CQC report explained · a residential care home
What the CQC found at The Laleham
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicines were not always administered, stored, counted or returned safely. Inspectors also found concerns about skin care equipment, environmental risks and infection control.
- Effective?
- Requires improvement
- Care assessments had improved but were not always detailed enough. Oral care and access to dental services needed improvement, and people were not always supported in the least restrictive way.
- Caring?
- Requires improvement
- This question was not inspected during this focused visit. People and relatives gave positive feedback, and staff were described as kind and compassionate.
- Responsive?
- Requires improvement
- This question was not inspected during this focused visit. People were involved in care plan reviews and staff helped arrange healthcare appointments.
- Well-led?
- Requires improvement
- Audits and checks did not identify important problems with medicines, records, restrictions and care planning. The service had also failed to notify the CQC about three notifiable events.
What inspectors found, October 2022
Rated Requires Improvement; inspectors found continuing risks with medicines, infection control, care records and checks.
This was an unannounced focused inspection on 30 and 31 August 2022. Inspectors spoke with people, relatives, staff and a healthcare professional. They reviewed care records, medicine records, staff files and management records.
Some improvements had been made since the previous inspection. Staffing levels and recruitment checks had improved. Staff knew people well, people and relatives gave positive feedback, and accidents and incidents were being reviewed.
However, important problems remained. Medicines were not always managed safely. Some areas were not clean, infection control arrangements were not always effective, and records did not always give staff enough detail. Checks and audits had failed to find several of these problems.
The overall rating was Requires Improvement. Safe, Effective and Well-led were also rated Requires Improvement. Caring and Responsive were not inspected during this visit, so their previous ratings were used to calculate the overall rating.
Staffing improved
Inspectors found enough staff to meet people's needs. Fire warden cover and recruitment checks had also improved since the previous inspection.
“At this inspection we found some improvements. Staff told us there were sufficient staff to meet people's needs.” from the report
Learning from incidents
The home had improved how it recorded and reviewed accidents and incidents. Action plans were used where needed.
“Accidents and incidents were documented on forms which were reviewed by the registered manager to identify trends and patterns.” from the report
Kind staff
People and relatives gave positive feedback about the care. Staff spoke about residents with kindness and compassion.
“Staff spoke positively about residents, with kindness and compassion.” from the report
Healthcare support
Staff worked with several healthcare professionals and helped people attend appointments. A visiting professional said staff knew people well.
“When needed staff sought support from healthcare professionals including occupational therapists, district nurses and the mental health team.” from the report
Medicines were not always safe
seriousPain patches were not rotated as instructed. Medicine counts did not always match records, storage arrangements were unclear for one medicine, and returns to the pharmacy were not fully recorded.
“Some medicines were not being administered in line with the patient safety leaflet guidance.” from the report
Infection control problems
seriousSome areas were not clean. Toilet and handwashing arrangements were unsuitable in places, and inspectors were not assured that staff used and disposed of protective equipment safely.
“We were not assured that the provider was promoting safety through the layout and hygiene practices of the premises.” from the report
Care guidance was incomplete
needs fixingSome care plans did not explain clearly how to manage skin care, pressure-relieving equipment, diabetes or catheter care. Checks on pressure-relieving equipment were not recorded.
“Care plans did not contain information including what signs and symptoms to look for if there were concerns of infection, and where to escalate the concerns.” from the report
Restrictions and records
needs fixingBathrooms had been locked without properly considering people's rights and choices. Records about people's mental capacity were inconsistent.
“We found that bathrooms had been locked from the outside to prevent people accessing them.” from the report
Weak oversight
seriousAudits failed to identify several problems found during the inspection. The provider had not notified the CQC about three events that should have been reported.
“The registered manager and provider did not fulfil their regulatory responsibility to notify us of certain events and incidents.” from the report
Dental care needed improvement
minorSome oral care assessments had limited information, and records did not show when some people had last seen a dentist.
“Support with dental care could be improved.” from the report
- 01What has been done to make sure medicine counts, storage, patch rotation and pharmacy returns are now checked properly?
- 02How have cleaning, handwashing facilities, toilet access and protective equipment arrangements been improved?
- 03Have all care plans on the new electronic system been reviewed to include clear guidance about skin care, pressure equipment, diabetes and catheter care?
