The Laleham

Updated 15 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

The Laleham is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Laleham is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with ten members of staff including care staff, the registered and deputy manager as well as the provider. We spoke with five people living at the service, five relatives and a healthcare professional. We reviewed a range of records. This included eight people's care records and a range of medicine records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 15 October 2022

About the service

The Laleham is a residential care home providing personal and nursing care to up to 60 people in an adapted building. Some people were living with dementia. At the time of our inspection, the service was supporting 44 people.

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

People and their relatives gave positive feedback about the Laleham and the support from staff. However, issues identified as needing improvement at our last inspection had not been addressed, for example medicines management and prevention and control of infection. We found that in these areas, there was a lack of effective auditing and checks to identify these issues. Some people needed support to keep their skin healthy and intact. Systems and checks to keep people’s skin healthy were not effective.

The provider was in the process of implementing an electronic care planning system, and therefore care plans and risk assessments did not always contain the level of detail for staff to be informed of how best to support people. Staff we spoke with had the skills and experience to support people and knew people well. Risks to the environment had not always been identified by the provider, for example uncovered radiators which could place people at risk of burns. Once these were identified they were addressed by the provider.

There were sufficient staff to meet people’s needs, and improvements had been made to the recruitment process. People and their relatives told us they felt confident staff had the knowledge and training to protect them from the risk of abuse. When accidents and incidents occurred, there was a clear process to learn and improve.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We found toilets had been locked without considering restrictions to people. Once we identified this the provider unlocked the doors. The service is in need of updates; there were areas where wallpaper was coming away from the walls, and where improvements could be made to make the service more dementia friendly.

People were involved in their assessments and review of their care plans. When people’s needs changed people and their relatives told us staff were responsive and booked appointments for them to see a wide range of healthcare professionals. One person told us, “If we get appointments they put it straight in the diary so you always have transport. And I always have someone with me, it’s usually a senior.” However, we found improvements were needed in relation to oral care and people accessing a dentist.

Staff told us the culture of the service had improved with the registered manager. One staff said, “When [registered manager] came it was the best thing that ever happened. So much wasn’t getting done and we weren’t a team. Now things run smoother.” People and their relatives felt engaged in the service and we received positive feedback about the care people received. Staff worked with a range of healthcare professionals to provide joined up care. Although we found improvements in some areas, other areas continue to need improvement.

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 14 July 2021) 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 some improvements had been made but the provider was still in breach of regulations. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

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 carried out an unannounced comprehensive inspection of this service on 29 and 30 April 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care, good governance, fit and proper persons employed and staffing.

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, Effective 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 not changed. 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 The Laleham on our website at www.cqc.org.uk.

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 continued breaches in relation to medicines management, prevention and control of infection, and 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 continue to monitor information we receive about the service, which will help inform when we next inspect.