This inspection took place over two days on 14 and 16 November 2016. The first day was unannounced, which meant the service did not know in advance we were coming. The second day was by arrangement.Lightbowne Hall is a large three storey detached property in Manchester. The home provides residential care for up to 52 people. At the time of the inspection there were 50 people living in the home. The home has large communal areas on each floor with separate dining areas. Each floor also has a quiet lounge. The kitchen and laundry facilities are on the ground floor of the building and there is a hairdresser’s on the first floor. All floors are accessible by a lift and stairs. The service provider had transferred in 2015 from Ideal Care homes to Anchor Care homes.
At the comprehensive inspection of Lightbowne Hall on 16 July and 4 August 2015 we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). We issued the provider with seven requirements stating they must take action to address these breaches. We shared our concerns with the local authority safeguarding team.
Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan, and to confirm that they now met all of the legal requirements.
During this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations.
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.”
At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC). 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.
The registered manager was on annual leave at the time of the inspection. There were arrangements in place to cover the management of the service including an area manager and support from the deputy managers.
People's medicines were not managed safely. For example, we found one person had recently been discharged from hospital with a new medication supply that would last for ten days, therefore the service was required to order more medication with the local pharmacy. We noted this did not happen in a timely manner and resulted in the person missing five doses of their medicines.
We found accident records at the home were comprehensive and evidence showed people were monitored effectively following an accident. However, we found one incident had not been responded to in a timely manner, resulting in a person not receiving medical attention for two days.
Audits on the home’s quality were not accurate which meant systems to improve the quality of provision at the home were not always effective. We found the home in breach of the regulation in relation to good governance as there were not effective systems in place to monitor the quality of the service. Surveys were completed but the information was not collated and used to improve the provision of care at the home.
At the last inspection we found there were not sufficient levels of staff of staff on duty. At this inspection we found staffing levels had increased and people we spoke with confirmed staffing levels were adequate.
During this inspection, we found that the provider had made some improvements to safe care and treatment. Risks to people's health and well-being were identified and a plan was in place to manage those risks appropriately. Staff had access to this information and they were able to reduce the recurrence of the identified risk. Risk assessments were reviewed regularly when there was a change in people’s needs.
Care plans were based on the needs identified within the assessment, however we found three care plans did not have a dementia specific care plan in place, and therefore it did not reflect the current needs of these three people.
People had access to activities, however we received mixed feedback with regards to the activities provided. People were not always protected from social isolation. The range of activities available were not always appropriate or stimulating for people.
At the last inspection we found individual plans to support people in an emergency had been formulated on their admission to the home but had not been reviewed since. At this inspection we found people had a personal evacuation plan that reflected their current level of mobility. However, we found the service was not undertaking regular fire drills, to ensure staff were fully prepared in an emergency, such as a fire.
We found staff were recruited safely. Suitable checks were made to ensure people recruited were of good character and had appropriate experience and qualifications.
We reviewed the information and support available to ensure people received adequate nutrition and hydration. We found records were held as required to support people at risk of not receiving enough nutrition and hydration. We found advice given by specialist teams including GPs and dieticians were followed. Records in relation to monitoring people’s intake of food and fluids were completed when required.
Staff had received appropriate training, supervision, and appraisals to support them in their roles. Staff, with the support of their line manager, identified their professional needs and development and took action to achieve them, although we noted supervisions did not happen as often as stated in the provider’s policy.
People told us they knew how to complain if they were unhappy and records showed the service responded appropriately to complaints they had received. One relative commented that the service did not respond appropriately to their complaint; the area manager arranged a meeting with this person shortly after to discuss their complaint.
We found that the home was properly maintained to ensure people's safety was not compromised, however we found two carpets within the home that were heavily stained and threadbare. These carpets had been identified during a number of home audits, but had not yet been replaced.
Staff sought consent to care from people they supported. Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and how to support people effectively, however we found some of the staff were not aware of the people living at the home who were subject to a DoLS.
The environment had some adaptations for people living with dementia.
Staff maintained people’s dignity, and respected their privacy. Care records were kept confidentially.
Staff expressed confidence in the management team and in each other. There were regular staff meetings where staff could contribute their views.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.