Lucerne House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff were recruited safely, with the correct checks being made to ensure they were suitable for their role. Staff had an induction and completed ongoing training. The environment was regularly checked for safety and any issues quickly resolved. Improvements had been identified in relation to the management of medicines to ensure they were managed safely. Staff were knowledgeable about abuse and knew how to raise concerns and alerts. Risks to people were managed in the least restrictive way possible. Staff knew people well and understood the risks associated with their support needs. However, care plans and records did not always contain the relevant or up to date information. Work was ongoing to improve this but further time was needed to implement and fully embed into everyday practice.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us about improvements made to the learning culture of the service. One person told us, “New management do check and when they say they will do something they will.” One person’s relative said, “Staff action everything I have asked for. They even action things they have identified themselves.” Another relative told us they felt listened to and said the manager was very good. However, they did not think feedback was always taken on board.

The management team told us they had identified a number of areas that needed to be improved. This included both the care home Lucerne House and the Supported Living services. They had put into place a governance system to provide a framework to the changes and embed them into daily practice. Staff told us they had been told about changes at the supported living services. One staff member told us they were not aware that changes were needed but once they were made aware they could see how the changes would be beneficial. One staff member said, “The majority of changes are positive we can see what has been wrong and what is now being done. It’s about seeking the right advice.” Staff told us what actions they would take if they were concerned about a person, or any accidents and incidents. Staff were confident that appropriate actions were taken when concerns were raised.

The management team had identified that there was a lack of a governance structure and oversight. This had been introduced and whilst it had been implemented and started to become embedded into daily practice within Lucerne House, it was yet to be fully implemented within the Supported Living services. Discussions with the management team demonstrated, that at this time, they had oversight of the services and current concerns. They were aware of the importance of fully implementing and embedding the governance structure into daily practice.

Some people’s relatives told us there were considerations being made in relation to their loved one’s moving to a different service. Whilst they did not discuss this in detail they told us they were working with the relevant organisations to ensure any decisions made were in people’s best interests.

Managers told us before anyone moved into the service an assessment would be completed to identify what setting would suit each person and ensure the person’s needs could be met. They would also ensure the person would be compatible with people already living in the home. This would be achieved by visits to the home and getting to know people already living there. Staff told us they were mindful that people’s needs change and they may need to move to a different service. They gave us examples of people who, for example, had been supported to develop their independence and had moved to Supported Living services.

We did not receive any feedback from partners about this evidence category.

There were systems in place to ensure transitions into and out of the service were managed safely. This included working with people, families and health and social care professionals. This helped ensure any changes to people’s living arrangements was inclusive and supportive.

Relatives told us they felt their loved ones were safe at the service. They were confident that people were protected from the risks of abuse or harm.

The management team told us how they worked with the local authority safeguarding team, people, and their families to protect people from the risk of harm, abuse or discrimination. They told us this work was ongoing. They gave us examples of when concerns had been raised, actions taken and what they had learnt from the experience. Staff told us they had received safeguarding training. They were able to describe different types of abuse and tell us what actions they would take if they believed someone was at risk. This included reporting to the most senior person on shift and escalating upwards if no action was taken. Staff were aware that some people were at risk of discrimination by others when away from the home. Some staff told us how they had professionally and successfully challenged members of the public when people had been subjected to discriminatory comments.

We saw people approaching staff openly. They appeared comfortable and relaxed in staff company. We observed people bringing concerns to staff attention and staff responded with genuine care and concern. We saw people sitting with staff and engaging with them, having fun with laughter and smiles.

There was a safeguarding policy. Staff received regular safeguarding training. When concerns were identified referrals were made to the local authority safeguarding team and appropriate actions were taken to ensure people were protected.

People told us they were supported to manage risks safely. One person spoke to us about going out and the mobility aids they used. They explained how staff made sure these aids were working correctly and supported them to use them appropriately. Relatives told us their loved ones were safe at the service. They said staff were aware of the risks involved in supporting people. One relative told us, “All I want is for him to be safe and know that he is happy there and we know he is.”

