Lebrun House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Lebrun House provides accommodation and personal care for up to 20 older people, living with dementia. At the time of inspection, 18 people were living at the service.

Bedrooms are located over three floors and can be accessed via stairs or a lift. Communal bathrooms and toilet facilities are available throughout. There are several communal areas; a dining room with adjoining lounge and another lounge area which connects to a conservatory with seating area. There was some garden space, which two people spent time sitting in during the inspection.

At our last inspection in September 2017, the service was rated as Requires Improvement with breaches in Regulation 11 (Need for consent) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated activities). There was a lack of specific mental capacity assessments that did not include the views of people or relevant others. There was also a lack of adequate quality assurance systems and care plans that did not hold person centred information about people. The provider was issued with two warning notices and required to be compliant by February 2018. At this inspection, improvements had been made and Regulations 11 and 17 were no longer in breach. However, we still found some areas for improvement. This is therefore the fifth time that Lebrun House has been rated Requires Improvement overall.

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

The environment, training and activities were not specific for people living with dementia. Although all people living at Lebrun house had dementia related support needs, staff had either not had training or it had not been reviewed since 2015. We found there was a lack of signage around the building to support people to remember where they were. Previous signs used to familiarise and reassure people had been removed. People’s care plans contained detailed information about people’s histories and their preferences, however activities offered to them were not person centred to these. People, relatives and staff told us that they felt activities could be improved and that they wanted opportunities to go out, yet this was not currently happening.

Staff had received a wide variety of training and people and their relatives were confident that staff had the right skills and knowledge to support people effectively. However, staff had not received more specific training required to meet the needs of some people, for example in epilepsy management. We have made a recommendation about this.

We found that consideration had not been made to whether other types of communication would be beneficial to people, such as pictures added to documentation. We have made a recommendation about this.

Although there had been significant improvements to people’s care plans, only half had been transferred to new paperwork and so more time was needed to embed positive changes. There was improvement to the amount of quality audits completed by the registered manager and other external sources. However, there were some issues we found that had not been recognised by the registered manager.

People, their relatives and professionals told us they felt people were safe. Staff demonstrated a good knowledge of how to safeguard people and there were suitable numbers of staff to meet people's support needs. People received their medicines safely. The building was kept

We inspected Lebrun House on the 14 and 15 September 2017. This was an unannounced inspection. Lebrun House is a care home that provides accommodation for up to 20 older people who require a range of care and support related to living with a dementia type illness and behaviours that could be challenging to others. At the time of the inspection 17 people lived there.

There was no registered manager for the home, however, there was an interim manager in post who was supported by the provider and consultant. Following our inspection the manager informed us she had applied to become the registered manager and was awaiting her interview with 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.

We carried out an inspection at Lebrun House in July 2014 where we found the provider had not met the regulations in relation to the safe management of medicines and records. A further unannounced inspection took place on in February 2015 where we found improvements were still required in relation to medicines and records. We also found improvements were required in relation to consent, quality assurance and notifying the commission of the absence of a registered manager. The provider sent us an action plan and told us they would address these issues by June 2015.

We undertook another inspection in April 2016 where we found some improvements in relation to medicines, notifications and consent had been made. However not all legal requirements had been met in relation to records and quality assurance and the provider and registered manager did not have oversight of the service. We found further breaches in relation to risks, care was not always person centred, and there had been no assessment of staff competencies. We met with the provider and registered manager to discuss our concerns and issued them a warning notice in relation to records and quality assurance. A warning notice is part of our enforcement powers. It informs the provider that we may take further action if they do not comply with the notice. It also gives the provider a timescale within which they must comply. For the remaining breaches the provider sent us an action plan and told us they would address these issues by September 2016.

We carried out a further unannounced inspection in December 2016 where we found improvements had been made, however, not all legal requirements had been met in relation to people’s records and mental capacity. The provider sent us an action plan and told us they would address these issues by 10 February 2017.

At this inspection we found there were still shortfalls. People’s care plans did not reflect the person-centred care people required and received. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and applications for Deprivation of Liberty Safeguards (DoLS) had been submitted when required. However, there was no information about how people who lacked capacity were able to make decisions or how restrictions may affect them.

People were supported by staff who were kind and caring. They knew people really well. The understood people as individuals and were able to provide detailed information about the care and support people received. There was a range of activities taking place throughout the day. These included group and one to one activities designed to suit each individual person. People were able to make individual and everyday choices and staff supported them to do this.

