Lady Spencer House

Lady Spencer House is a residential care home that provides personal care to up to 24 people. The service provides support to adults, some of whom were living with dementia. On the day of the inspection 23 people were using the service. The premises are an older style purpose-built building on three floors with communal space including a lounge and dining room on the ground floor and a further lounge on the first floor. Most bedrooms had a hand basin and there were shared bathroom facilities on each floor.

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

For the most part, people were protected from the risk of the spread of infection, although we found some items in people’s rooms required cleaning or replacement. We also found staff did not always use the correct bins to dispose of Personal Protective Equipment (PPE). Some bins were not lidded or emptied frequently enough. The manager took steps to address this straight away.

The provider continued to have a booking in system for visiting. This had not been reviewed to reflect the easing of the government restrictions on visiting imposed as a response to the COVID19 pandemic. Some relatives told us they did not like this because they felt it prevented them from seeing their family members as frequently as they would like.

There were enough staff on shift, and we saw that the manager had several ways with which they checked staffing numbers were sufficient such as a dependency tool, practice observations and whole shift observations.

Care plans and risk assessments were completed as required and regularly reviewed and updated. Everyone had a personal evacuation plan detailing the support they required to evacuate the building in the event of a fire. We saw that fire evacuation equipment was in place on all floors.

People told us they felt safe, and staff were aware of their responsibilities to protect people from harm. They understood who to report any concerns to both within the service and to external bodies. People’s medicines were managed safely, and we saw that appropriate referrals were made to external professionals to ensure people’s health care needs were met. People received appropriate support to maintain a healthy diet. We saw people had enough to eat and drink and that food provided appeared to be of a good quality. Where people were at risk of not eating or drinking enough, this was monitored, and appropriate referrals made.

Although some areas of the home and some furnishings were tired and in need of replacement at the time of the inspection, a refurbishment programme was underway. The manager assured us that people were being consulted about this work and that the needs of everyone, including those living with dementia, were being considered when making improvements to the environment.

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. People told us that staff were kind, attentive, respected their decisions and protected their dignity and privacy.

People had a range of opportunities on offer to occupy their time in ways that were meaningful to them. This ranged from having access to newspapers, quizzes and word searches, to group and individual pastimes such as playing the guitar, making bread and popping to the shops. Staff engaged positively with people and there was an amiable and comfortable atmosphere in the home.

The provider and manager had good oversight of the service. There were robust quality monitoring systems which included seeking feedback from people, their relatives and staff through a variety of means. The manager was visible within the service and frequently carried out practice observations to review the quality of care provided. There was a strong emphasis on staff development and learning. Staff completed a wide range of training to support them to carry out their roles well. Incidents, accidents, events and complaints were all used to identify areas for development and improvement of the service.

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 26 June 2019) and there was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

At our last inspection we recommended that the provider sought advice from the fire safety officer from Bedfordshire to ensure they had taken all reasonable steps to protect people from the risks associated with fire. At this inspection we found the service had sought this advice and had taken steps to improve fire safety at the service.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Recommendations

We have made a recommendation that the provider reviews their policy in relation to visiting at the service to consider the most recent easing of government restrictions introduced during the COVID 19 pandemic.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lady Spencer House is a residential care home providing support for people living with dementia and other health conditions. There are individual bedrooms, shared bathrooms, a kitchen, dining room, lounges and a garden area. The service provides support to up to 24 people. At the time of our inspection there were 22 people using the service.

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

People were not always protected from the spread of infection of COVID-19 as staff and professional visitor vaccination status was not correctly checked and recorded.

People were supported to have visitors to the home using a booking system as well as go out for meals and drinks to meet with friends or relatives.

People’s rights in relation to isolation rules were at risk of not being upheld. This was because the registered manager was not aware of current government guidelines.

Visitors were checked for their COVID-19 status by taking a lateral flow test, having their temperature taken and answering some screening questions prior to entering the building.

People were supported by staff who kept the house clean and tidy and understood the importance of following measures to reduce the risk of spreading infection. They followed cleaning schedules and wore the correct Personal Protective Equipment (PPE) and regularly sanitised their hands.

People and staff took part in regular testing for COVID-19. Staff understood the additional measures to follow when anyone had confirmed a positive test result for COVID-19 and felt supported should they need to isolate themselves.

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 (5 May 2019)

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the Infection Prevention and Control (IPC) practice, whether it was safe and that the service was compliant with IPC measures. This was as a part of CQC’s response to care homes with outbreaks of COVID-19.

We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 a breach at this inspection in relation to the requirement that all staff and professional visitors (not exempt) prove as of 11 November 2021, they are fully vaccinated against COVID-19.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Lady Spencer House is a residential care home that was provides personal care to up to 24 people aged 65 and over. On the day of the inspection they were providing a service to 23 people

People’s experience of using this service:

The registered manager was working with the provider to develop a person-centred culture within the service. However, the outcomes for people did not fully reflect this and more work was needed to embed this way of thinking within the team.

Although risks to people’s health and well-being were identified and monitored, we found staff were not proactive in responding to risky incidents when they occurred. This resulted in a near miss incident during our inspection.

Although there were enough staff to meet people’s needs during the inspection, we have recommended the provider consider again whether they always have enough staff to meet people’s needs. This was the case particularly at night due to the complex arrangements for evacuating some people in the event of an emergency.

We have recommended the provider seeks guidance from the fire safety officer in relation to the accommodation arrangements and staffing levels for two people living on the top floor of the building.

The premises was undergoing refurbishment at the time of the inspection. We have recommended that the provider uses this opportunity to consider current good practice guidance in relation to creating a dementia friendly environment.

People gave mixed feedback about their experiences of living at Lady Spencer House. Many people felt there was not enough to do, and that staff did not spend time talking to them. Some people felt that staff were kind but others said staff sometimes shouted at them. We observed that staff were kind but were task focussed in their approach to care.

