Archived: Lorne House

Lorne House is a residential care home providing personal and nursing care to 13 adults with a learning disability and/or physical disability at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties registered for the support of up to 14 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People’s medicines were ordered, stored and disposed of safely. Medicine records were completed correctly. People were encouraged to take positive risks and risk assessments were in place to minimise the risk of avoidable harm.

People were supported by well trained staff. Staff supported people to eat and drink enough to keep them healthy. When people required access to health care this was arranged to ensure the best outcome for the person’s wellbeing. The service was decorated in a homely way that met the needs of the people living there.

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.

Care was delivered with dignity and respect. People told us they liked the staff who supported them and were happy with the care and support they received.

People’s support plans contained detailed information to ensure their individual needs and preferences had been considered. They were reviewed regularly to reflect any changes. We have made a recommendation about end of life care planning.

People were involved in a variety of activities that reflected their own hobbies and interests. There was a procedure in place for addressing complaints and this was correctly followed.

An effective system of checks and audits was in place. People and staff were regularly consulted about the quality of the service.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 12 July 2018) and there was one breach 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 improvements had been made and the provider was no longer in breach of regulations and had improved to good in all the key questions.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Lorne House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lorne house were registered for 14 beds and accommodated 13 people at the time of the inspection. Two of these people were in hospital.

The service had a registered manager who was registered in March 2016. 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 service was last inspected March 2017 and the overall rating was required improvement. We made some recommendations to the provider about records with medicines and offering too much processed food.

At this inspection we found the provider had made some improvements, however further improvements were needed to become fully compliant with the fundamental standards of quality and safety. This was the second time the service has been rated requires improvement.

We found concerns with risks to people's safety including the management of medicines.

Lorne House was designed, built and registered before 'Registering the Right Support' and other best practice guidance had been published. Lorne House was operating and developing in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service should be able to live as ordinary a life as any citizen, and this was always the case for every person living at the service.

Risks to people arising from their health and support needs were not always assessed and plans were not always in place to minimise them. Where people were at risk of choking, guidelines from Speech and Language Therapist (SALT) were not followed.

Audits were taking place but had not identified the concerns we found at inspection.

Care plans contained detailed information about people’s personal preferences and wishes as well as their life histories.

Feedback was sought from the people who used the service and their families.

People were supported to access the support of health care professionals when needed.

Safeguarding principles were embedded and staff displayed an understanding of what to do should they have any concerns.

There was enough staff to meet people's needs on a day to day basis, staffing levels were not increased to accommodate when staff accompanied people to an activity. Due to two people being in hospital this was not such an issue on the day of the inspection but we discussed this with the registered manager. The registered manager had already acknowledged this and was in the process of recruiting more staff.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role and we saw evidence of this. Staff received effective supervision and a yearly appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received a varied and nutritional diet and enjoyed the food offered.

The interactions between people and staff showed that staff knew the people well and were kind and respectful.

The management team were approachable. People, relatives and staff felt any concerns would be taken seriously and acted on.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

At our previous comprehensive inspection in January 2015, we identified two breaches of regulations relating to consent and the maintenance of records. We rated the service as ‘Good.’ We carried out a follow up inspection in July 2015 to check that improvements had been made. We found that the provider was now meeting the regulations however improvements were still required. We made a recommendation that the provider should integrate the Mental Capacity Act 2005 into the service’s assessment, care planning and recording systems.

Lorne House provides personal care and accommodation for up to 14 people with learning disabilities. There were 13 people living at the home at the time of our inspection.

There was a registered manager in post. 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 told us they felt safe at the service and relatives confirmed this. We found the provider had not passed one safeguarding allegation to the local authority’s safeguarding adults team in line with their policies and procedures. Instead, they had dealt with the concerns raised through their complaints procedure and had carried out their own investigation. We passed this information to the local authority’s safeguarding team.

Checks and tests were carried out to ensure the safety of the premises. There was an ongoing refurbishment programme in place. Most of the bathrooms had been refitted and the laundry room was being extended. A recent environmental health inspection had been carried out following an anonymous concern. Minor issues had been identified and the service had kept its five star [highest] food hygiene rating.

We looked at the management of medicines. There were some omissions and inconsistencies with the recording of medicines. We have made a recommendation about this.

People did not raise any concerns about staffing levels. Some relatives and staff told us however, that more staff were required. The provider was reviewing staffing levels and was going to implement a suitable tool to assess staffing levels.

Recruitment checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. We saw that training was carried out in safe working practices. Staff were also working towards a training programme to meet the specific needs of people who lived at the home.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Information about people’s capacity and DoLS authorisations was included in their care files. We noted however, that records did not always demonstrate how staff followed the requirements of the MCA. We have made a recommendation about this.

People told us they enjoyed the meals at the home. Several staff however, raised concerns about the standard of meals at the home and said there was an over reliance on processed meals. We read people’s food records and noted that certain meals were repeated on a regular basis such as hot dogs and chips, quiche and chips and fish fingers.

People had access to a range of healthcare services to ensure their health needs were met.

People and relatives told us that staff were caring. We saw positive interactions between people and staff. People’s privacy and dignity was promoted.

Care plans were person centred and documented the care and support which needed to be provided. We found that improvements were required with regards to promoting people’s independence and participation in a range of daily activities. We have made a recommendation about this.

The service had their own seven seated vehicle which was used to take people out into the local community and to their day centres. People undertook various activities such as attending football matches, shopping trips and various outings to nearby villages and towns. People were also supported to go on holiday.

There was a complaints procedure in place. There was one ongoing complaint. None of the people of relatives with whom we spoke during the inspection raised any complaints. Meetings and surveys were carried out to obtain people’s opinions. It was not clear however, whether these were always effective at obtaining some people’s feedback.

Monthly board meetings were carried out to review and monitor the service. During the inspection however, we identified some areas for improvement and made recommendations relating to a number of areas such as medicines management, MCA and promoting people’s independence in a range of daily activities. Most of these had not been highlighted by the provider’s monitoring system.

Some staff told us that there had been issues with staff dynamics, team work and morale although this was improving. During our visit we saw positive interactions between all members of the staff team.

During this inspection we found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that all 21 staff had received safeguarding training and this has been regularly refreshed, with the last courses being completed in 2012 and 2013. We saw that the manager checked staff understanding of the process and safeguarding expectations during supervision and within staff meetings.

We noted that the staff team was very stable and all of the staff had been in post for over two years and the majority had worked at the home for over five years. From a review of five staff files, including those of the most recently recruited we saw that the recruitment process met the regulatory requirements. We found that the provider had appropriate processes in place to ensure that staff were fit and able to perform their role.

We saw evidence that regular meetings with people, advocates, staff and relatives had taken place on a variety of topics. Relatives we spoke to told us the care was great at the home and they had no complaints.

We found that that people were provided with a choice of suitable and nutritious food and drink. People were protected from the risks of inadequate nutrition and dehydration.

We found that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Also that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.