A comprehensive inspection of Lee Beck Mount, took place on 19 June and 4 July 2018. This was unannounced on day one but announced on day two as we needed to make sure the registered manager was available.

Lee Beck Mount is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of registration, the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. However, the service is now working towards developing the provision in line with these principles. 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.

Lee Beck Mount is situated in the Lofthouse area, near Wakefield and provides care and support for up to 13 people with learning disabilities. Local shops and community facilities are a short distance away. Accommodation is provided over two floors and with single occupancy rooms. There were 11 people living at the home on a permanent basis at the time of our inspection.

The home had a 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.

In August 2016 the home was rated as requires improvement. We found the provider did not ensure people’s nutritional and hydration needs were met, medicines were not always safely managed and they did not have effective systems in place to monitor the quality of the service. We told the provider they needed to take action; we received an action plan telling us what they were going to do to ensure they were meeting the regulations. At this inspection we found the provider was still in breach of regulations for the management of medicines and good governance. We also found additional areas of concern.

Some areas of medicines were not always well managed. Quality management audits were in place but were not always effective. The audits did not identify the concerns found during this inspection, which included, areas of the care plans were not always accurate and staff had not received annual appraisals during 2017/2018. Accidents and incidents were not analysed in a way which enabled trends to be identified.

Regular safety checks took place, although, prior to our inspection the gas safety certificate had expired and the home did not have a fire risk assessment in place. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies.

Staffing levels were sufficient, although, at times one person did not receive their allocated one to one hours and an increase in staffing numbers was not put in place to cover some recent planned absence. Staff were recruited safely and completed an induction when they started work. A range of training courses had been completed by staff but, it was not always clear how often these should be renewed. Staff received regular supervision during 2018 but annual appraisals were not conducted in line with the registered provider’s policy.

The registered provider had a safeguarding policy in place and staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Risks to people had been assessed. Advocacy services were available if people, so wished.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We found the home

This inspection took place over two days. Day one was unannounced and on 4 August 2016 and day two was announced and on 8 August 2016. At the last inspection in June 2014 we found the provider was breaching one regulation because they did not have systems in place to make sure people’s nutritional needs were met. At this inspection we found the provider was still in breach of the same regulation.

Lee Beck Mount provides care for up to 13 people who have a learning disability. The service had a registered manager. 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.

People told us they felt safe, and talked about how they were involved in health and safety procedures, which helped keep them informed about staying safe. Staff understood safeguarding procedures and their responsibility to report any concerns relating to abuse or allegations of abuse. People were not protected against the risks associated with the unsafe management of medicines.

There was enough staff deployed to keep people safe. However, some people received additional funding for one to one staffing support but it was not clear from the rotas or care records these were being allocated appropriately. Staff were skilled and experienced to meet people’s needs because they received appropriate training and support.

People told us they were happy in the home and said they were well cared for. We observed staff providing support and it was evident they knew people well. We saw examples where care was person centred and independence was promoted, which included people making decisions about where to spend their time and when to make a drink. We also observed practices that did not promote individuality and independence such as meal everyone carrying their dinner on a tray from the serving hatch and eating their dinner from the tray, which replicated a ‘canteen’ type of setting rather than a ‘home’ setting.

People’s care records were personalised and provided information so staff understood their history and what was important to them. People’s needs were assessed and support plans described what staff needed to do to meet people’s needs. However, some information was not up to date so these were not always accurate. A range of other professionals were involved to help make sure people stayed healthy.

People who used the service and staff provided positive feedback about the management team who worked alongside everyone overseeing the care given and providing support and guidance where needed. The provider encouraged everyone to share their views and ideas about the service to help drive improvement.

The provider was not carrying out appropriate audits and checks so did not have effective systems in place to monitor the quality of the service. Information to show how the service was well led was not always accessible. Concerns or complaints were responded to and resolved where possible to the satisfaction of the person.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

The questions we asked on this visit were: is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with seven people who use the service, the registered managers and two care staff. We also reviewed records relating to the management of the home which included, three care plans, daily care records, health care plans, staffing records, questionnaires and health and safety records.

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

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

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was well maintained bright and clean. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

We saw people had completed annual health check and there were records of contacts with other professionals. One person in the home now self-medicates. Everyone living in the home has their money and medication locked within their own rooms.

We saw the managers had in place regular health and safety checks and any repairs required were recorded and dealt with in a timely manner.

Is the service effective?

