The Laleham

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.

The Laleham is a residential care home which provides support for up to 60 people. People using the service are older people, some people were living with dementia and other health care needs. Bedrooms are set over three floors; each floor can be accessed by a passenger lift. There are communal rooms on each floor as well as a main communal lounge and dining room on the ground floor. There were 42 people using the service at the time of this inspection.

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

Risks were not always well managed. Where people had fallen, their risk assessments had not always been updated with measures taken to reduce the risk of injury. The GP had provided the home with anticipatory care plans for people. These detailed additional safeguards that could be taken in the event of falls, records of decisions about actions taken to fulfil the suggested safeguards were not always completed.

Oversight of accidents and incidents did not ensure lessons were always learned, or methods always explored or developed to reduce the risk of future occurrences. Reviews of accidents and incidents were incomplete and did not always link back to risk assessments to inform future care planning.

When people experienced anxiety or distress, they could behave in a way that was upsetting to other people and potentially injurious. Care plans and strategies to support people at these times were not well developed.

Medicines were not always managed safely, when tablets were boxed, people had not always received their medicines as prescribed. Protocols around the administration of some medicines were unclear. Medical oxygen cylinders were not stored safely or in line with published guidance.

People were not protected by robust recruitment procedures. We looked at four recruitment files and found important information missing.

A recent fire audit identified there were insufficient fire marshals in the event of a fire. This had been brought to the attention of the provider at the time, however, no action was taken to address this.

Although the registered manager and service provider carried out regular audits, governance and oversight of the service was not wholly effective. It had failed to identify the concerns found at this inspection. Some of the concerns identified during this inspection were pointed out to the provider following the last inspection. The owners of the service (provider) had remained the same although its legal entity had changed.

The premises looked clean and tidy, however, we had some concerns about the controls in place to minimise the risks posed by COVID-19. Many floor coverings and furniture had been renewed, there was an ongoing maintenance plan to ensure the upkeep and decoration of the home.

People and relatives had been asked to complete feedback forms about the quality of the care provided. Analyses of the feedback had not yet taken place.

The service was compliant with the Mental Capacity Act 2005. Although, where staff could have discussed matters with people to inform care planning, this had not always happened. People’s needs were assessed before being offered placements at the service.

Equipment had been maintained as needed. The provider was in the process of acting upon a recommendation to renew the fire alarm system.

There were enough staff to meet people’s care needs, the provider used a dependency-based assessment tool to determine staff numbers required. Staff had received training about people’s specific needs.

Other risks, such as measures needed to monitor and manage people’s skin care and their nutrition, were well established and managed.

People were offered a variety of meal choices and alternatives were prepared if people did not like what was offered. We received varied feedback about the quality of the food. The registered manager told us people were given the opportunity to suggest favourite meals and provide feedback about the food to the provider.

Staff were responsive to people’s health needs. People had been supported to access healthcare resources such as dieticians, SALT, psychiatrists, mental health teams, consultants and specialist nurses.

Staff spoke with people with kindness and respect, people were asked for permission before being supported with any care needs.

People were offered different activities. Throughout the inspection, people took part in various activities such as quizzes and singing. Staff made sure people who preferred to stay in their bedrooms had one to one time to avoid isolation.

There was a complaints procedure, available in large print. Complaints had been addressed in line with the provider’s policy.

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 the service under the previous provider was Requires Improvement, published on [5 July 2019].

Why we inspected

The inspection was prompted in part due to concerns and based on the previous rating. We received concerns about diabetes management and the support people received to avoid breakdown of their skin and formation of pressure areas.

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 have found evidence that the provider needs to make improvements. Please see the Safe, Effective Caring, responsive 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 The Laleham 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 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 breaches in relation to the management and mitigation of risk, medicines, staffing, person centred care and the governance of the service.