About the service:

Lucerne House is a residential care home for up to ten people living with a learning disability and/or autism. The organisation also supports two people who live in their own home, (known as Flat 6). At the time of our inspection these people were not in receipt of personal care so we did not carry out an inspection of the support they received. People living at Lucerne House had learning disabilities and their needs were varied. Some people needed support with living with autism, diabetes, dementia and epilepsy. Some people displayed behaviours that challenged others.

People’s experience of using this service:

Lucerne House was registered before Registering the Right Support (RRS) had been published. Nevertheless, we found the care service reflected the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. ‘People with learning disabilities and autism using the service can live as ordinary a life as any citizen’ – Registering the Right Support Policy.

¿ There were good recruitment procedures and enough staff to meet people’s individual needs. People told us they felt safe. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed.

¿ People’s medicines were managed safely and the registered manager worked with health professionals to make sure people were only prescribed medicines that were needed.

¿ People’s needs were effectively met because staff had the training and skills to fulfil their role. This included training to meet people’s complex needs in relation to epilepsy, diabetes and behaviours that challenged.

¿ Staff attended regular supervision meetings and received an annual appraisal of their performance.

¿ Staff supported people in the least restrictive way possible. People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

¿ People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them.

¿ People were supported to attend health appointments, such as the GP or dentist. If assessed as appropriate and in line with individual needs, appointments were held at Lucerne House.

¿ People told us they had enough to eat and drink and menus were varied and well balanced. People’s meals were served in a way that respected their specific needs and beliefs.

¿ People were supported to take part in a range of activities to meet their individual needs and wishes. Some attended college courses and day centres and others preferred to choose a daily plan of activities arranged with the support of staff. People also told us they enjoyed visiting their friends and inviting friends and their family members to their house. A social care professional told us, “In my experience (staff) have been very supportive of the relationships the people who live at Lucerne House have with their family members.”

¿ The environment was clean and well maintained. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks were all up to date.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis.

¿ People and relatives were given information on how to make a complaint and said they would be comfortable raising a concern or complaint if they needed to.

Rating at last inspection:

This service met the characteristics of Good. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection:

Good. The last inspection report was published on 27 April 20

Lucerne House provides residential care for up to 10 people with learning disabilities. In addition, they also provide care and support to two people who live in their own supported living accommodation (flat).

At the last inspection in June 2016 we found the 'well led' question in relation to the flat required improvement. There was no effective system to regularly monitor the quality of care provided at the flat. There was no environmental risk assessment or systems to support people to raise any problems they might have had with the building. The provider sent us an action plan that told us how they were to meet the breach of regulation by October 2016.

This unannounced focused inspection on the 24 February 2017 was to check that the provider had followed their plan and to confirm they now met legal requirements. We looked specifically at the 'well led' question in relation to the flat and we found that that they had now met the specific breach of regulation previously found. However, we continued to find areas of practice that require improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Lucerne House) on our website at www.cqc.org.uk.

A registered manager was 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 and associated Regulations about how the service is run.

Although the provider visited regularly to review the running of the service and to provide supervision to the registered manager there were no records of these visits or any actions taken. These areas of record keeping were identified at the last inspection and remain an area for improvement.

There were improved systems in place to oversee care provision. For example as people’s needs changed the care and support provided had been increased or decreased in line with their wishes and needs. When there were concerns about people’s health or well-being additional advice had been sought to ensure people’s needs could be met. An environmental risk assessment had been carried out and reviewed to ensure that the building was safe. Equipment was serviced regularly. Support was provided as and when needed to ensure the building was kept clean and in a way that met the needs of the people who lived there.

There were regular audits carried out in relation to the management of medicines and staff had received training to enable them to meet the needs of the people they supported. There were opportunities for people to share their views about the care and support they received. It was evident that when shortfalls occurred, for example, in relation to light bulbs not working or a problem with the boiler, people knew how to raise the issues and records showed they were addressed promptly.

Whilst the breach of regulation has been met we could not improve the rating for well led from requires improvement because there remained an area of record keeping that had not improved. We will check this during our next planned comprehensive inspection.

Lucerne House provides residential care for up to 10 people with learning disabilities. In addition, they also provide supported living for two people who live in their own home, one of whom receives support with personal care. The majority of people were under 65 years of age. People’s needs were varied and included autism, diabetes, dementia and epilepsy. Some people displayed behaviours that challenged others.

Whilst the majority of people had good communication skills, a small number of people needed support with communication and were not able to tell us their experiences, so we observed that they were happy and relaxed with staff. At the time of our inspection there were eight people living at the home.

