This inspection visit was carried out on 28 June 2018 and was unannounced.

At the last comprehensive inspection in February 2017 the service was rated as Good.

Lester Hall Apartments is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service cares for people with mental health needs. At the time of our inspection there were 30 people using the service.

There were two registered managers in post who job shared. 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.

Systems and processes did not ensure the safe management of medicines and people could not be confident they were supported to take their medicines as prescribed.

There was a lack of systems to monitor the quality of the service and identify where improvements were needed to ensure people received safe, good care as a minimum.

Procedures for controlling the risk of infection were not embedded in staff working practices and were not effective in supporting the prevention of infection for people.

Where people were at risk of poor nutrition or dehydration, records were not completed accurately or correctly to show people had received nutrition and fluids in line with their assessed needs. People were positive about the quality and choice of meals provided.

Records did not reflect that all potential risks to people had been assessed appropriate, and did not include the detail and guidance regarding the measures staff needed to take to reduce risks. Staff demonstrated a good understanding of actions they needed to take to keep people safe.

Care plans were not always updated in a timely manner and records did not consistently provide the detail and information staff needed to meet people's needs. The registered manager was in the process of reviewing and updating care plans and records.

People were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures. There were enough staff available to meet people's needs as assessed in their care plans.

Staff had completed a range of training to provide them with the knowledge and skills they needed to meet people's needs. Training records were not maintained accurately or fully completed to support the effective analysis and monitoring of staff training.

People were supported to access a range of health professionals to maintain their health and well being. The service worked in partnership with other agencies to ensure people received the care and treatment they needed.

People's needs were assessed prior to them using the service. People were supported to make choices and decisions about their care. Staff understood the principles of the Mental Capacity Act 2005, sought consent before providing care and respected people's right to decline care and support.

People were treated with kindness, respect and compassion and were given emotional support when needed. Staff supported people to achieve as much independence as possible and protected people's right to privacy and dignity.

People and their relatives were involved in planning their care and were able to make changes to how their care was provided.

People had access to a range of varied activities and were supported to be involved in their local community. People maintained contact with their friends and family and were therefore not isolated from those people closest to them.

People understood how to raise concerns and complaints and were confident these would be listened to and acted on.

The registered manager and the registered prov

This inspection visit was carried out on 21 February 2017 and was unannounced.

We last inspected Lester Hall Apartments in July 2014 and found the service was meeting the requirements of the regulations.

Lester Hall Apartments provide care for up to 33 people with a range of needs which include mental health needs, physical disabilities, dementia and drug and alcohol dependency. The service is based in a large residential property that has been converted to provide apartments and spacious communal areas. It is situated close to the village of Wigston in Leicester. At the time of our inspection visit there were 28 people using the service.

The service had 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 were kept safe from the risk of harm. Staff knew how to recognise signs of abuse and who to raise concerns with. Risks to people's safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessments and promoted people's safety, although some risk assessment records required further development to provide the detail staff needed to keep people safe.

There were enough staff to provide safe and effective care. Staff were skilled in meeting the needs of people using the service including how to respond when people became distressed or agitated.

People's medicines were managed in a way that kept them safe. People received the medicines they needed when they needed them.

Staff told us they felt supported in their roles and the registered manager and provider gave clear guidance and leadership. Staff had completed the training and qualifications they needed and we saw they used this knowledge to provide people with safe and effective care.

Staff were knowledgeable of and acted in line with the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing care and support and respected people's right to decline care. Care plans required further development to include the support people required to make specific decisions, for example in relation to their healthcare. This is important to ensure people have the support they need to make their own decisions.

People had their health and social needs assessed and care plans were put in place to meet their needs to guide staff on how best to meet these. People were supported to have sufficient to eat and drink and access a range of external health professionals. This meant that people were supported to remain as healthy as possible.

We saw positive relationships between people and staff who were caring and attentive in their approach in meeting people's needs. Staff demonstrated that they knew people well and took time to chat with them and provide reassurance. Staff promoted and upheld people's privacy and dignity and respected people as individuals.

Care plans included information about people's needs, preferences, life history and how they preferred their care to be provided. Staff used the information they had about people's interests and preferences to tailor their care and support. Care plans were regularly reviewed and updated to reflect changes in people's needs. This meant that people received personalised care that reflected their preferences and met their needs.

People were supported to take part in a range of activities to meet their social needs. People had been asked what was important to them and how they liked to spend their time. Staff used information to plan the activities provided. This meant people were able to spend their time in the way they preferred.

People and relatives were provided with opportunities to be

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was unannounced which meant the provider was not aware we were visiting. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Lester Hall Apartments is a care home that provides accommodation for up to 20 people with a range of needs which include old age, physical and mental health and alcohol and drug dependency. Each person has their own apartment. There were 20 people using the service at the time of our inspection.  

