Archived: Lee Gordon House

At our last comprehensive inspection of this service 6 May 2014, we found the provider had not met all of their legal requirements and were in breach of the regulations. This was because the provider did not always have appropriate arrangements in place to manage medicines. After this inspection, the provider wrote to us to say what they would do to meet their legal requirements in relation to the breach. We carried out an inspection in August 2014 to check that they had followed their plan and found they met legal requirements.

The home had an established 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 and associated Regulations about how the service is run. We refer to them as the manager throughout this report.

Lee Gordon House provides accommodation with personal care for up to six people with learning disabilities or autistic spectrum disorder. It does not provide nursing care. At the time of our visit six people were living at the home.

Lee Gordon House is a large detached home in a residential area in Burton Green. All the bedrooms and communal areas are located on the ground floor. There is a large sitting room with a dining area. The sitting room is designed so it provides a space where people can sit and watch television and another area where people can sit and enjoy other activities. There is a large kitchen and a separate laundry room.

We found staff were not always available at the times people needed them to support people safely and at the times they preferred. The registered manager was addressing this and staff hours were being increased to provide greater supervision and support for people. Recruitment procedures made sure staff were of a suitable character to care for people safely at the home.

Relatives told us they felt people were safe at Lee Gordon House. The manager and staff understood how to protect people they supported from abuse, and knew what procedures to follow to report any concerns. Staff had a good understanding of risks associated with people’s care needs and how to support them.

Medicines were stored and administered safely, and people mostly received their medicines as prescribed. Audits were carried out of medicines to ensure they were managed in line with good practice guidelines, however, records of administration were not consistently maintained. People were supported to attend health care appointments when they needed to maintain their health and wellbeing.

Staff were kind and supportive to people’s needs and people’s privacy and dignity was respected. People were encouraged to be independent as much as possible in assisting with tasks around the home and shopping. People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink.

The management and staff teams understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and supported people in line with these principles. People were supported to make everyday decisions themselves, which helped them to maintain their independence. Where people were not able to make decisions, relatives and healthcare professionals were consulted for their advice and input.

People were supported to pursue their hobbies and interests both within and outside the home. Activities were arranged according to people’s individual preferences, needs and abilities and staff were keen to explore a variety of new activities for people. People who lived at Lee Gordon House were encouraged to maintain links with friends and family who visited them at the home.

Relatives knew how to make a formal complaint and were able to discuss any concerns they had with staff and the manager. Staff supported people living at the home when they identified they were unhappy about something. The provider obtained the views of relatives by way of meetings and customer surveys. Relatives were kept updated about changes to the service by the manager.

Staff felt the management team were supportive and promoted an open culture within the home.

Staff were able to discuss their own development and best practice in supervision sessions and during regular team meetings. A programme of training and induction provided staff with the skills and knowledge to meet people’s needs.

The manager felt well supported by the provider’s area manager who visited regularly and their views and ideas were encouraged on how to improve the service.

The provider carried out regular audits to check the quality of care people received. Audits by the registered manager and senior member of care staff were conducted regularly to continually monitor and improve the quality of the service.

We found the service had appropriate arrangements in place for the management of medicines.

Medicines were kept securely and safely.

There were processes in place to ensure medicines were not used beyond their expiry date.

There were protocols in place for people who required their medication on an "as required" basis to support staff in administering that medication consistently.

Staff administering medication received appropriate training.

The registered manager of this service was on maternity leave at the time of our inspection. A senior member of staff was acting manager in the registered manager's absence.

Below is a summary of what we found. The summary is based on our findings during the inspection, observing the support provided to people, speaking with the staff who provided the support and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spent time looking around the home. We saw it was suitable, safe and accessible for the people who lived there. We looked at maintenance records and saw regular checks were made to ensure the safety of the premises.

We saw risk assessments had been carried out to identify, assess and manage risks relating to the health, welfare and safety of the people who lived in the home.

We looked at how medicines were managed. We found handwritten amendments to the Medication Administration Records (MAR) did not provide clear information to staff. We found the amounts of medication received and the amounts in stock had not always been recorded on the MAR. This made it difficult to audit these medicines to check they had been administered as recorded.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). A DoLS application had been made where a person had been under a level of supervision that might have restricted their liberty. This meant the correct protocols were being followed when decisions had to be made that could deprive people of their liberty.

Is the service effective?

Lee Gordon House provides care for up to six people who have complex needs. All the people who lived there had either no or limited verbal communication. We saw care plans were sufficiently detailed so staff would understand what support people required and how people preferred that support to be delivered. We saw staff were observant of people's behaviours and responded appropriately and promptly. Staff we spoke with had a good understanding of people's needs. They were knowledgeable about any changes in people's health and how those changes were to be managed.

Is the service caring?

Care plans contained detailed information about how people showed if they were unhappy or in pain. This information supported staff in providing appropriate support and reassurance. We saw people appeared happy and well cared for.

People were supported to do as much for themselves as they were able. One person had changed their clothes independently. A member of staff gently went to assist them when they saw the person had put one item of clothing on inside out.

Is the service responsive?

We saw that where there had been changes in people's health, they were promptly referred to the appropriate healthcare professional.

Whilst the people who lived at Lee Gordon House had complex needs, the manager was aware of their responsibility to ensure their opinions were recognised. The service was working towards developing menus and activities around people's evidenced and recorded likes and dislikes. Records demonstrated people's views and preferences had been taken into account in the preparation of their support plans

Is the service well led?

Records showed staff had received both mandatory training and training to support them in meeting the specific needs of the people they cared for. Staff received supervision through individual meetings, group meetings and observed practice. Staff had regular team meetings when presentations would be given on different areas such as infection control, food hygiene and safeguarding. This provided an opportunity to share knowledge about best practice and to identify areas where the quality of care could be improved.

Staff spoke positively about the support they received from the management team. One staff member told us, "When you have a problem you can approach them and they will help you to solve that problem. Sometimes they can't solve it the way you want them to but they show an interest to help you solve it."

Staff spoke positively about providing people with choices and respecting their ability to make decisions about their care. Care plans contained details of people's routines and described how they preferred support to be delivered. We saw that staff acted upon changes in people's health and referred them to external healthcare professionals when necessary. A visiting relative spoke positively about the care and support provided to their family member and described them as 'very relaxed and very happy.'

Staff we spoke with understood their obligations if they witnessed or suspected abuse. When restrictions had been placed on a person that amounted to a deprivation of their liberty, an appropriate 'Deprivation of Liberty' application had been sent to the local authority.

We saw staff spoke kindly and attentively to people. We identified that staff were stretched to deliver the care required due to the increased level of support required by one person. The manager was monitoring the situation with staff and external professionals to ensure the needs of everyone who lived at Lee Gordon House continued to be met.