Risk assessments were in place and staff had a good understanding of the risks associated with the people they looked after. Medicines were stored, administered and disposed of safely by staff who had received appropriate training. Staff had a clear understandi

We carried out an inspection at Lebrun House on the 20 July 2014 where we found the provider had not met the regulations in relation to the safe management of medicines and records. A further unannounced inspection took place on 3, 4 and 5 February 2015 where we found improvements were still required in relation to medicines and records. We also found improvements were required in relation to consent, quality assurance and notifying us of the absence of a registered manager. A notification is information about important events which the provider is required to tell us about by law. The provider sent us an action plan and told us they would address these issues by June 2015.

We inspected again on 18 and 20 April 2016 where we found some improvements in relation to medicines, notifications and consent had been made. However not all legal requirements had been met in relation to records and quality assurance and the provider and registered manager did not have oversight of the service. We found further breaches; risks associated with supporting people had not always been identified. Accidents and incidents had been documented with the immediate actions taken. However there was a lack of information about follow up actions. Staff had received training but there had been no assessment of competencies to ensure they had understood the principles of what they had learnt. People did not receive person-centred care and there was a lack of stimulation for people throughout the day. We met with the provider and registered manager to discuss our concerns and issued a Warning Notice in relation to records and quality assurance. A Warning Notice is part of our enforcement powers. It informs the provider that we may take further action if they do not comply with the notice. It also gives the provider a timescale within which they must comply. For the remaining breaches of regulation the provider sent us an action plan and told us they would address these issues by 30 September 2016.

We carried out this unannounced inspection on 12 and 13 December 2016. We found some significant improvements had been made, however other areas still needed to be addressed and changes embedded into practice. The provider had engaged the services of an external consultant to support them to make the necessary improvements at the home. There had been a number of changes at the service and the provider and consultant had kept us informed of what was happening before our most recent inspection.

Lebrun House is a care home that provides accommodation for up to 20 older people who require a range of care and support related to living with dementia and behaviours that may challenge. At the time of the inspection 16 people lived there. There was a registered manager for the home however they were not currently working there. There was an interim manager in post who was supported by the provider and consultant. 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.

We found significant improvements had taken place since our last inspection. There was an audit system, however this had not identified all the shortfalls we found and people’s records did not reflect the care they required and received. However, this did not impact on people because staff had a good understanding of their needs and were able to tell us about the care people needed and received.

There had been improvements in the way risks were managed and risk assessments were in place. However, we found occasions where further improvements were needed to ensure these changes were fully embedded into practice and all risks were managed safely.

There were systems to help ensure staff were suitable to work at the home. However

We carried out an unannounced comprehensive inspection at Lebrun House on the 20 July 2014 where we found the provider had not met the regulations in relation to the safe management of medicines and records. A further unannounced inspection and took place on 3, 4 and 5 February 2015 where we found improvements were still required in relation to medicines and records. We also found improvements were required in relation to consent, quality assurance and notifying the commission of the absence of a registered manager. A notification is information about important events which the provider is required to tell us about by law. The provider sent us an action plan and told us they would address these issues by June 2015. We undertook an inspection on 18 and 20 April 2016 to check that the provider had made improvements and to confirm that legal requirements had been met.

At this inspection we found some improvements had been made however not all legal requirements had been met.

Lebrun House is a care home that provides accommodation for up to 20 older people who require a range of care and support related to living with a dementia type illness and behaviours that may challenge. On the day of the inspection 20 people lived there. There is a registered manager at the home. 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.

Staff knew people well and had a good understanding of their individual needs and choices. However, risks were not always safely managed and care plans did not reflect the care and support people. We found that people with behaviours that may challenge others or themselves did not have sufficient guidance in place for staff to deliver the support they needed. Not everyone who required them had risk assessments in place that guided staff to promote people’s comfort, nutrition, and the prevention of pressure damage.

On occasions people were not treated with respect and language within care plans was not always respectful. Despite this we observed staff were kind and caring and enjoyed looking after people who lived at the home.

There was not enough for people to do throughout the day. We saw one group activity during the inspection but for those who chose not to or were unable to take part there were no one to one activities or stimulation.

Staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards however; there was no information about how people were able to make choices or decisions. Staff had a good understanding of abuse and how to protect people from the risks associated with abuse.

People were given choice about what they wanted to eat and drink and received food that they enjoyed. However, mealtimes were sometimes disorganised and people did not always receive support in a timely way.

Staff received regular training and supervision. However, there was a lack of competency assessments and supervision. This had not ensured good practice was embedded into care delivery.

The audit systems had not ensured that actions identified at the last inspection had been addressed. The systems to assess the quality of the service provided were not always effective and had not identified the shortfalls we found.

