This inspection took place on 25 April 2017 and was unannounced. At the last inspection, the service was meeting the legal requirements and was rated as good.

Heartlands Care Lanrick House provides accommodation and or personal care for up to 32 people, some of whom may be living with dementia. On the day of our inspection 20 people were living at the home.

There was a registered manager at the service but they had recently resigned from their post. 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. A new manager had recently started working at the service, who told us they would be starting the process of registering with us. We were also assisted by the regional manager who was working at the service on the day of our inspection.

We have made a recommendation that the provider considers ways to improve their quality assurance systems to support the drive for continuous improvement.

People felt safe living at the home and their relatives were confident they were well cared for. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. People received their medicines when they needed them. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff received training and ongoing support to ensure they had the skills and knowledge to meet people’s needs.

People were supported to make their own decisions and where they needed help, decisions were made in their best interest and involved people who were important to them. Where people were restricted of their liberty in their best interests, for example to keep them safe, the provider had applied for the appropriate approval. Any conditions detailed in the associated approvals were documented and understood by staff.

Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People had sufficient amounts to eat and drink and were able to access the support of other health professionals to maintain their day to day health needs. People were offered opportunities to join in social activities and were encouraged to follow their hobbies and interests. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes.

People and their relatives felt able to raise any concerns or complaints and were asked for their views on the quality of the service. Staff felt supported by their colleagues and the management team.

This inspection took place on the 28 May 2015 and was unannounced. This was the first inspection of Lanrick House since the new provider had taken over in February 2015. We had begun enforcement action in relation to the previous provider as we had serious concerns about the health, wellbeing and safety of people who used the service.

Lanrick House is registered to care for up to 32 people who may have dementia and physical disabilities. At the time of the inspection only 10 people were using the service as the service had a suspension placed on new admissions by the local authority due to their safeguarding concerns. This had now been lifted as the local authority had seen improvement in the safety and quality of care since the new provider had taken over.

The registered manager had remained in post during the change of provider. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. The Deprivation of Liberty Safeguards are for people who cannot make a decision about the way they are being treated or cared for and where other people need to make this decision for them. The provider followed the principles of the MCA and DoLS to ensure that people were supported to make decisions in their best interests when they lacked capacity to do so themselves.

People were safe as staff knew what constituted abuse and who to report it to if they suspected someone had been abused.

Staff were knowledgeable about people’s care needs and knew how to reduce the risks of harm by following the risk assessments and care plans that had been implemented.

Staffing levels were sufficient, people did not have to wait for help and support when it was needed. People’s medicines were managed safely, staff were trained and knowledgeable to support people with their medication as required.

People had enough to eat and drink. They told us they enjoyed the food and had been involved in drawing up the menus based on their individual preferences.

People had access to a range of health care professionals and were supported to attend appointments when required.

People told us they were happy and felt well cared for by the staff and management. Interactions between staff and people were kind, caring and compassionate. People’s privacy and dignity was respected. Relatives and friends were free to visit at any time.

Care was delivered dependent on people’s individual preferences. People were encouraged to have a say in how the service was run through regular meetings and being involved in their own care planning.

Systems were in place to ensure continuous improvement. People, staff and visitors told us they liked the new provider and found them approachable. Staff told us they felt proud to work at Lanrick house.

This inspection took place on the 14 January 2015 and was unannounced.

At our previous inspection in August 2014 we found that the provider was not delivering care that was safe and met people’s needs. There were insufficient staff numbers, people were at risk of infection due to poor standards of cleanliness of the home and the provider’s quality systems were ineffective. We had begun enforcement action and had issued a notice of proposal to cancel the provider’s registration.

The local authority was conducting a number of safeguarding investigations of suspected abuse and had suspended all placements into the service.

At this inspection we found that standards in the delivery of care had not improved, people still did not receive the care and treatment they required. The provider had made some improvement in the cleanliness of the home and had increased the staffing levels. However staff were not trained to administer people’s medication during the night time hours and people were not able to have medication that was prescribed to them. The provider’s quality monitoring systems continued to be ineffective, care was not being delivered as planned and the provider remained in breach of a number of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Lanrick House is registered to care for up to 32 people who live with Dementia and physical disabilities. There were 14 people receiving a service.

There was a registered manager in post. 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 did not always receive their medication as it was prescribed. Some people were not able to have their medicines when they needed them due to there being insufficient trained staff to be able to administer them.

