Lennox House is part of the Care UK Community Partnership Company. It provides residential care and nursing care for up to 87 older men and women at purpose built accommodation in a residential area of North London. The home is divided over four floors. On the ground floor intermediate care (this is short term care for people who usually live in their own home) is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors.This inspection took place on 16, 18 and 22 January 2017. At our previous comprehensive inspection on 28 July and 10 August 2015 the service was meeting all but one the regulations we looked at, in relation to staff not all having had appraisals. This breach had been met by the time of the unannounced focused inspection on 30 June 2016 that we undertook to look specifically at that previous breach of regulation. Subsequent to the June 2016 focused inspection we were informed of serious concerns about a safeguarding incident, that CQC had not been informed of, which had occurred in March 2016. We carried out a further focused unannounced inspection on 5 and 9 August 2016. As a result of that inspection we identified three breaches of regulations Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and Regulation 18 of the registration regulations 2009 in respect of notification of incidents. Please refer to the remainder of this report in respect of our findings in relation to those breaches.
There was no registered manager in place. 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.
Medicines were not managed safely for everyone using the service. We found significant errors and people had missed their medicines due to a lack of supply or other administration and recording errors. Medicines audits carried out in November and December 2016 had identified similar issues, but no action had been taken to address these serious concerns since as the issue of medicines not being ordered in time had been identified again at a recent staff meeting on 11 January 2017. We also found errors in administration and recording of medicines during this inspection.
Apart from medicines audits in November and December 2016, an infection control audit carried out by the housekeeper in January 2017 and a current review of accident and incident trends, no other audits were provided, despite several requests. Audits were not therefore being used to effectively assess and improve the service. The provider informed us that they were undertaking a full review of the service in light of management and oversight failures that had been identified. This review was on-going and not been completed at the time of the inspection. CQC asked for a copy of the plan for reviewing the service, but this was not provided.
There had been significant management change. Since the previous registered manager’s departure in August 2016, the service had been managed by two of the provider’s operational support managers, one until late November 2016 who was then replaced by another from late November and was in place at the time of this inspection. There was no registered manager in post, although the provider was attempting to recruit to the post at the time of the inspection.
The staff of the service had access to the organisational policy and procedure for protection of people from abuse. They also had the contact details for the safeguarding team at the local authority in which the service is located. The members of staff we spoke with said that they had training about protecting people from abuse, which we verified on training records and staff were able to describe the action they would take if a concern arose. However, we found that although improvements had been made to reporting concerns there had been two instances where these responses had not been timely enough.
We saw that risks assessments concerning falls, healthcare conditions and risks associated with skin care and the prevention of pressure sores were detailed, and were regularly reviewed for most people. However, we found a small number of instances where these reviews and actions required did not receive a timely response or follow up to care already known to be required. Staff were not always ensuring specific individual support was provided consistently.
The service had experienced staff changes among the activities co-ordinator team. There was insufficient effort being made to engage and stimulate people with activities, including people who remained in their rooms.
There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately and making the necessary applications for assessments when these were required.
People were usually supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home each week, but would also attend if needed outside of these times. Staff told us they felt that healthcare needs were met effectively and we saw that staff supported people to make and attend medical appointments, for example at hospital. However, there were a small number of occasions when healthcare needs were unclear and where follow-ups had not taken place as quickly as they should be.
Almost everyone we spoke with who used the service, relatives and friends, praised staff for their caring attitudes. We saw that most staff were approachable and friendly towards people and based their interactions on each person as an individual. However, there were exceptions where staff were not engaging with people or were uncertain about how to respond to people living with dementia.
Staff we spoke with felt more positive about the way the service operated and that their views were being sought and listened to more than they had previously experienced.
As a result of this inspection we found that the provider was in breach of Regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.