We spoke with seven people who used the service and they told us they could make

decisions about their day to day lives, such as choosing what to wear, when to go to bed and what to do during the day. We saw one of the people likes to have their nails done and they have been able to do this regularly. People’s comments included:

“I like it here it’s my home”

“I have made good friends”

Is the service caring?

People who lived in the home spoke very positively about the staff and we observed good relationships amongst staff and people who lived in the home. We saw staff encouraging people to make their own choices and to engage in activities they enjoyed. Staff were kind and attentive and it was clear they knew and had a good rapport with the people they were supporting.

Is the service responsive?

We looked at three peoples care records and saw there were now clear descriptions of how people like to spend their day and how they wished to be supported. They were all personal to the person and it was evident people had been involved in creating their care plans with the goals they wished to achieve.

We noted when someone had refused food it was not clear, from the records, what action had been taken and how this person nutrition was being monitored. Other people’s weight was fluctuating and although records had been kept they had not been reviewed and action taken noted. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service well led?

People told us they were involved in aspects of the home. One person told us they did the fire checks with a staff member each week.

We saw the easy read questionnaires which had been given to everyone in the home in March this year. The feedback from people was positive. We saw there were regular meetings for people who live in the home.

You can see our judgements on the front page of this report.

We made an unannounced visit to follow up the action we asked the provider to take when we visited in July 2013.

Our previous visit showed three areas which needed action: People did not have person centred care plans. People were not always protected from unsafe equipment because the provider had not ensured the equipment used in the service was serviced and maintained. Although people told us the service provided safe and effective care we found the provider had not monitored some important aspects of the service.

Following the July inspection the provider sent us an action plan telling us what they would do to achieve compliance. During this inspection we checked if improvements had been made.

We spoke with five people who lived in the home. All were very happy living at Lee Beck Mount and spoke positively of the staff who supported them. Some of their comments included:

“I love it here. I wouldn’t change it.”

“I like all the staff.”

We saw people were relaxed and related well with the staff. We observed staff treated people kindly and with respect. (GAP)We looked at five people’s care records and saw they had a care passport which described the person, what support they needed and how they wished to be supported. We saw evidence that person centred care plans were being developed for each person.

We spoke with the two managers and a new member of staff who told us how they were encouraging people to become more involved in their care.

We saw the home was maintained and there was a system to record any maintenance issues. However, we saw that this system was not always updated.

The provider had monitored important aspects of the service and checks had been carried out as required.

We found that not all records were available and not all those seen were up to date.

We spoke with five people who used the service. They said they were happy with the care and support they received. People were complimentary about the staff who assisted them. One person said, “Staff are very nice and they always help me.” Another person said, “I’ve lived here a long time and I’m very happy.” People told us they could make decisions about their day to day lives such as choosing what to wear, when to go to bed and where to spend their time.

We observed staff assisting people who used the service. People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff were friendly and treated people they supported in a respectful way. They knew the people they were supporting very well. Staff told us people were given opportunities to make choices and decisions throughout the day and those decisions were respected.

Although people told us they were happy with the care, we found sometimes the care was not individualised or planned to enable people to care for themselves. Service provision for people with learning disabilities should be helping people to live as independently as they can. People were not always given opportunity to access community services.

The provider had not monitored some important aspects of the service and checks were not always carried out. They had policies and procedures which identified systems what they should do to ensure effective and safe care is delivered but these were not always followed.

Lee Beck Mount provided accommodation for 12 people who required personal care. During the visit we spoke to the two managers, two staff and two people who used the service. People told us they were happy with the care and support they received. Comments included:

“I like the food, the staff and going to the day centre.”

“The staff look after me very well.”

“I love this home.”

“The staff spoil me, I love it.”

We observed care practices and people who used the service were treated with respect and dignity. We looked at three care plans and found that they were up to date, provided good information about how people's care and support needs were assessed. People said they were happy and felt safe living at the home. We saw evidence that demonstrated the provider had taken appropriate steps to ensure that staff were suitably skilled and experienced to carry out their roles. People told us that they were aware of the complaints process, knew who to speak to and felt confident that complaints would be investigated and responded to.

All bedrooms were spacious, provided en-suite facilities and decorated to people’s own personal tastes. There was a large communal lounge area, a dining room, a kitchen area and a covered patio area outside.

The local authority Commissioners told us they had no concerns about the service. There have been no safeguarding issues or any other concerns identified.