provider used a range of quality monitoring systems such as audits of care records, health and safety and medicines management and made continuous improvements in response to their findings.

Interactions between staff and people living in the home were appropriate and respectful. Staff took time not to rush people and listened to what they had to say.

We saw that care plans were reviewed monthly and daily records we viewed confirmed that staff provided people with care and support as described in their care plans.

We saw that regular activities were planned to take place at the home and in the community. The home encouraged people to be part of their local community by entering events such as the local flower show.

People we spoke with told us that they liked the food at the home. People had a choice of meals and staff were aware of people's preferences in relation to food and drink.

Staff told us that they received effective support and supervision appropriate to their role. This was reflected in records we saw at the home.

We found there were effective systems in place to monitor the quality of the service provided.

We met the registered manager and four care workers. We talked with them about the needs of people who used the service.

People had positive views to share with us about what it was like for them to live at Lampton House. Examples of comments people made included, 'it's like a first rate guest house'. 'The place is my home'. 'The staff remember your name'. 'The activities organiser is wonderful there is so much to do'. 'The staff can't do enough for you'.

People felt safe and secure living at Lampton House. They were supported by staff who understood their role in safeguarding them from the risks of abuse.

People were receiving a suitable service in a homely and relaxed environment. They were supported by enough skilled and suitable staff to properly meet their needs.

People were supported to make their views known about the service. Complaints were dealt with in an open and transparent way by the manager and provider.