A large proportion of staff had not received safeguarding training and did not know the provider’s whistle blowing procedure. Some staff we spoke with did not know what constituted abuse and who to report it to.

People were not always involved and had not always given consent to their care, treatment and support. The principles of the Mental Capacity Act were not always followed.

Staff were not always aware of people’s assessed needs, information in care plans was not forwarded on to staff promptly. This left people at risk of receiving care that was neither safe nor effective.

Most interactions between staff and people were kind and caring. However we observed one person spoken to in a disrespectful manner. The manager was aware of issues around this person but they had not been addressed formally.

People’s confidential information was not kept securely, private information was left in an area where it was visible to visitors.

Some activities were available but did not meet the needs of people with more complex needs. Some people spent long periods of time with little or no stimulus.

The provider had installed new flooring in the downstairs living areas, however it had begun to bubble up in areas and act as a potential trip hazard. The environment did not offer support to people living with dementia. There were no signs and physical prompts to orientate people to time, date and space.

Staff told us they felt supported but we found that they had not received the relevant training to fulfil their role effectively.

We found several continued breaches of Regulations of The Health and Social Care Act. You can see what action we have taken at the end of the report

We visited Lanrick House on a responsive inspection because we had received concerns about the health, safety and welfare of people who used the service. This inspection was unannounced which meant that the service did not know we were coming.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask –

Is the service safe?

People were not receiving the care they had been assessed to need.

Care records were not up to date and relevant to the needs of people.

Equipment was not maintained and safe for use with people.

The service was not clean and did not prevent the spread of infection.

There were insufficient staff to meet people's assessed needs.

Is the service responsive?

When people required health appointments the service did not always respond in a timely manner.

Staff did not always receive the training they needed to respond to fulfil their role effectively.

Daily living skills and activities within the community or within the service were not available to people.

Is the service caring?

People's dignity was not always respected.

Some people were happy with the care they received. One person told us: "The girls are lovely".

Staff were kind and caring when interacting with people.

Is the service effective?

People's health care needs were not always met.

Assessments were not thorough and did not reflect people's needs.

Regular monitoring of people’s healthcare did not take place to ensure that any changes were identified.

Is the service well led?

The responsible person did not routinely monitor the quality of the service.

Policies and procedures were not in place to ensure the appropriate management of staff absence.

The manager did not receive any formal support and supervision.

Equipment, fixtures and fittings were not adequately maintained.

There were no improvement plans to ensure that matters arising within the service were dealt with in a timely manner.

We visited Lanrick House on a planned, unannounced inspection which meant the service did not know we were coming. We were supported throughout the inspection by the registered manager and provider.

Below is a summary of our finding based on our observations, speaking to people who used the service, the staff supporting them and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is it safe?

The service followed the correct procedures in safeguarding vulnerable adults from the risk of abuse and followed the guidelines set out in the mental capacity act.

Recruitment procedures were in place to ensure suitable staff were employed.

People received their medication at the times they needed it.

Is it effective?

Everyone had a care plan which informed staff how to meet people's needs. Assessments included people's needs for specialist equipment, mobility aids and dietary requirements.

People had access to a range of health professionals when they required them.

Is it caring?

Staff treated people who used the service with dignity and respect.

One person who used the service told us: “It’s beautiful here”. Another told us: “They (staff) are very obliging”.

Is it responsive?

If people's needs changed the service sought the appropriate support from other agencies.

People who used the service had their likes and preferences respected and acted upon.

Is it well led?

The service had systems in place to monitor the quality of the service provided.

The manager followed the relevant legislation and consulted with the appropriate professionals at the required time.

We inspected Lanrick House on a follow up inspection. We had previously had concerns about the care, welfare and safety of people who used the service. We had served a notice to suspend all admissions into the service and we were considering further enforcement action.

We were informed by the manager at Lanrick House and the local authority that the care being delivered at Lanrick House had improved. We returned to check for improvement on an unannounced inspection which meant the service did not know we were coming.

We spoke to people who used the service and observed their care. We spoke with staff, visiting relatives, the manager, the provider and the local authority as part of the inspection process. One person told us; “It’s wonderful here” and “Things are getting better”.

We looked to see if people’s care and welfare needs were being met. We found that the new manager had implemented systems which ensured people’s individual needs were being met.

We checked that people who used the service were safe from abuse or the risk of abuse. We found that systems were in place to protect people from harm.

