Lambton House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides support and accommodation for up to 57 people assessed as requiring residential care. This includes support for people who may also be living with dementia or a physical disability. At the time of our inspection there were 46 people living at Lambton House.

At our last inspection in September 2016 we rated the service good. At this inspection we found the service had deteriorated in two domains and rated the service as requires improvement in safe and well led. This is the first time the service has been rated requires improvement.

There was a registered manager in post at the time of our inspection who had worked at the service for 26 years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Medicines were not always managed safely. We found records, instructions and staff practices were not always up to date to ensure people received their medicines and nutritional supplements as prescribed. Staff were not following National Institute for Clinical Excellence (NICE) guidelines for the safe management of medicines.

The management team carried out a range of quality monitoring audits at the service. However, some of these audits had failed to pick up the issues with medicines management we found during our inspection. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services. They ensure people are provided with a good service and meet appropriate quality standards and legal obligations.

People were protected from abuse by staff who were trained and knowledgeable about safeguarding adults and understood their responsibilities. The provider had suitable policies and procedures in place for staff to follow to keep people safe. Staff understood their responsibilities in relation to respecting people’s privacy and dignity.

Where people had been assessed as at risk of harm there were plans in place for staff to follow to minimise the risk for the person.

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

People's care needs were assessed and detailed plans were in place to meet their individual needs. People told us they were cared for by staff who knew them very well, promoted their independence and understood how to support them.

There was enough staff employed at the service to provide people with safe care. We saw the provider regularly reviewed the staffing levels to ensure people had the maximum amount of time with staff.

There was a range of stimulating and engaging activities provided by the service which included outings, arts and crafts, reminiscing sessions, sing-a-longs, baking and pamper sessions.

People enjoyed the food they received and had choice over meals in line with their preferences and cultural needs. People were supported to maintain their health and had regular contract with health professionals.

People lived in premises which were adapted to meet people’s individual needs, well maintained, clean and safe. The provider employed their own maintenance team who carried out a range of health and safety checks throughout the service to ensure its safety.

The provider had a robust recruitment system in place to ensure they employed suitable people.

The provider had a training programme in place

This inspection took place on 24 and 31 August 2016 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Lambton House was last inspected by CQC on 30 June 2015. The location was rated Requires Improvement in all five domains. An inspection visit took place on 26 November 2015 to follow up on the risks in relation to people who had diabetes and found that the registered provider had followed their action plan and had made improvements at the service. We checked the remaining actions during this inspection visit.

Lambton House provides care and accommodation for up to 49 people with personal care needs. On the day of our inspection there were 48 people using the service, some of whom had a dementia type condition.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and staff, and described potential risks and the safeguards in place. Staff had been trained in how to safeguard vulnerable adults. Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and training sessions were planned for any due or overdue refresher training. Staff received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

The registered provider had followed their action plan and made improvements to the home to make it more dementia friendly, and plans were in place to continue to improve the environment.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service, and family members, were complimentary about the standard of care at Lambton House. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into Lambton House and care plans were written in a person centred way.

The registered provider protected people from social isolation however more activities could be provided during the day to stimulate and entertain people who used the service.

People who used the service, and family members, were aware of how to make a complaint and did not raise any concerns during the inspection visit.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. Family members told us the management team were approachable and understanding.

This focused inspection took place on 26 November 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Lambton House provides care and accommodation for up to 47 people who require nursing or personal care. On the day of our inspection there were 42 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last unannounced, comprehensive inspection on 24, 29 and 30 June 2015, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Lambton House on our website at www.cqc.org.uk.

This focused inspection took place to follow up the breach relating to the risks to people who had diabetes, which had not been properly assessed and the risks mitigated.

After the comprehensive inspection of June 2015 we asked the provider to take action to make improvements. The provider wrote to us to say what they would do to meet legal requirements in relation to this breach. We undertook this focused inspection to check that the registered provider had followed their action plan and had made improvements at the service.

We found improvements had been made in the way the home protected people against the risks associated with diabetes.

This inspection took place on 24, 29 and 30 June 2015 and was unannounced. This meant the provider did not know we planned to carry out the inspection.

We carried out our last inspection of Lambton House in October 2013 and found the service to be compliant. Since that date the provider changed the name of their company and re-registered with the Care Quality Commission. However the actual provider and the registered manager did not change.

Lambton House provides accommodation for up to 47 people who require personal care. At the time of our inspection there were 42 people living in the home. Lambton House does not provide nursing care. During our inspection we found the majority of people living in the home had dementia type conditions.

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. Lambton House has a registered manager in post.

The provider had robust recruitment and selection procedure in place and carried out all relevant checks when they employed staff.

We found the provider had in place a number of building safety checks including fire, water and electrical testing.

People had emergency evacuation plans in place and these were accessible to emergency services that may be required to evacuate people from the building.

The provider did not have in place plans to administer people’s PRN (as when required) medicines.

The home had not been adapted to meet the needs of people with sensory impairments including people living with dementia. This included the use of colour to enable people to differentiate items and signage to guide people.

Advice and guidance had not been sought to support people with diabetes. There were no additional menu options for people with this condition.

The provider had made Deprivation of Liberty Safeguards applications to the local authority to deprive people of their liberty and keep them safe.

Staff were given appropriate training and support by the provider who had in place staff supervision meetings and appraisals.

We observed staff to be caring and compassionate towards people and staff used their knowledge of people to engage them in conversation. We saw staff supported people with dignity on most occasions.

We found most of the activities were designed around large groups and did not take into account people’s histories, likes and dislikes.

We found people had in place care plans for people which were reviewed at monthly intervals and then a more substantial review was conducted every six months.

People and relatives we spoke with told us they would speak to the registered manager to make a complaint but none had made any complaints. We found there had been no complaints since our last inspection.

The registered manager described to us the improvements they were making to the service including the development of a summer house and developing Hen Power, a programme designed to engage people in keeping chickens. This has been found to improve people’s well-being.

The provider had in place comprehensive audit arrangements to monitor the service.

We found many records which were incomplete or inaccurate.

We found a number of 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 the report