Staffing levels had impacted on people receiving the support required to ensure their social needs were met. Recruitment checks took place to ensure as far as possible staff were suitable to work at the home. However, criminal record checks were not always completed before staff commenced work.

Staff had a clear understanding of the procedures in place to safeguard people from abuse.

There were systems in place to ensure medicines were stored, administered and disposed of safely.

Peop

We found that people who lived at the home were happy and felt safe and well supported. They told us the food was good and the staff were kind and always treated them with respect.

One person told us, "I can't really fault it". We spoke with a visitor who told us, "The home is spotlessly clean," and "I am always made very welcome." We saw that staffing levels were appropriate across both day and night shifts to provide support to people living at the home. We saw from staff files that proper checks were carried prior to staff working unsupervised at the home. There was an organised schedule of regular training in place to ensure that staff were able to carry out their duties efficiently and keep people safe.

Staff we spoke with told us they felt listened to and supported by the management. One staff member told us, "It's a good team," another said, "I wouldn't change anything."

The premises were well laid out, decorated and maintained to a good standard and felt comfortable and homely.

There were effective systems in place at the home to assess their performance and ensure improving standards of care were maintained. This included gaining feedback from people at the home, relatives and visiting professionals.

The majority of people who lived in the home were unable to engage in the inspection process due to their complex needs. However two people we spoke with said they liked living at the home and enjoyed the activities provided. One person told us the, “Food is very good.” Another said they were, “Well looked after.”

During our visit we spoke with five people who lived at the home and three members of staff. We saw records that showed that all staff were trained in all mandatory subjects. Staff we spoke with told us they were encouraged to undertake extra training in other areas. They also told us that they felt their job was not only to provide care for the people in the home but to promote their independence. Staff were friendly and respectful when dealing with people. We observed them knocking and waiting for an invitation in before entering rooms and seeking people’s permission before doing anything for them.

The home was clean, safe and homely and records we examined showed that there were audits in place to maintain standards of hygiene and personal care. We saw records of surveys and meetings at regular intervals to seek and act upon the views of people living at the home, relatives, visitors and staff.

Due to varying mental capacity the majority of people we spoke with were unable to comment specifically around any improvements made to the service. However, one person told us that they wanted to go into the garden for a walk, the door to the garden was open and they were observed walking to and from the garden. Another person said they liked their room.

The majority of people in the home were quiet with little interaction between each other, and struggled to participate in conversation about their experience of living in the home. We asked one person what they liked about living at Lebrun House and they said “just like it”. Another just nodded in response to questions asked.

Lebrun House is a care home that provides accommodation for up to 20 older people who require a range of care and support related to living with a dementia type illness and behaviours that may challenge. On the day of the inspection 16 people lived there. There is a registered manager at the home. 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.

This was an unannounced inspection and took place on 3, 4 and 5 February 2015.

At our last inspection of 20 July 2014 we found the provider had not met the regulations in relation to the safe management of medicines and records. The provider told us they would be making improvements. At this latest inspection we found further improvements were still needed. Photographs to help staff identify people were not in place in the medicine administration records.

Staff did not have a clear understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Doors to the home were locked and people were unable to leave the home when they wished. However, there was no information in people’s care plans to show the restrictions were appropriate for everybody.

There was induction training in place when staff started work at the home. However, they had not received regular training and updates in line with the provider’s policy and this needs to be improved. We saw further training had been booked. Staff had a good understanding of the care they provided to people.

Staff knew people well; they had a good knowledge and understanding of the people they cared for. They were able to tell us about people’s care needs, choices, personal histories and interests. We observed staff caring for people with kindness and respect. People were comfortable in the company of staff and approached them freely. However care records did not contain enough information to guide staff to ensure people received a consistent level of care.

People were supported to take part in a range of activities and visitors told us they were always welcome at the home.

There were enough staff working at the home and recruitment processes ensured the registered provider employed staff who were suitable to work with adults. Staff understood safeguarding procedures and what they needed to do to protect people from the risk of abuse.

Healthcare professionals including GP’s, district nurses and mental health team were involved in supporting people to maintain their health.

Breakfast and lunchtimes were relaxed, sociable occasions. People were offered a choice of nutritious meals and were supported to eat and drink sufficient amounts.

There was a complaints policy and procedure in place, and complaints were responded to appropriately.

We observed staff offering people choices and helping them to make decisions throughout the day.

The culture within the home was open, staff told us all staff worked together as a team and supported each other.

There were a number of breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.