The provider’s had governance systems in place. However, we have recommended that they look at how they can improve these to include monitoring of staff practice as well as records.

People’s care plans were personalised to give guidance to staff on how to support people effectively. However, daily records were generic and did not capture individualised information.

People and their relatives were involved in discussions about their care and in developing their care plans.

Staff were knowledgeable about safeguarding people from avoidable harm and how to report their concerns internally and externally to local safeguarding authorities.

People’s dignity and privacy was promoted and respected by staff. People were encouraged to eat a healthy balanced diet and to drink plenty of fluids. Staff supported people to attend health appointments.

Staff had supervisions to discuss their progress and training in subjects considered mandatory by the provider to develop their skills and knowledge.

Rating at last inspection:

Good (report published 16 July 2017). At this inspection we found improvements needed to be made to the care provided to people and the service is now rated ‘requires improvement’.

Why we inspected:

This was a scheduled inspection based on the previous rating.

The service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For details of the action we told provider to take please refer to the end of the full report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We originally carried out an unannounced comprehensive inspection of this service on 23 March 2015 and rated it 'Good'. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lady Spencer House on our website at www.cqc.org.uk.

We carried out our second unannounced comprehensive inspection on 30 June 2016. Prior to this inspection we had received concerns in relation to the care people were receiving and the management of the service. In addition, concerns had been raised about the nutritional status of the meals provided meaning that people were not always supported to maintain an adequate dietary intake. We therefore needed to ensure that people's care was being delivered in line with the fundamental standards.

The service had a registered manager. 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 felt safe and trusted in staff because of the care and support they received. Staff were knowledgeable about the risks of abuse and understood how to respond appropriately to any safeguarding concerns, to further ensure people’s safety and welfare. Risk to people and the environment had been assessed and identified hazards which people may face. They were user friendly and provided guidance for staff to manage any risk of harm, whilst empowering people to be as independent as possible.

People were cared for by sufficient numbers of staff who had been recruited into their roles safely. This meant that people were provided with consistent levels of care by staff who knew them well. Staff had undergone appropriate checks before commencing their employment to ensure they were safe to work with people.

Suitable arrangements were in place for the safe administration and management of medicines.

Staff received a robust induction when they commenced work at the service which provided them with the skills and knowledge they required to support the people they cared for. This was enhanced by on-going refresher training and additional training which further helped to develop staff skills. Staff received regular supervision and support to identify areas for self-development and to ensure they remained competent to meet people’s needs in the best possible way.

The service had systems in place to ensure the principles of the Mental Capacity Act (MCA) were being followed. There was evidence to show that people had consented to their care and that decisions made on their behalf were in their best interests.

People were happy with the food at the service and mealtimes were relaxed. The food served was nutritious; people had a variety of choice and were given support when required. People's nutritional needs were assessed to ensure they were met. People were supported to see health and social care professionals as and when required and prompt medical attention was sought in response to sudden illness.

There were positive relationships between people and members of staff and staff treated people with kindness and compassion. Staff had spent time getting to know people which helped them to provide people with care based on their wishes. People were involved in making decisions about their care and the running of the service. They were provided with information about their care and the service, as well as external organisations they may wish to get in touch with for additional support or advice. Staff ensured they treated people with dignity and respect at all times.

People's care was person-centred. Care plans had been written with people's involvement to ensure they were reflective of their needs, wishes and preferences and were reviewed on a regular basis to ensure they were accurate and up-to-date. The service had arranged a range of different activities to provide people with stimulation which helped to prevent social isolation and motivated people to maintain their independent living skills. People were aware of how to complain and there was a clear complaints procedure in place. Complaints were taken seriously and responded to appropriately.

There was an open culture at the service. People were positive about the care they received and were happy with the staff that supported them. Staff were aware of their roles and responsibilities and were motivated to perform them well and meet people's needs. People and staff were positive about the leadership at the service. They felt well supported and were able to approach the registered manager and team leaders whenever they needed to. There were management systems in place to monitor and review the quality of care being provided and to identify areas for development.

During this inspection, we were unable to substantiate the concerns raised, therefore there were no changes to the rating of 'Good', and no breaches of regulation were identified.

We visited Lady Spencer House on 21 November 2013 to ensure that the compliance actions which had been made when we visited the service on 25 July 2013 had been achieved.

The majority of the people we spoke with were unable to respond to specific questions about their experiences as they had complex needs. They spoke with us about random topics and looked happy and content.

We spoke to a relative who was visiting on the day of our inspection. The person was complimentary about the care provided to their family member.

We observed positive interactions between staff and people who use the service. People looked relaxed in the company of staff.

We found that the system in place to maintain appropriate standards of cleanliness and hygiene in the home had been reviewed to ensure that people lived in a clean hygienic environment. People were now protected against the risks of unsafe or unsuitable premises. This was because areas in the home that required attention and posed a risk to people's safety had been addressed.

We found that people were protected against the risks of unsafe or inappropriate care and treatment. This was because records relating to their care and treatment were now accurately and appropriately maintained.

We found that people were satisfied with the care and support they received. A relative of a person who use the service said, 'I am happy with the care my' is receiving. I visit different times of the day and never come across anything untoward. There are staff around all the time'. Another relative said, 'My 'always look clean and is provided with plenty of fluids'.

We found that people were supported to have adequate food and hydration. Equipment used in the home was properly maintained and suitable for its purpose. Recruitment processes were robust to ensure staff were fit and suitable to work with people.

We found that appropriate standards of cleanliness and hygiene in the home were not maintained. People were not protected against the risks associated with unsafe or unsuitable premises.

Records relating to people's care and treatment and other records were not accurate and appropriately maintained.