Lansdowne House - Leicester, a domiciliary care agency for 48 people, was rated Requires Improvement overall at its March 2016 inspection, with Safe and Well-Led domains falling short due to gaps in risk assessments, staff recruitment checks, medication protocols, mental capacity procedures, and audit effectiveness. Effective, Caring and Responsive domains were rated Good, underpinned by positive feedback from people and relatives, individualised care plans, and effective staff practice in nutrition and health referrals.
Concerns (11)
moderateCare planning: “when we saw another care plan that noted that the person had an identified risk of pressure sores, there was a no risk assessment in place outlining safety measures”
moderateRecord keeping: “records did not always show that the necessary documentation for staff was in place to demonstrate they were fit to supply personal care to people”
moderateMissed or late visits: “we found a small number of instances where people had late calls and had to wait up to over an hour for staff to arrive”
moderateMedication management: “medicines to be taken as needed did not specify the required dose and in what circumstances it could be given”
moderateConsent / capacity: “We did not see evidence that the provider had relevant procedures in place to assess people's mental capacity”
moderateStaff training: “not all staff had been trained in essential issues, such as health and safety, behaviour that challenged the service, moving and handling techniques, first aid”
moderateGovernance: “No evidence was seen that the audit system had identified that a relevant reference was not sought as part of the staff recruitment process”
minorSupervision / appraisal: “supervision had not been frequent in the past year”
minorCultural competency: “The person was recorded as not being able to speak English fluently. However, there was no evidence that the agency had tried to match this person with a staff member”
minorComplaints handling: “some informal complaints did not have evidence of any follow-up action. There was no evidence of a response sent to the complainant”
minorSafeguarding: “They did not contain the contact details of all relevant agencies where staff could report their concerns to”
Strengths
· People and relatives consistently praised staff as friendly, kind, caring and respectful of dignity and privacy
· Risk assessments were generally in place covering environmental hazards, mobility and equipment checks
· Staff trained in safeguarding and understood reporting responsibilities to external agencies
· Nutritional needs well supported, with staff respecting individual dietary preferences and ensuring hydration
· Care plans were individualised and developed with involvement of people using the service and their relatives
Lansdowne House - Leicester, operated by Age UK Leicester Shire and Rutland, was rated Good overall across all five key questions at its May 2017 inspection, with 57 people receiving personal care at home. Key areas for improvement included gaps in risk assessments, incomplete MCA/DoLS staff training, unexplained medication record gaps, and occasional late care calls, all of which the provider was actioning at the time of inspection.
Concerns (10)
moderateCare planning: “one care plan stated that a person was at risk of developing pressure sores. However, there was no risk assessment in place to guide staff to ensure that measures were in place to prevent this happening.”
moderateStaff training: “not all staff had received training about the operation of the law [MCA]. The home care manager told us that this training had been organised and was due to be provided to staff in the near future.”
moderateStaff training: “This did not include relevant subjects such as protection from developing pressure sores, Parkinson's disease, mental health conditions and diabetes.”
moderateConsent / capacity: “Staff did not all understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS)”
minorMedication management: “there were a small number of gaps, which had not been explained in medicine records. The registered manager said this would be followed up, to ensure that people always received their medicine on time.”
minorMissed or late visits: “one person's lunchtime call time was recorded as being from 30 minutes to 60 minutes early on some occasions.”
minorSupervision / appraisal: “two staff members said that had been an issue trying to get through to their line managers if they had any queries.”
minorComplaints handling: “The procedure set out that the complainant should contact the service. It was not clear that people could refer complaints to the local authority if they wished.”
minorCultural competency: “there was no information on people specific wishes in relation to their religious and cultural needs such as how to respect religious artefacts.”
minorGovernance: “There were a small number of comments made which needed action, though there was no action plan in place.”
Strengths
· People and relatives unanimously felt safe with staff and praised their kindness, friendliness and caring approach.
· Robust staff recruitment checks including DBS were in place for all staff reviewed.
· Staff were trained in safeguarding and understood their responsibilities to report concerns internally and externally.
· Care plans were individualised and developed with people and their relatives, reflecting personal preferences and needs.
· New staff completed induction training including the Care Certificate and shadowing by experienced staff.
Lansdowne House - Leicester is a domiciliary care agency rated Good across all five key questions at its October 2019 inspection, with 44 people receiving personal care. Minor gaps were noted in medication administration records, mental capacity assessments, care plan detail, complaints written responses, and the comprehensiveness of quality audits, all of which management committed to address.
Concerns (5)
minorRecord keeping: “there were a small number of gaps in medicine administration records. The office manager said this would be followed up with staff.”
minorGovernance: “Quality audits were carried out to drive improvement of the service. Some needed to be more comprehensive to ensure all aspects were audited.”
minorComplaints handling: “People had not received a written response to their complaints. The office manager said that this would be carried out in the future.”
minorConsent / capacity: “Care records showed people's capacity to make decisions, though not all mental capacity assessments had been carried out. The office manager said this would be carried out.”
minorCare planning: “Care plans had information about people's preferences and their life histories, though did not have a lot of information about their likes and dislikes.”
Strengths
· People felt safe with staff; no falls reported for one person since starting with the service, with staff described as extremely professional.
· Sufficient staffing levels consistently reported by people, relatives and staff.
· Staff well trained with ongoing relevant training; induction provided on joining the service.
· People and relatives spoke very positively of care staff, describing them as kind, considerate and caring.
· People supported to maintain independence, privacy and dignity.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
caring: Kindness and respect
Good
caring: Privacy, dignity and independenceGood
caring: Involvement in care decisionsGood
responsive: Care planning and responsiveness to needsGood
responsive: Timeliness of callsGood
responsive: Complaints handlingGood
well-led: Governance and quality assuranceGood
well-led: Staff support and managementGood
well-led: Notifications and regulatory complianceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Planning and promoting person-centred, high-quality care and support with opennessGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood
well-led: Working in partnership with othersGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood