Lancaster House

Lancaster House provides rehabilitative support and accommodation for ten adults with enduring mental health needs.

Lancaster House is a large terraced property situated in a residential area close to Blackburn town centre. There were eight people accommodated at the home on the day of the inspection.

At our last inspection we rated the service 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 ongoing 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.

At this inspection we found the service remained Good.

Risk assessments were in place to keep people safe. We saw individual risk assessments were in place in relation to people’s health care needs. We also saw risks in the environment had been considered to ensure the safety of people who used the service, staff and visitors.

Medicines were managed safely. Staff had received training in administering medicines and their competencies were checked regularly. We found medicines were stored safely and the medicine administration records were completed without any gaps.

Recruitment systems and processes in place were robust. We saw references, identity checks and Disclosure and Barring Service checks were completed before staff were employed. People who used the service told us and records we looked at showed adequate numbers of staff were on duty.

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

All new staff members were expected to complete an induction when they commenced employment. Training courses were available to staff which were relevant to their roles. Staff members told us and records confirmed that staff members received supervisions and appraisals on a regular basis.

People who used the service told us staff were kind and caring. We observed interactions from staff that were kind, caring and respectful.

Staff members knew people very well, including their preferences, background and history. People’s care records contained information relating to their sexuality, cultural/spiritual needs and relationships.

All the staff we spoke with told us they would be happy for a family member to be cared for by the service.

We saw detailed, person centred support plans were in place. These clearly reflected people’s choices and preferences, including what they had already achieved and what they still wanted to achieve. Records also showed that people were supported by their key worker, to identify ‘SMART goals’. These goals were both realistic and achievable and gave people a direction and something to work towards.

None of the people we spoke with had needed to make a complaint but they were able to tell us who they would approach if they needed to. The service had a complaints procedure in place.

All the people we spoke with knew who the registered manager was and told us they were approachable.

The service’s management and leadership processes achieved good outcomes for people.

The service was meeting all relevant fundamental standards.

Further information is in the detailed findings below.

We last inspected this service on 02 September 2014 when the service met all the regulations we looked at.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service said they felt safe at this care home. Staff had been trained in safeguarding people from abuse and were aware of the need to report any suspected issues of abuse.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults. There were sufficient staff to meet people’s needs.

We found the ordering, storage, administration and disposal of medicines was safe.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

People told us they were encouraged to plan their menus, shop for their food and cook their meals with support from staff when required. Some people told us they were proud of the skills they were learning.

New staff received induction training to provide them with the skills to care for people. All staff were well trained and supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

Staff had been trained in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

There were systems to repair or replace any broken equipment. Electrical and gas appliances were serviced regularly. Each person had an individual emergency personal evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

The home was warm, clean, well decorated and fresh smelling. People who used the service were responsible for cleaning with staff support. People made good use of the covered seating area in the garden.

We saw that independent living was the aim of the service and on the day of the inspection one person told us he was moving to a flat to live more independently.

We observed there was a good interaction between staff and people who used the service. We observed the good relationships staff had formed with people who used the service and how they responded well to any questions or advice people wanted.

We observed that staff were caring and protected people’s privacy and dignity when they gave any care. The care was mainly around people’s mental health needs but we did not see any breaches in people’s confidentiality.

We saw that the quality of recovery plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. People agreed to the restrictions placed upon them to help them get better.

We saw that people who used the service were able to attend meetings, 1 – 1 sessions and activities to gain their views. Professionals were asked for their views in the way the service was managed. Staff were encouraged to participate in how the home was run.

Policies and procedures were updated regularly and management audits helped managers check on the quality of the service.

People were able to access the community on activities, were helped to gain employment or attend courses to improve their knowledge.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Two people who used the service said, "I am very happy thank you. I have no complaints and can talk to staff if I do have any worries" and "You can talk to anyone really if you had any concerns but I would talk to my key worker". Two other people who used the service said they had no worries. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one.

The service was safe, clean and hygienic. There were policies and procedures for the control of infection. Two people who used the service told us, "I help cook and enjoy that. We also clean and do our own laundry. They help you to be independent" and "I clean my room myself but staff will help me if I need to. I also do my own laundry. It is very clean here".

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. Two people told us, "I see my key worker every week and can talk to her about my care and support" and "They sit down and talk to us about our care every week. You can tell them what is going well and what is not. You try to achieve goals which help you to try to become independent".

Specialist dietary, medication and community support needs had been identified in care plans where required. Most people were younger adults and did not require any specialist equipment.

The service helped people with mental health problems to recover and if possible achieve independent living. All four people we talked with said the care was good, they were happy at the home and felt more able to do the things they wanted to do without incident. One person commented, "They talk to us every week and we can say how we are doing and how we can do better". The care service was providing an effective recovery program.

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Two people who used the service told us, "My key worker is very good. I think the staff are well trained" and "The staff are very supportive. They are all pleasant and caring. I like my key worker and we are going out this afternoon to buy me a new television. The staff know what they are doing and I think they are well trained". Two other people said they thought the staff who supported them were good at their jobs.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. Most people accommodated at the home went out to places of interest or shopping on the day of the inspection. Two people who used the service told us, "I do lots of things. I see my son, cycle, go out shopping or for a meal. I join in the group activities such as shopping" and "I go kick boxing and sometimes go to archery but I like shopping as well".

The registered manager and key staff held regular meetings with people who used the service. There was a staff meeting held at least once a week for various grades. Staff were able to voice their opinions. We saw that results from questionnaires had led the service to provide extra staff or improve the environment. The service produced a newsletter called 'The Voice'. With the agreement of people who used the service their achievements and activities were recorded as was useful information and some staff profiles to explain to people what their role was.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

Staff training was on-going, as was supervision and appraisal. A staff member we spoke with said, "I have completed a psychology degree which gives me an advantage because it was specifically around mental disorders. I get more than enough training to do the job. I get supervision regularly, at least monthly. We get good support from management at any time. I like working here. It is a new experience every day and I feel very well supported".

People living in the home told us they were satisfied with the support they received and had no complaints. Comments included, 'I am happy living here', 'Staff are good' and 'It's a good place'.

People using the service had opportunities to express their views and opinions about their support and were involved in making safe decisions about their individual needs and choices. Records showed people were involved in the planning of their support and had agreed to the services provided.

People told us staff treated them well and talked to them about their daily needs and preferences. During our visit we observed staff encouraging people to make safe choices and supporting them to be as independent as possible.

People were supported with a range of meaningful activities. From discussion, observation and looking at records we found people's activities were tailored to their individual needs and preferences.