Lennox House 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. Lennox House is registered to provide personal care and accommodation for up to 87 people. At the time of this inspection there were 37 people in residence. This is because the home was under a voluntary embargo, and so had temporarily stopped admitting new people until improvements were made. The home is divided over four floors. The ground floor was not currently occupied. Residential care for people using the service who did not require nursing care was provided on the first floor. Nursing care was provided on the other two floors.

This unannounced inspection was carried out on the 10, 11, 13 and 20 September 2018.

At the time of the inspection there was a registered manager in place. 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.

Our last inspection of this service was on 30 and 31 August 2017 and we found concerns relating to regulation 11, 12 and 17 of the Health and Social Care act 2008 (Regulated Activities) Regulations 2014. We found that the provider had not effectively operated systems and processes to monitor and improve the quality and safety of the service. The provider was not following the requirements of the Mental Capacity Act 2005 (MCA). We also found that people at risk of falls were not properly assessed and monitored.

At this inspection, we saw that methods of monitoring the quality of the service had been largely improved. The service had put in place a range of audits to review people’s care. There were systems for reviewing and investigating when things went wrong. However, we found the registered manager still required support from the provider to deliver high-quality and sustainable care.

Risks to people had been identified, assessed and reviewed. Each person's care plan had several risk assessments, including the associated hazards and what measures could be taken to reduce risk. The previous inspection had identified unsafe practices in the management of falls. At this inspection we saw that improvements had been made.

The service had continued to operate systems to keep people safe from abuse. The service carried out appropriate staff checks at the time of recruitment and on an ongoing basis. Although there was a high staff turnover, overall, there were sufficient staff deployed to keep people safe.

The service had learned and shared lessons from incidents. There were adequate systems for reviewing and investigating when things went wrong. Equipment within the home had been serviced and maintained on a regular basis. A fire risk assessment was in place and regular in-house fire safety checks had been carried out. There was an effective system to manage infection prevention and control.

The previous inspection identified that staff had not consistently received supervision and appraisal. At this inspection we found that although there were arrangements for ongoing staff support, they were not effective.

We found staff had the skills, knowledge and experience to carry out their roles. They supported people to have maximum choice and control of their lives. People confirmed they were involved in planning their care. Their care records showed relevant health and social care professionals were involved in their care. The service was working within the principles of the Mental Capacity Act (MCA) 2005. People told us they liked the food offered, they could choose what they wanted to eat.

We found staff to be compassionate and caring. People we spoke w

This inspection took place on 30 and 31 August 2017 and was unannounced.

The last inspection was carried out in January 2017. The overall rating for the service was inadequate. We found the provider was in breach of Regulations 12 (safe care and treatment), 13 (safeguarding) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During our comprehensive inspection in August 2017 the service demonstrated to us that improvements had been made and no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Lennox House is part of the Care UK Community Partnership Company. It provides residential care and nursing care for up to 87 older men and women at purpose built accommodation in a residential area of North London. The home is divided over four floors. On the ground floor intermediate care is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors. At the time of our inspection there were 68 people living at the home.

The home did not have a registered manager in place. 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. An interim regional manager had been appointed.

We found that the registered provider had made improvements in their quality monitoring systems. They had received support from the local authority and this was continuing at the time of the inspection. It was too early for the provider to be able to demonstrate that these processes were fully embedded and that these improvements could be sustained over time, including when support from the local authority is withdrawn.

Although, we saw some improvements, there had been a lot of input from the local authority. We were concerned about the length of time taken to address the concerns raised at the last inspection. However, recent developments such as the appointment of a new clinical leads, interim manager and new permanent staff had helped. However, we still received some negative feedback from some people using the service and some relatives about staffing and activities.

The provider has acknowledged this is work in progress. We saw evidence there was an active recruitment drive and a number of new staff had been appointed.

Overall, there was evidence risks to people had been identified, assessed and reviewed. The home had improved how it managed accidents and incidents, including falls.

Whilst we noted, that best interest meetings had been held with relatives and relevant health and care professionals for some people, this had not been consistently applied. We saw that the service did not always meet the requirements of the Mental Capacity Act 2005 in supporting people.

Improvements had been made in supporting people to meet their nutritional needs. People were able to make choices about the meals and drinks they wanted.

People were supported to meet their health care needs and had access to a range of external health care professionals.

Improvements had been made in ensuring people’s privacy and dignity were respected. Staff cared for people in ways which recognised people's rights to make their own decisions. People’s privacy and dignity were respected.