The service had a registered manager.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe at the home and that they were well cared for. Staff knew how to recognise and report signs of abuse. Staff understood the risks associated with people’s care and protected them from harm. Staffing levels were based on people’s and enough staff were on duty to meet the needs of people who used the service. The provider’s recruitment procedures ensured as far as possible that only people suited to work at the service were recruited.

Staff had received appropriate and relevant training to be able to meet the needs of people who used the service. Staff had a good understanding of people’s needs and they had supported people in line with their care plans. Senior staff understood the relevance of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).  This is legislation that protects people who lack mental capacity to make decisions and who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. DoLS had been authorised for two people who used the service.

All of the people we spoke with told us that they enjoyed the food at the service. People with special dietary needs had those needs met. 

The provider worked closely and effectively with health and social care professionals to ensure that people’s health needs were met. 

Staff treated people with kindness and consideration. People and their relatives were able to express their views about their care and support to the management team and staff. People had been supported to access advocacy services. People’s privacy and dignity had been respected. Staff respected people’s cultural backgrounds and supported them appropriately. Staff understood the individual needs of people they supported. People’s views, and their relative’s views, had been sought and acted upon. That had been through regular surveys, resident’s meetings and daily interaction with people.

The provider promoted a culture that put people’s needs at the centre of decision making. Staff knew how they could raise any concerns about the service. The registered manager understood their responsibilities and had ensured that staff understood what the aims of the service were. The provider had effective procedures for monitoring and assessing the quality of service.

People we spoke with in many instances had lived at Lester Hall Apartments for many years. All told us that in the main they were happy with the care and support they received from staff and felt they had good access to health care professionals. People told us they were happy with the accommodation and for some having their personal space was very important to them. People told us they were happy with the meals provided.

People gave conflicting information as to their awareness of their care plan. People in some instances said they had a keyworker who was supportive whilst others said they didn’t think a keyworker was necessary to them. Others said they would like to have a keyworker. People’s understanding and awareness of advocacy services and raising concerns and complaints was mixed.

People in some instances told us they preferred their own company and chose to remain in their room, whilst others told us they enjoyed taking part in the activities at the service. On the day of our visit we saw a number of people taking part in a game of pool, dominoes, cards and bingo. We also saw people going out in the community either by themselves or accompanied by staff or friends and relatives. People in some instances told us that at times they felt isolated and would benefit from being encouraged to take part in activities.

We looked a range of records which included a number of people’s care plans around consent to care and treatment and nutritional and hydration needs. Care plans were in place and had been regularly reviewed. Records recording staff training were up to date.

We spoke with six people who use the services of Lester Hall Apartments. They spoke to us about their experiences and views of the service. People’s comments were positive and included - “with (provider’s name) and the carers it’s like a family firm and they take ever such good care of you.” And “I am very comfortable here; I have my own apartment and can come and go as I please.” People told us how they spent their day. One person told us “I play scrabble with the social skills lady on Tuesdays and Thursday, we play ‘themed’ scrabble. They also take me to the local shops.” A second person told us: - “I like to spend time in my apartment watching television I also go out to the shops with the social skills lady; I recently went to the supermarket to buy some essentials things

Records showed that the service supported people to access a range of health care professionals who work with the staff of the home to monitor and promote people’s health. Monitoring of people’s health included regular reviews with a range of health care professionals. People's diversity, values and human rights were respected. The service supported people to access advocacy services and had used legislation which included the Mental Capacity Act to promote people’s safety and welfare where people were unable to make an informed decision for themselves.

When we inspected Lester Hall Apartments in April 2011 people told us that they were very satisfied with the care and support they received.

We spoke with seven people who use the service and asked them about the care and support they receive and the attitude and approach of staff. We asked people if they knew how to raise a concern and whether they felt safe at Lester Hall Apartments. We received positive comments from people which included:-

"I'm looked after extremely well.", "Staff are extremely nice they'll do anything for you.", "Mrs Lester (registered manager) gives me a lot of confidence.", "I moved into another home for a while but I didn't like it, so Mrs Lester helped me to move back here.", "I know Mrs Lester would sort things out for me, she's always willing to listen and has time for me.", "Chef will do something for you if you don't like what's on the menu.", "The food is lovely, you always have a choice and you can ask for something else if you wish."

We spoke with two visitors who were visiting relatives. They told us that they were confident that their relatives received good quality care and support. They said:-

"My father has told me he's happy here. There are some great staff that look after him well.", "They've got the ethos right of involving families, which has provided support to all of the family, we can visit whenever we choose." , "I can't rate them highly enough for hospitality.", "I think they're brilliant. My sister appears happy and settled. They've provided good support to all the family."

We spoke with a visiting community matron who provides support to someone who receives a service. They said:- "They're very caring and aware of the persons needs. The managers are good at contacting health care professionals and keeping us informed. They were very quick in acquiring assistive technology."