The management team and staff knew people and understood the risks associated with the people they supported. They told us they had identified that work was needed to ensure people’s care plans and risk assessments reflected their current needs. They said this work had commenced. Staff told us they had received training to help ensure they had the skills to support people with specific risks. This included mobility and falls, positive behaviour support and risks associated with people’s health needs, for example seizure management. The following are examples of what staff told us in relation to supporting people to manage risks safely. “ Follow their support plans, make sure that I know what to do in a safeguarding situation, who to contact. Carrying out my role correctly and the correct training.” “It is just about knowing them (people) and their capabilities and speaking with them about risks and things they want to do. (Take into account) risks and their capacity, and if they want to continue, try to manage and reduce risks.” “Try to talk with people, try not to make situation worse, after listening, try to reduce the risk.”

We saw staff supporting people safely. They enabled people to take risks that they had been assessed as safe to do. Whilst staff were aware some people may become unsteady when they were walking and at risk of falls, they supported them to independently mobilise around the home but further support was offered when people went out. Some people experienced seizures and staff showed us the procedure they followed to access support and keep people safe when they went out. Some people were at risk of becoming anxious or distressed. We saw staff were observant to changes in people’s demeanour and supported people safely and with kindness to prevent any deterioration to their moods. This included sitting and talking with people and distraction techniques.

Care plans and risk assessments included information about risks associated with people’s care and support needs. However, these did not always include the required information and some information was conflicting. For example, staff told us about the support they provided to a person who was at risk of seizures. This information was detailed however, it had not been included within the care plan. A further care plan contained conflicting information throughout about how to support a person with their diabetes. Again, staff were able to tell us about the care and support provided. This needs to be improved to ensure all staff have access to current and relevant guidance. Feedback from a health and social care professional told us the management team were not always proactive in ensuring documentation in relation to regular checks of a person had been completed as requested, to help establish any themes to the person’s needs throughout the day. Other care plans included information that was relevant and reflected people’s current needs. The management team were aware improvements were needed to care plans and record keeping. This work had commenced but further time was needed to fully implement this.

People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. This section relates to Lucerne House and not the ‘supported living’ settings. One person told us about their room. They told us they enjoyed spending time there. Relatives spoke about Lucerne House being a homely environment.

The management team told us concerns had been raised previously about aspects of the environment. They told us, and we saw, work was ongoing to address this. One staff member told us they were frustrated that general maintenance work was not always completed in a timely way. The management team and staff told us although they were not directly responsible for the maintenance at the Supported Living services they undertook regular checks to identify any areas of concern. They would then support people to raise these with the landlord

Our observation in this section relates to Lucerne House and not the ‘supported living’ settings. We saw that maintenance work was ongoing at Lucerne House and further redecoration was planned. However, these areas related to the quality of the living environment and did not impact on people’s safety. We saw people had free access throughout the home. Where people needed support, for example, using the stairs, staff provided this

There were processes in place to help ensure the environment was safe. There were fire risk assessment and regular fire safety checks and fire drills for Lucerne House and the supported living services. Personal emergency evacuation procedures were in place in people’s care plans to ensure staff and emergency services were aware of people's individual needs in the event of an emergency evacuation. Regular health and safety checks were completed. Servicing contracts in place included electrical equipment, gas and legionella testing for Lucerne House and the supported living services. There was a maintenance plan which identified areas of the service that needed to be addressed. These were priority rated and recorded when completed.

People and relatives told us there was enough staff. People were able to go out with staff on a regular basis, for example to the town, shopping, to the pub, for a coffee. Relatives we spoke to had been positive about the care and support their loved one received, they felt that they were well supported, that staff personalised the support they provided to people.

Staff told us that the induction and training they received enabled them to feel confident, and that they had the knowledge and understanding on how best to support people. Staff told us following the recent recruitment there was enough staff to meet the needs of the people living in Lucerne House and the Supported Living Services. Staff told us that the management team were approachable and that they had a good working relationship with their colleagues. One staff member told us, “Everyone is lovely, all like a family.” The management team told us that they were now in the process of reviewing keyworker roles. These would include monthly communication with people’s families.

Our observations in this section relate to Lucerne House and not the Supported Living settings. Staff were present in the communal areas and were interacting and supporting people throughout the day. Staff were friendly, kind and knowledgeable about the people they supported.