There was no 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. An acting manager was appointed in March 2016 and since the inspection they have submitted their application for registration.

We carried out an unannounced inspection on 28 November and 03 December 2014 of both services where we rated the home as ‘Requires Improvement’ in all areas. We issues specific requirement notices in relation to safe care and treatment, person centred care, consent, independence and dignity and governance. We received no action plan from the provider to tell us how they would make improvements. We carried out this comprehensive unannounced inspection of both the care home and Flat 6 on 29 and 30 June 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that overall significant improvements had been made in the running of the home.

Oversight of Flat 6 was less thorough than that of Lucerne House. There was no environmental risk assessment in place and one person’s risk assessment documentation was not up to date.

There were enough staff who had been appropriately recruited, to meet the needs of people. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. Staff understood what they needed to do to protect people from the risk of abuse. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

The acting manager and staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed that restrictions were required to keep some people safe and where this was the case referrals had been made to the local authority for authorisations.

Staff had a good understanding of people as individuals, their needs and interests. Some people attended day centres and work placements and staff also made sure that those who did not had the opportunity to go out every day. People’s spiritual needs were met.

People had access to healthcare professionals when they needed specific support. This included GP’s, dentists and opticians. Some people had specific fears in relation to their healthcare needs and the home went the ‘extra mile’ to make sure that their needs could be met in a way that suited them. This included obtaining easy read information that explained procedures and arranging for professional visits to be carried out in their home.

People were asked for their permission before staff assisted them with care or support. Staff had the skills and knowledge necessary to provide people with safe and effective care. Regular training was provided specific to meeting people’s needs and if staff identified additional training that they would like to receive, arrangements were made for this to happen. Staff received regular supervisi

Two inspectors carried out this inspection. The focus of the inspection was to follow up on a warning notice issued following our last inspection in April 2014 and to follow up on compliance actions issued at that time. We answered the questions is the service safe and is it well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The home had changed to a new pharmacy supplier and new systems were still being put in place. They systems for the management of medicines were not robust. When shortfalls were found there was not always evidence that actions had been taken to resolve them.

A number of staff personnel files did not contain all required pre-employment checks. Criminal records checks were obtained for staff. However, systems were not in place that ensured that matters raised through this process had been discussed with prospective staff and where appropriate, potential risks had been minimised. This meant that the provider could not demonstrate that staff employed to work at the home were suitable.

Records were not always sufficiently detailed to determine how staff dealt with situations. For example, a verbal complaint had been made to the home but there were no records of the investigation or actions taken.

Is the service well led?

There was no effective system in place to regularly assess and monitor all areas of the home and to ensure that when shortfalls were identified appropriate actions were taken.

A single inspector carried out this inspection. The focus of the inspection was to follow up on compliance actions issued at our last inspection in January 2014, to look at additional outcomes and to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had not needed to make any applications but there were policies and procedures in place and the manager had been trained to understand when an application should be made and, how to submit one. We were told that arrangements would be made for the staff team to receive training on this subject. There were shortfalls in record keeping in relation to the management of some medicines.

A number of staff personnel files did not contain all required pre-employment checks. This meant that the provider could not demonstrate that staff employed to work at the home were suitable. There was no system in place to demonstrate that all staff received regular supervision. A number of records were misplaced, some were found over the course of the day and others could not be located. This meant that the home was unable to demonstrate that they were meeting the standards in these areas.

Is the service effective?

People told us they were happy living at Lucerne House and that their needs had been met. Staff had a good understanding of people’s needs and it was evident that they knew people well. If people had complex needs, specialist advice and support had been sought to assist staff. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were treated with respect and staff were courteous. They explained to people what they were doing and offered them a choice of a variety of activities. We saw that staff supported people to achieve their wishes. For example, one person in supported living told us, “I swapped my bedroom and lounge around so that I have a bigger bedroom and a smaller lounge. We don’t use the lounge much and I needed more space so we had a meeting and agreed to do it. We like the way it is now.”

Is the service responsive?

Records confirmed that people’s preferences, interests and diverse needs had been recorded and that care and support had been provided that met their wishes. People had access to activities that were important to them. For example, some people had work placements; some went to college and some, day centres. People were supported to attend religious services, to go to clubs and a disco. They visited friends and invited their friends to visit them.

Is the service well led?

The organisation had arranged for a consultant to support them with addressing shortfalls identified at the last inspection. It was evident that progress had been made in some areas and that systems needed time to be embedded fully. However, there was still no effective system in place to regularly assess and monitor all areas of the home.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of the inspection.