We checked that equipment that was used to support people who used the service was safe and fit for its purpose. We found that maintenance was being regularly undertaken and equipment was safe for its intended use.

We inspected Lanrick House on a planned follow up inspection. At our previous inspection we had concerns that the provider was not meeting the care and welfare needs of people who used the service. We had imposed a condition on the provider to stop all admissions into Lanrick House until the quality of care and standards had improved.

On our arrival at Lanrick House we were informed that the interim agency manager had now left the service and a new manager was in place. We were later joined by the new manager and provider who supported us throughout the inspection.

We looked to see if people’s care and welfare needs were being met. We found that the service was not meeting people’s needs appropriately and people were receiving or at risk of receiving poor care.

We looked to see if people who used the service were being safeguarded from abuse. We found that the service was not responding to incidents of abuse and people were at risk of abuse through poor care practices.

We spoke with visiting health professionals to the service and they informed us of concerns they had over the quality of care being delivered at Lanrick House.

We checked the safety and suitability of the building and equipment we found that people were being cared for in a poorly maintained building with equipment that was unsafe and unhygienic.

Lanrick House was non-compliant in the three outcome areas we inspected.

On the 26 April 2013 we had issued a warning notice to the provider of Lanrick House as they were in breach of Regulation 9 of the Health and Social Care Act 2008.At this inspection we looked to see if improvements had been made and if the service was now compliant with the regulation.

The provider had recruited a new manager who had been in post for two weeks. They supported us throughout the inspection with the provider and we were later joined by the provider’s consultant.

We spoke with people who used the service who were able to talk with us. Some people were unable to speak to us due to their frailty. One person who used the service told us: “I am very happy here; I have my own bedroom and do what I want to do. I had a funny turn last week and hurt my arm and have carpet burn to my knees. My arm still hurts now but I don’t need a doctor. The carers are ok, no problems”

We spoke with staff at Lanrick House, one member of staff told us: “I have been here four months now and like it. I haven’t looked at any care plans. The other care staff tell me what to do and now I know what people like and need as I have got to know them".

At this inspection we found that the provider was still in breach of Regulation 9 of the Health and Social Care Act 2008. People who used the service experienced poor care that had a significant impact on their health, safety or welfare due to poor communication and care delivery.

We received concerns that Lanrick House was not meeting the regulations in relation to the care and welfare of people who used the service. This was an unannounced inspection which meant the service did not know we were coming.

We spoke with people who used the service, the acting manager, care staff and ancillary workers. We spoke with visitors and relatives. One person who used the service told us they were happy to be at Lanrick House. Another person told us that sometimes the staff shout unnecessarily loud but this could be due to the number of people who used the lounge areas at any one time or that the television was on too loud. Visitors told us that the staff were friendly.

Some people were unable to speak with us, so we spent time in the communal area and observed the activity and interactions between people and staff. Some people remained in bed for the duration of this inspection. We visited them to observe the care and support they received.

We looked at records of people who used the service and although we found some improvements we found some inconsistencies in the care planning and recording of care provided. This meant that people's care needs were not being met adequately or in a consistent and reliable way.

We saw equipment in use that was not properly maintained, safe to use or suitable for purpose.

We inspected Lanrick House on a follow up inspection. We previously had concerns about the staffing levels at Lanrick House which impacted on the standard of care being delivered to people who used the service. We visited to see if improvements had been made. This was an unannounced inspection which meant the service did not know we were coming.

We saw that staffing numbers had been increased and staff we spoke with told us that they now felt able to meet the needs of the people that used the service.

We looked at records of people who used the service and although we found some improvements we found some inconsistencies in the care planning and recording of care provided. This meant that people’s care needs were still not being met adequately or in a consistent and reliable way.

During our inspection we found that the service was not following procedures to safeguard people who used the service.

We visited Lanrick House on a planned unannounced inspection, which meant they did not know we were coming.

When we arrived people were either up or getting up for breakfast.

People who used the service told us they were happy there but staff were always busy.

Relatives of people who used the service, said they were very happy with the care their relatives received.

We spent time with people who used the service and they told us they would like to go out more often. One person told us they loved the old time music sing along.

Some people who used the service were being cared for in their bedrooms due to their complex needs and other people were more independent.

We looked at care plans for people who used the service and spoke to visitors and other agencies who support the service.

We had concerns over the staffing levels at Lanrick House which impacted on people's care and welfare. We were also concerned that people who used the service were not fully involved in the planning of their care.