CQC report explained · a nursing home
What the CQC found at Lewin House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found suitable risk assessments, enough staff, safe medicines management and appropriate infection control. Accidents and incidents were reviewed for patterns and action was taken where needed.
- Effective?
- Good
- The home had improved its approach to consent and was compliant with the Mental Capacity Act requirements. Staff had training and supervision, and people had access to health and nutrition support.
- Caring?
- Good
- People, relatives and professionals gave positive feedback about staff. Inspectors saw respectful care, protection of privacy and support for independence.
- Responsive?
- Good
- Care plans contained detailed information about people's needs and preferences. Activities were varied, but inspectors recommended better equality, diversity and human rights training and identified a need to improve support for a person with sight loss.
- Well-led?
- Good
- Inspectors found a positive workplace culture, approachable management and regular checks on care quality and safety. Staff felt listened to and worked well together.
What inspectors found, September 2018
Rated Good; inspectors found safe, kind and well-organised care, with some improvements still needed in equality training and support for sensory impairments.
Inspectors visited unannounced on 12 July 2018. They spoke with people living there, relatives, staff and health professionals. They reviewed care records, medicines records, staff files and management checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines management, clean facilities and suitable risk assessments.
Staff were described as caring and respectful. Care was personalised, and dementia care was a particular strength. People had access to activities, health professionals and support at the end of life.
The home had fixed an earlier problem with recording consent under the Mental Capacity Act. Inspectors recommended better equality, diversity and human rights training. They also asked managers to follow up how staff support people with sensory impairments.
Safe staffing and medicines
Inspectors found enough staff to meet people's needs. Medicines were stored, given, recorded and disposed of safely.
“Sufficient staff were deployed to safely meet people's needs.” from the report
Consent improved
The home had acted on the earlier inspection finding about consent. Care plans and staff training had been updated, and the home was now compliant with the relevant regulation.
“At this inspection, we consider the service had made satisfactory changes to ensure consent was correctly obtained and recorded.” from the report
Dementia care
Staff used people's histories, familiar objects and personalised approaches to reduce distress and help people settle. Dementia care was identified as a strength.
“Care of people with dementia was a strength of the service, and staff were passionate to develop this area to an outstanding level.” from the report
Kind and respectful care
People and relatives praised the staff. Inspectors saw staff protect privacy, use preferred names and encourage people to do what they could for themselves.
“People's privacy and dignity was protected and promoted.” from the report
Activities and social links
Activities encouraged meaningful involvement, including music, visits and links with local groups and schools. Staff adapted activities around people's interests.
“Activities were varied and inspired meaningful interaction and engagement between people.” from the report
Equality and diversity training
needs fixingRecords did not prompt staff to consider all protected characteristics. Managers did not have specific equality and diversity training or systems for asking people about these needs.
“We recommend that the provider reviews their policies, procedures and training to raise awareness of equality, diversity and human rights.” from the report
Support for sensory impairment
needs fixingInspectors saw a staff member give a meal to a person who was blind without explaining the food or checking their spectacles. Managers were asked to make sure staff had the right skills.
“This was fed back to the management team to follow-up and make sure staff had the skills and knew how to support people with sensory impairments.” from the report
- 01What equality, diversity and human rights training have staff completed since the inspection?
- 02How do you record and review each person's cultural, religious, personal and other protected needs?
- 03How do staff support people who are blind or have other sensory impairments, including at mealtimes?
- 04How are consent, mental capacity decisions and Deprivation of Liberty Safeguards kept up to date?
- 05How will you make sure the activities and dementia support remain suited to my relative's interests and needs?
This was an unannounced inspection of all five key questions and the premises, care and management systems were reviewed; the overall rating and four key-question ratings remained Good, while Effective improved to Good. This explanation was written from the published report of 28 September 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.
What inspectors found, September 2016
Lewin House was rated Good overall; inspectors found kind, safe care, but the Effective rating was Requires Improvement because consent and capacity records were not always correct.
Inspectors visited on 10 and 11 August 2016 without telling the home in advance. They spoke with people living there, visitors, staff and a healthcare professional. They also observed care and checked care plans, medicines records, recruitment files and staff training records.
The home was rated Good for Safe, Caring, Responsive and Well-led. Inspectors found people were protected from harm, medicines were handled safely, staff were kind and respectful, care was personalised, activities were available and managers monitored the service.
The Effective rating was Requires Improvement. The home did not always follow the Mental Capacity Act when making decisions for people who could not make certain decisions themselves. Records also did not clearly show how conditions attached to authorisations to deprive people of their liberty had been followed.
The report says the home breached Regulation 11 about consent. The provider was asked to send a report explaining what it would do, and CQC said it would check that the action was taken.
Kind and respectful care
People and visitors gave positive feedback about staff's kindness, patience and compassion. Inspectors observed staff treating people with dignity and taking an interest in their lives.
“People were treated with kindness, affection and compassion.” from the report
Safe medicines management
Staff who gave medicines were trained and assessed. Records showed medicines were given and controlled drugs were checked properly.
“People's medicines were managed safely.” from the report
Personalised support and activities
Care plans included people's routines, wishes and support needs. The home provided activities and adapted areas to help people with dementia engage with their surroundings.
“Care plans were personalised and detailed daily routines specific to each person.” from the report
Good management oversight
The provider and managers used audits, visits and communication systems to monitor care. Staff said they felt able to raise concerns and approach managers.
“The provider monitored the service to make sure it met people's needs safely and effectively.” from the report
Consent and capacity records
seriousThe home did not always record how best-interest decisions were made for people who lacked capacity. It also did not clearly record how restraint or other restrictions complied with conditions on liberty safeguards authorisations.
“These were breaches of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Care plan handwriting
needs fixingSome handwriting in care plans was difficult to read. Inspectors found that this could lead to staff misunderstanding a person's care instructions.
“This was not the case, but an example of how different interpretation could lead to inconsistency in people's care.” from the report
Mixed views about staffing
minorSome people said there were not enough staff or little one-to-one time, while others felt staffing was adequate. Inspectors found people's needs were met during the visit and call bells were generally answered promptly.
“We received mixed feedback on whether the home was adequately staffed.” from the report
- 01How do you now record best-interest decisions for people who cannot make particular decisions themselves?
- 02How do you record and monitor compliance with conditions attached to Deprivation of Liberty Safeguards authorisations?
- 03How many staff are on duty on each shift, and how do you respond when people need more one-to-one time?
- 04What has been done to make sure handwriting and other care plan instructions cannot be misunderstood?
- 05What activities and support would be available for my relative, including if they have dementia or specific interests?
This was an unannounced inspection covering all five CQC questions and the overall rating, with records, care, staffing, medicines, management and people's experiences checked. This explanation was written from the published report of 9 September 2016 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 Lewin House
2 rated inspections over 2 years: the service has held its Good rating throughout.
- September 2018Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2016GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 29 November 2010.
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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