We spoke with four of the nine people living at Lucerne House and with one person from the domiciliary service. People told us that they liked living at Lucerne House. They said that their keyworkers helped them to make plans to do the things they wanted to do.

One person in the domiciliary service told us, “I love living in my own home. I decide what to do each day and have a busy timetable.” They said, “I have a mobile phone so I can get help if I need it in an emergency.”

People living at Lucerne House told us, “My keyworker discusses my care plan with me.” Another person said, “I talk to my keyworker if I need any support.”

We observed that staff ensured that consent was obtained prior to providing care and support. We found that care plans were detailed and documented the needs of people and how they should be met. However, some of those seen had not been reviewed for several years.

There was inadequate monitoring of the systems in place for the safe management of medicines and this meant that some of the information available to staff was not up to date.

Staff told us that they received training to perform the duties of their various roles within the home. However, the home was unable to demonstrate that this had taken place. There were no systems in place to ensure that staff attended supervision meetings.

The systems in place to regularly assess and monitor the quality of the care provided were not effective.

People we spoke with said that the home offered the support they needed and that the care staff were, “Great.” One person said that they were really happy living at the home and went to college as well as working. One person showed us their room and told us that they had everything they wanted.

We saw that people were very involved in their support plans and all knew who their key worker was. The home was clean and comfortable. We found that staffing levels were appropriate and that the service provided extra staff to support people in outside activities. The staff had received training and regular supervision sessions.

Lucerne House provides residential care for up to 10 people with learning disabilities. In addition, they also provide supported living support to two people who live in their own home, one of whom receives support with personal care. The majority of people accommodated were under 65 years of age. People’s needs were varied and included autism, diabetes and epilepsy. Some people displayed behaviours that challenged others. Whilst the majority of people had good communication skills, a small number of people had communication difficulties and were not able to tell us their experiences, so we observed and they were happy and relaxed with staff. At the time of our inspection there were nine people living at the home.

At the last inspection in September 2014, we took enforcement action against the provider and issued a warning notice in relation to the assessing and monitoring of the quality of service provision. We set a timescale for compliance of 17 November 2014. We also asked the provider to make improvements in the management of medicines, staff recruitment records and record keeping. An action plan was received from the provider detailing how they would address these areas. We carried out this unannounced inspection on 28 November and 3 December 2014 to check that improvements had been made. We found that the provider had met the requirements of the warning notice. However, we also identified some additional concerns.

There has been no registered manager in post since November 2013. An acting manager was appointed at that time. At the time of our inspection an application for registration was being processed and the manager has since been registered in post. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.’

Changes had been made to the monitoring of the home and the quality of care provided. Audits were carried out and shortfalls identified were followed up. However, some aspects required further attention to ensure that people were safe. For example, whilst there was an environmental risk assessment in place for Lucerne House, there was no risk assessment for the supported living accommodation.

Risk assessments were carried out to ensure that people were safe and that staff had clear guidance on how to support people However, there was limited evidence that risk assessments were always updated appropriately to take account of changes to people’s needs.

People’s abilities to make informed decisions had not been assessed and staff were not following the requirements of the Mental Capacity Act 2005. They had not assessed if an application needed to be made in respect of any person to the Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS are regulations that have to be followed to ensure that people who cannot make decisions for themselves are protected. They also ensure that people are not having their freedom restricted or deprived.

We saw records that led us to believe that people were not always treated in a caring manner. We observed staff interacting with people in a very positive way. People told us that the staff respected their privacy and a visitor to the home told us, “Staff have so much patience, they get on well with everyone.”

People were happy with the activities provided. Records showed that people had opportunities to participate in a wide range of activities. Some people attended day centres, some had work placements and others told us that they could participate in activities that they enjoyed. One person told us they went swimming every week. People attended a club once a week, and those who chose to, attended a monthly disco.

There were safe systems for the recruitment of new staff and a robust system had been introduced for the management of medicines. Staff had access to a training to meet people’s needs. Staff had attended training on dealing with challenging behaviour and diabetes. Further specialist training had also been booked. A staff member told us, “We are always going on training, in the past year we’ve had more training that we’ve ever had.”

Staff attended regular supervision meetings and told us they were well supported by the management of the home. Staff meetings were used to ensure that staff were kept up to date on the running of the home and to hear their views on day to day issues. Resident’s meetings were held regularly to update people on changes, and to provide opportunities for people to have a say about their home and matters important to them.

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.