Lee House

Lee House provides accommodation and personal care for up to 27 older people. At the time of our inspection the home was providing support to 24 people.

The home had 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.

At the last inspection in January 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People using the service and their relatives were very positive about the care and support provided at Lee House. They said staff treated people respectfully and in a kind and caring manner.

We found 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. Individual care and support needs were fully assessed, documented and reviewed at regular intervals.

People were assisted as required by suitable numbers of staff who were trained and well supported in their job roles. Staff members had been safely recruited and had received an induction to the service. Staff we spoke with were confident that they provided a good service to people and said they would recommend Lee House to others. They had access to supervision and additional support when required.

People and their relatives or friends felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues. Staff also said they felt comfortable in raising any concerns should they have any.

Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. Risks associated with people’s support were monitored and managed well. People had risk assessments in place staff were made aware of any hazards that could affect the delivery of safe care. Well maintained and up to date care records supported staff to meet people’s needs and preferences.

People received their medicines safely and on time from staff who were trained to manage medicines safely.

People using the service and their relatives said how clean the home was kept.

An experienced registered manager promoted high standards of care and person-centred support for people using the service at Lee House. They monitored the quality of the service and made changes to improve the service provided when required. People who used the service, their relatives and staff found the registered manager and her staff to be approachable and responsive.

Lee House provides accommodation and residential care for 27 older people. At the time of our inspection the home was providing support to 21 people. The home had 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 were protected from the risk of abuse because staff had received appropriate support and training which enabled them to identify the possibility of abuse and take appropriate actions to report and escalate concerns. People and their relatives said risks were assessed and managed appropriately. We saw risk assessments were person centred, detailed and responsive to people’s needs.

There were systems in place to monitor the safety of the environment and equipment used within the home minimising risks to people. There were arrangements in place to deal with foreseeable emergencies.

There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff started work ensuring people were supported by staff that were suitable for their role.

Medicines were managed, stored and administered safely.

There were processes in place to ensure new staff were inducted into the home appropriately and we saw staff received regular training, supervision and annual appraisals. Staff were aware of the importance of gaining consent for the support they offered people. The registered manager and staff were able to demonstrate their understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation.

People were supported to maintain good health and had access to a range of health and social care professionals when required. People’s nutritional needs and preferences were met.

Staff demonstrated a good understanding of the needs of the people they supported and could describe peoples’ preferences as to how they liked to be supported. We observed staff speaking with and treating people in a respectful and caring manner and interactions between people, their relatives and staff were relaxed and friendly.

People received care and treatment in accordance with their identified needs and wishes. Care plans documented information about people’s personal history, choices and preferences, preferred activities and people’s ability to communicate. Staff respected people’s privacy and dignity. People and their relatives told us they were made welcome in the home and they enjoyed the social events they were invited to attend.

People were supported to engage in a range of activities that met their needs and reflected their interests. There was a complaints policy and procedure in place and information on how to make a complaint was on display in the reception area of the home so it was accessible to all.

People and their relatives told us the atmosphere in the home was open, friendly and welcoming. People told us and we observed that the registered manager and staff were approachable.

The home and provider took account of people’s views with regard to the service provided through satisfaction surveys that were carried out on an annual basis. There were systems and processes in place to monitor and evaluate the quality of the service provided.

The management of the home’s records was maintained to a good standard. We found the records we inspected clear and easily accessible.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

The home was clean, tidy and well-maintained. People commented on its cleanliness, saying 'Their standards are very high.' Infection control audits were carried out, staff had appropriate infection control training and regular cleanliness checks were carried out to ensure people were protected from the risks of infection.

People had access to portable alarms so they were able to summon help in an emergency. Fire evacuation procedures were displayed and staff were aware of how to assist people should the home need to be evacuated.

Risks were individually assessed and managed for people who used the service, even if they were relatively independent and did not require full care plans. This meant staff were aware of how to keep each person safe. Some risk assessments needed to be updated following changes in people's circumstances to ensure that this remained true for those people.

The home performed checks on all new staff to ensure people were protected against the risks of inappropriate staff being employed. Staffing levels were adjustable based on the home's needs and there were enough suitably qualified, skilled and experienced staff to keep people safe.

The Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place and people were free to leave the home as they pleased.

Is the service effective?

Records of care showed that the service was delivered in line with people's care plans, which meant that the needs they were assessed as having were being met. Staff received appropriate training so they were sufficiently knowledgeable to care for people to an appropriate standard.

Where required, expert input was used to ensure people's care reflected relevant research and guidance. The home made effective use of specialist services such as continence nurse services to ensure that effective care was provided.

Is the service caring?

The service encouraged people to remain as independent as possible so they were able to make choices and retain their daily living skills. People told us, 'I don't need much support: they work with me' and, 'We are all different but they do take individual needs into account.'

Care planning took into account people's likes and dislikes, life history and things that were important in them. This meant that people were supported to live as they wished to and their care package was tailored to them as individuals.

There was a wide range of activities available, which people told us was 'very good.' People were able to spend their time occupied with meaningful tasks, activities and hobbies as they wished.

People told us staff were caring. They said, 'Staff are very helpful and friendly' and 'The staff are very kind to me.' We saw staff interacting with people in a respectful and caring manner.

Is the service responsive to people's needs?

Each person who used the service had a six-week assessment period so that the service was aware of what their needs were and how to respond to them.

Referrals were made in a timely manner where required so that people's needs were met if the home was unable to meet them itself. People told us, 'I see the doctor every week, the chiropodist every six weeks and anyone else I need,' and, 'Communication with the home is very good.'

Staffing levels were adjusted where required on a short-term basis to respond to any additional needs on specific shifts. This enabled people to receive any extra support they needed, such as to attend hospital appointments.

People had the opportunity to feed their views back to the service via meetings, questionnaires and informal conversations. People said the staff listened to what they said and 'they take it on board.'

Is the service well-led?

The home had an experienced registered manager in post, who at the time of our visit was in the process of recruiting extra staff to cover long-term leave. The manager told us they employed staff on the basis of them having the right personal qualities and skills to fit with the existing skill mix of the staff team. People we spoke with said, 'The staff work very well as a team' and 'They are there for each other.' Staff told us their manager was supportive and they felt able to raise concerns.

The manager and provider regularly gathered the views of staff, people who used the service and people's relatives and used these to monitor and improve the quality of the service. Data from surveys was compared with similar services and showed that the home was performing above average. One person told us, 'They explain what they are doing and why. You can ask questions and you are very much listened to.' Data was gathered to ensure the service learned from incidents and adverse events.

We found that people participated in regular discussions regarding the activities, meals and the care they received. People's feedback was taken into consideration and changes were made to the service accordingly.

Staff told us that they enjoyed working in the home and that they had a team building training since our last inspection. The leader of the care team said that it had a 'very positive and motivating effect on all staff'.

We found that areas of improvement were identified by the manager and the provider. Appropriate action plans were made and were being implemented at the time of our inspection to ensure people welfare and safety by reviewing records, care plans regularly and evidencing people's or their representatives' involvement in these processes.