There were systems in place to ensure that there were enough staff to meet the individual needs of people, and that they had the correct skill sets. Staff received training specific to the needs of the people they supported such as positive behaviour therapy and epilepsy training. Some people had been assessed as needing one to one support and this was provided appropriately. Staff completed an induction and training, and this was monitored by the management team, staff undertook competency assessments to ensure they had a good understanding of their roles and responsibilities. Some staff training was ongoing, but staff and the management team advised they were working towards getting all the mandatory training up to date. Relevant pre-employment checks were completed before staff started work at the home. This included references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Where people invited us to see their bedrooms they told us, or demonstrated, that these were organised in a way that suited them. People who were being supported to clean their rooms appeared engaged and happy to do so. Relatives of people living at Lucerne House did not express any concerns about the cleanliness of the services, one relative said their loved one, “Always looked clean and tidy.” Another relative told us that they had, “Made suggestions about the cleanliness of their loved one’s room.” They said that they had felt listened to. Some relatives of people who lived in the supported living services raised concerns about the cleanliness of their loved one’s bedrooms and bathrooms, describing in detail what they had observed. Whilst CQC has no remit over accommodation in Supported Living services we do ensure that people are being support to live safely. We highlighted the concerns raised with us to the management team and recommended that procedures for ensuring cleanliness in Supported Living were clarified with people and their relatives.

Staff told us they received infection control training and training related to food hygiene as they supported people in the preparation of meals. Staff in Lucerne House and the Supported Living services told us they were responsible for the cleanliness of the communal areas however people were responsible for their own bedrooms. Staff told us they were aware of people’s individual abilities in relation to cleaning their rooms and provided the support appropriate to the person’s needs. Staff told us they were provided with personal protective equipment.

Lucerne House was generally clean and tidy throughout. We saw people being supported to clean and tidy their own rooms, with staff making this an enjoyable and engaging experience. Where people invited us to see their bedrooms we saw they were clean and organised in a way that suited each person.

The management team had identified improvements were needed to ensure people were protected from the risk of infections and to maintain the cleanliness of the service. They had reviewed and were implementing a range of processes including audits, checks, cleaning rotas and walk rounds. These had been implemented at Lucerne and had started to become embedded. They had yet to be fully implemented at the Supported Living services. The management team told us further time was needed for these to be fully embedded into everyday practice.

People did not talk to us about their medicines. However, we observed them being offered their medicines on an individual basis. Medicine cupboards were in people’s rooms so they received these on a one to one basis. Relatives who commented told us they did not have any concerns about their loved one’s medicines.

The management team told us medicine management concerns had been identified. Measures had been put in place to resolve these concerns and improvements had commenced. They told us these changes had been implemented and embedded at Lucerne House but this had only just commenced at the supported living services. Staff told us they only gave medicines if they had received medicine training and assessed as competent. They told us about specific training they had received to support individuals, for example medicines used in emergency situations. Staff told us about changes to the medicine processes at the Supported Living services. People were now responsible for ordering, collecting and taking their own medicines. This was done with the appropriate support from staff to ensure this was done safely. One staff member told us how they supported a person with the process with a view to developing the person’s independence.

It had been identified that improvements were needed and these had been implemented in Lucerne House but further work was required at Supported Living services. Medicines were ordered and given safely. We identified that room temperatures for medicines stored in people’s bedrooms had not been monitored. This was addressed immediately. Medicine care plans were in place. People’s medicines at Lucerne House had been reviewed by the medicine optimisation team to ensure they were appropriate for people’s needs. Regular audits had been introduced and were completed to identify areas that may need to be improved or developed. Although staff were clear about the support needed for individuals, guidance in care plans lacked consistency and a newly developed audit system had not been fully implemented. New systems were being implemented at the Supported Living services where people were supported to manage their own medicines. This was to promote people’s independence. Although staff were able to tell us how they supported each person with their medicine’s, improvements were needed to care plans to guide staff to ensure consistency. An audit system had been developed but this had not yet been fully implemented. The management team were aware these improvements were needed and told us work was underway to fully implement and embed these into daily practice. Following the inspection, we were told about a medication assessment tool that had been completed for people at the Supported Living services which helped to develop a relevant care plan. Further work was ongoing to allow staff to set individual goals with people and measure progress in relation to promoting people’s independence.