- 04How are decisions about restrictions and mental capacity now recorded and checked?
- 05What evidence can you show that the two continuing breaches have been fully addressed?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 15 October 2022 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, July 2021
Rated Requires Improvement; inspectors found kind staff and some good care, but serious safety, medicines and management weaknesses.
The unannounced inspection took place on 29 and 30 April 2021. Inspectors spoke with nine people and seven staff, reviewed eight care records, medicines records, recruitment files and management records, and checked infection control.
All five areas were rated Requires Improvement. Inspectors found risks from falls, medicines, oxygen storage, fire safety, infection control and recruitment were not always managed properly. Care plans did not always reflect people's needs or preferences, and the home's checks had not identified or fixed important problems.
There were also positive findings. Staff were described as kind and respectful, staffing levels met people's care needs, people received help from health professionals, and activities were provided. However, the report says the provider breached five regulations and was required to send CQC an action plan.
Staffing levels
Inspectors found enough staff to meet people's care needs. Call bells were answered in a reasonable time, although staff said they could be busy.
“There were enough staff to meet people's care needs.” from the report
Kind and respectful care
People said staff were caring and supportive. Inspectors saw staff treating people warmly, patiently and with respect.
“People thought staff were caring and respectful.” from the report
Health care support
Staff helped people access dieticians, speech and language specialists, mental health teams, consultants and specialist nurses. Advice from health professionals was followed.
“People had been supported to access healthcare resources such as dieticians, SaLT, psychiatrists, mental health teams, consultants and specialist nurses.” from the report
Activities and company
People were offered activities such as quizzes and singing. Those who preferred to stay in their rooms were offered one-to-one time.
“Where people preferred to stay in their rooms, activity staff ensured they spent one to one time with them.” from the report
Nutrition and skin care
Risks linked to skin damage, diabetes, nutrition and hydration were monitored with established measures. People received suitable food textures where specialists had advised this.
“There were effective systems in place to monitor and manage risks relating to skin integrity, diabetes, nutrition and hydration.” from the report
Falls and other risks
seriousRisk assessments were not always updated after falls, and accident records did not always show what should change. Guidance for supporting people who became distressed or whose behaviour could harm others was also unclear.
“The provider had failed to do all that was reasonably practicable to assess and mitigate risks.” from the report
Medicines
seriousA tablet count showed that one person had not received medicine as prescribed. Records for some medicines and as-needed medicines were unclear or incomplete.
“The person had not received their medicine as prescribed, putting their health at risk.” from the report
Fire and recruitment arrangements
seriousA fire report identified too few fire wardens, but no action had been taken. Some recruitment files lacked important information, including a suitable reference or health risk assessment.
“The provider and registered manager acknowledged no action had been taken.” from the report
Infection control
seriousCleaning arrangements did not cover all high-risk areas throughout the day. Used protective equipment could not always be disposed of at suitable points, and there was no emergency staffing plan for an outbreak.
“We were not assured by the providers management of infection control, this potentially put people at risk of harm.” from the report
Care planning and involvement
needs fixingSome people were not given the chance to contribute important information about their care, such as seizure support or bedrail decisions. Care plans were sometimes incomplete, inaccurate or not updated after incidents.
“People were not always involved in making decisions about their care.” from the report
Weak oversight
seriousThe home's audits had not found or corrected several problems, including issues raised at the previous inspection. Feedback collected from people, relatives and staff had not been analysed.
“Ineffective auditing processes did not bring about learning and improvement of care.” from the report
- 01What has been done to make sure falls lead to updated risk assessments, care plans and recorded preventative actions?
- 02How do you now check that boxed and as-needed medicines are given as prescribed and recorded correctly?
- 03Have the number of fire wardens, night-time emergency arrangements and fire drills been brought up to date?
- 04How are oxygen cylinders stored now, and how do you check that infection control and cleaning arrangements cover the whole home?
- 05How are residents and relatives now involved in care planning, and how is their feedback used to make changes?
This was an unannounced inspection covering all five CQC questions and infection prevention and control; it was the first inspection under the home's new legal entity, while the provider remained the same. This explanation was written from the published report of 14 July 2021 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 The Laleham
2 rated inspections over a year: the service has held its Requires improvement rating throughout.
- October 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2021Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- September 2019
Registered with the Care Quality Commission on 4 September 2019.
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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