We saw positive interactions between staff and people. Staff knew about people’s needs and interests.

People's religious and cultural needs

Lennox House is part of the Care UK Community Partnership Company. It provides residential care and nursing care for up to 87 older men and women at purpose built accommodation in a residential area of North London. The home is divided over four floors. On the ground floor intermediate care (this is short term care for people who usually live in their own home) is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors.

This inspection took place on 16, 18 and 22 January 2017. At our previous comprehensive inspection on 28 July and 10 August 2015 the service was meeting all but one the regulations we looked at, in relation to staff not all having had appraisals. This breach had been met by the time of the unannounced focused inspection on 30 June 2016 that we undertook to look specifically at that previous breach of regulation. Subsequent to the June 2016 focused inspection we were informed of serious concerns about a safeguarding incident, that CQC had not been informed of, which had occurred in March 2016. We carried out a further focused unannounced inspection on 5 and 9 August 2016. As a result of that inspection we identified three breaches of regulations Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and Regulation 18 of the registration regulations 2009 in respect of notification of incidents. Please refer to the remainder of this report in respect of our findings in relation to those breaches.

There was no registered manager in place. 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.

Medicines were not managed safely for everyone using the service. We found significant errors and people had missed their medicines due to a lack of supply or other administration and recording errors. Medicines audits carried out in November and December 2016 had identified similar issues, but no action had been taken to address these serious concerns since as the issue of medicines not being ordered in time had been identified again at a recent staff meeting on 11 January 2017. We also found errors in administration and recording of medicines during this inspection.

Apart from medicines audits in November and December 2016, an infection control audit carried out by the housekeeper in January 2017 and a current review of accident and incident trends, no other audits were provided, despite several requests. Audits were not therefore being used to effectively assess and improve the service. The provider informed us that they were undertaking a full review of the service in light of management and oversight failures that had been identified. This review was on-going and not been completed at the time of the inspection. CQC asked for a copy of the plan for reviewing the service, but this was not provided.

There had been significant management change. Since the previous registered manager’s departure in August 2016, the service had been managed by two of the provider’s operational support managers, one until late November 2016 who was then replaced by another from late November and was in place at the time of this inspection. There was no registered manager in post, although the provider was attempting to recruit to the post at the time of the inspection.

The staff of the service had access to the organisational policy and procedure for protection of people from abuse. They also had the contact details for the safeguarding team at the local authority in which the service is located. The members of staff we spoke with said that they had training about protecting people fr

This focused inspection was carried out due to concerns that had arisen since our previous inspection which suggested that a person using the service was placing themselves and other people at risk by their behaviours.

This inspection took place on 5 and 9 August 2016 and was unannounced. This inspection was carried out by two inspectors and an inspection manager. This report only covers our findings in relation to the specific concerns that were raised and our findings are reported under safe and well- led in this report. You can read the reports from our last comprehensive and focused inspections of the service by selecting the 'all reports' link for Lennox House on our website at www.cqc.org.uk

Lennox House provides accommodation for up to up to 87 older people, some of whom also suffer with dementia. On the day of the inspection there were 82 people residing at the home. The home is divided over four floors. On the ground floor intermediate care is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors.

There was 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 and associated Regulations about how the service is run.

On 5 July 2016 CQC attended a meeting with Islington Social Services Department. We were informed of an alleged incident of abuse that had occurred in March 2016. Islington Social Services Department had not been informed of the safeguarding concern until 6 May 2016 and CQC had not been alerted via a statutory or other notification by the provider. At this focused inspection, we found that the service had not properly considered the risk posed by a client to others or taken sufficient steps to monitor that risk or respond to it. This meant that some people at the home had faced unnecessary risks to their safety and wellbeing.

The service had failed to notify CQC of the alleged serious incident of abuse in March 2016, as they were required to do by the regulations. We found that the manager of the home had not followed the provider’s procedures for notifying incidents and responding to them. The provider was aware of the incident by at least 9 May 2016 when they met with the local authority to discuss it, but no notification to CQC had subsequently been made.

As a result of this inspection we found that the provider was in breach of Regulations 12 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the CQC Registration Regulations 2009.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can see what action we told the provider to take at the back of the full version of the report.

At our previous inspection of this service on 28 July and 10 August 2015, the provider was in breach of Regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff appraisals were not occurring which meant that staff performance and development was not being effectively reviewed. The provider sent us an action plan after the inspection detailing how they would address the breach. At this inspection we found that progress had been made, staff appraisals had all been completed and the provider was no longer in breach of this regulation.

