CQC report explained · a residential care home
What the CQC found at Lancaster House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safe recruitment, good safeguarding knowledge and well-managed risks. Medicines were mostly well managed, but one medicine's recorded stock was one tablet inaccurate.
- Effective?
- Good
- People's health needs, nutrition and training were well supported. Some staff needed a refresher on the Deprivation of Liberty Safeguards.
- Caring?
- Good
- Staff treated people with kindness, patience and respect. People were involved in decisions, supported to remain independent and helped to maintain their dignity.
- Responsive?
- Good
- Care plans reflected people's needs, choices and histories. The home supported hobbies, communication needs, complaints and end of life wishes, although some plans needed more information about anxiety triggers.
- Well-led?
- Good
- Inspectors found strong leadership, regular audits and good oversight of safety and quality. The manager had started delegating responsibilities to develop key staff, but records did not always show reflective review after significant incidents.
What inspectors found, July 2019
Rated Good; inspectors found kind, personalised care and strong leadership, with a minor medicines recording error and some records needing improvement.
This was an unannounced inspection on 25 June 2019. Two inspectors spoke with four people using the service, care and kitchen staff, and the manager. They observed care and reviewed care plans, medicines records, staff records, rotas and safety documents.
The home was providing accommodation and personal care for 28 people, with space for up to 31. Inspectors found enough safely recruited staff, well-managed risks, clean surroundings and suitable training. People's healthcare, food, consent and end of life care were also well supported.
People were described as happy with the care. Staff were kind, respectful and promoted independence. Care was personalised, with activities, communication support and complaints handling in place.
All five areas were rated Good. This means inspectors found consistently good care and management at the time of the inspection. The overall rating had improved from Requires Improvement at the previous inspection, published on 13 June 2018.
Kind and respectful care
Staff showed patience and compassion, including when people were distressed or anxious. They promoted privacy, dignity and independence.
“Staff were kind and caring towards the people who used the service and their relatives.” from the report
Personalised support
Care plans included people's preferences, life histories and choices. People could follow hobbies, take part in activities and spend time as they wished.
“The service supported people to follow a variety of hobbies and interests including arts and crafts, music, games and leisure activities in the local community.” from the report
Good health support
Staff monitored health needs and made prompt referrals to healthcare professionals. Advice from other professionals was recorded and understood by staff.
“Staff made appropriate and prompt referrals to other healthcare professionals such as dieticians, falls team, GPs, dentists, and the mental health team when needed.” from the report
Strong oversight
The manager and provider used regular audits covering safety, incidents, falls, infection control and other areas. Actions from earlier audits were followed up.
“There was a quality assurance system in place which gave the provider and registered manager comprehensive oversight of the service.” from the report
Medicine stock record
needs fixingThe recorded stock for one medicine was out by one tablet. The manager said they would investigate this.
“However, we did find recorded stock for one medicine was inaccurate by one tablet.” from the report
Incident records
needs fixingInspectors found that records did not always show reflective review or the support staff received after significant incidents.
“We noted some significant incidents had taken place but reflective review of these was not always evident in records.” from the report
Staff refresher training
minorStaff understanding of Deprivation of Liberty Safeguards was mostly good, but some staff needed refresher training.
“Staff understanding of DoLS was mostly good, but some staff needed a refresher.” from the report
Anxiety information in care plans
minorSome care plans needed more detail about what might trigger people's anxiety. The manager said this would be considered during future reviews.
“Some plans could benefit from more information about possible triggers for people's anxiety.” from the report
- 01How do you now check medicine stocks so that records are always accurate?
- 02How do you record learning and staff support after a serious incident?
- 03Which staff have completed refresher training on Deprivation of Liberty Safeguards?
- 04How are possible triggers for anxiety recorded and reviewed in care plans?
- 05How will the home continue the improvements made since the previous inspection?
This was an unannounced inspection covering all five key questions; the overall rating had improved from Requires Improvement at the previous inspection. This explanation was written from the published report of 19 July 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2018
Rated Requires Improvement; inspectors found safe, effective and caring support, but concerns remained about activities, care records and leadership.
The inspection took place on 27 February and 15 March 2018. The first day was unannounced and the second was announced because severe weather stopped the team completing the first visit. Inspectors spoke with people, relatives, staff and a healthcare professional. They observed care and checked care plans, medicines, staffing and management records.
The home was rated Good for Safe, Effective and Caring. Inspectors found safe medicines systems, trained staff, appropriate healthcare support and kind, respectful care. People were supported with food, drink, mental capacity decisions and end of life care, although some monitoring records were not complete.
The home was rated Requires Improvement for Responsive and Well-led. People did not always receive enough activities or fully personalised support. Some care plans and daily records were not kept up to date. The home had responded to earlier safeguarding concerns, incidents and management pressures, but inspectors said the improvements were not yet firmly established.
Safe medicines
Inspectors saw medicines being given safely by trained staff. Records matched the medicines checked and there was guidance for medicines given when needed.
“There were safe systems in place for the management and administration of people's medicines.” from the report
Kind care
People told inspectors they were happy with their care. Staff were seen using a calm, patient approach and respecting people's dignity, choices and independence.
“We observed staff delivering kind and compassionate care to people they were supporting.” from the report
Healthcare support
Staff monitored people's health and contacted healthcare professionals when needed. Inspectors saw appropriate plans for pressure care and end of life care.
“People had their health care needs met and staff were proactive in monitoring people's needs and flagging up any changes with the relevant health care professionals.” from the report
People's compatibility and safety
seriousSome people's needs were not compatible, which led to incidents between residents. The home had reviewed placements and some people had moved, reducing the number of incidents, but this had been a significant concern.
“People's needs were not always compatible leading to incidents between them.” from the report
Limited activities
needs fixingSome people had little to do and did not receive enough individual social contact. Planned improvements, including extra activity staff and new activities, were not yet fully in place.
“Throughout the day we saw that there was limited activity for people to engage in.” from the report
Care records not current
needs fixingCare plans did not always reflect changes in people's health, risks or support needs. Daily notes and food and drink records were sometimes incomplete or recorded on the wrong forms.
“Care plans were not always up to date and records did not always provide a detailed contemporaneous note.” from the report
Improvements not embedded
needs fixingThe home had taken action after earlier concerns, but inspectors could not yet see that all changes were firmly established. Staff skills and responsibilities also needed further development so the service did not rely so heavily on the manager.
“Improvements needed were being addressed by the service but were not fully embedded.” from the report
- 01What regular activities are now available, and how are they matched to each person's age, interests and mental health needs?
- 02How do you check that care plans are updated promptly when someone's health, medicines or risks change?
- 03How are food and drink intake, weight changes and records checked for people who may be at risk of poor nutrition?
- 04What changes have been made to ensure people with incompatible needs are not placed together and that incidents are reduced?
- 05Which senior staff now share responsibilities and on-call duties, and how do you check they can manage safely when the manager is absent?
This was a comprehensive inspection covering all five key questions, following concerns from the local authority, safeguarding concerns and a higher than expected number of incidents. This explanation was written from the published report of 13 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Lancaster House
4 rated inspections over 3 years: the service has held its Good rating throughout.
- July 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2018Requires improvementdown from GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- July 2011
Registered with the Care Quality Commission on 12 July 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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