This inspection took place on 30 June 2016 and was unannounced. This inspection was carried out by a single inspector. This report only covers our findings in relation to staff appraisals within the effective section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lennox House on our website at www.cqc.org.uk

Lennox House provides accommodation for up to 87 older people, some of whom are also living with dementia. On the day of the inspection there were 82 people residing at the home. The home is divided over four floors. On the ground floor intermediate care is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors.

There was 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 and associated Regulations about how the service is run.

We were assisted during our inspection by the registered manager and deputy manager.

We spoke in passing with three people using the service and a visiting relative. We did not ask these people about the specific area we were visiting to look at but had brief conversations about what they thought of the home. The responses we received did not raise any cause for concern. We noted that when a relative raised a suggestion to improve the storage of their own relative’s clothing the registered manager responded immediately and informed the person what they would do. The relative told us that they appreciated the response and action promised.

The issues we had found regarding staff appraisals at the last inspection had been addressed. The records of all staff appraisals showed that the entire staff team had undergone an appraisal within the last year and for newer staff the service highlighted when this was due.

The provider was no longer in breach of Regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of staff appraisals.

We spoke with three people who used the service on the day we inspected. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. We spoke with three relatives who regularly visited people who use the service. One of the relatives told us "the manager has made it more homely, I'd go there myself if I needed to live in a home".

We spoke with one of the activities coordinators, the registered manager and the deputy manager as well as five members of care staff during our visit.

We found that people’s dignity was respected and that people’s choices were promoted. We found that care staff supported people to be independent where possible and prompted and encouraged people to complete tasks.

We found that care plans and risk assessments were regularly reviewed and updated and that care plans reflected people’s current needs. We found that people’s care needs were being met and that staff had a good understanding of people’s current care needs.

We found that people were protected from risks and that the provider took appropriate steps to prevent risks for happening and to address identified risks. We also found that staff were appropriately supported and provided with relevant training and guidance.

We found that the records used to support both the delivery of the service and to provide care and treatment were appropriate and current.

One inspector visited the service over the course of a day on the 30th May 2012. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

There were 76 people in residence on the day of our visit. During our visit we observed care staff supporting people who use the service to make choices about their daily life. Some people who used the service did not have English as a first language. We saw that staff who were able to speak the first language of people using the service had been deployed so that they would have regular contact with the person whose language they spoke. The home was also able to provide end of life care so that people using the service would not have to be admitted to hospital.

Our SOFI observation indicated that the majority of interactions between people using the service and staff were positive and focused on providing care. We found that a range of individual plans that addressed people’s social, health and personal care had been completed and were regularly updated. The local GP visited the home twice each week, and a podiatrist, dentist and optician also visited regularly.

We found that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Our observations indicated that sufficient numbers of staff were rostered on duty to meet the needs of people who use the service. We found that staff received appropriate professional development. Our observations indicated that staff understood and met the needs of people using the service. We also found that people who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted upon.

People we spoke to told us that staff were caring and friendly, and that they enjoyed living at the home. We were also told that staff showed respect and promoted dignity whilst assisting with personal care. One resident commented that staff listened to them and took on board how they wanted to be helped. We found that some of the homes pre admission assessments contained very little information and have asked the provider to address this area.

Other residents commented that there were lots of activities on offer, and freedom to choose whether or not to be involved. Some people commented that there confidence and abilities had improved since living at the home, and that staff had been very patient.

People using the service spoke very positively about the meals provided, commenting that a good choice of quality meals were available, and that catering staff were very accommodating. During our visit we observed that for some residents assistance at mealtimes was not provided sensitively in a way that promoted dignity.

People we spoke to told us that the home was clean and fresh and free from offensive odours. Residents also said that they had lovely rooms that were very comfortable. During our visit we found two residents whose call alarms had fallen out of reach.

Family members and people using the service told us that they knew about the homes complaints procedure and what to do if they wanted to make a complaint.

Whilst people who use the service and their families commented that staff appeared competent and capable, our inspection of the homes training records indicated some staff had not completed mandatory training.

Lennox House is part of the Care UK Community Partnership Company. It provides residential care and nursing care for up to 87 older men and women at purpose built accommodation in a residential area of North London. The home is divided over four floors. On the ground floor

intermediate care (this is short term care for people who usually live in their own home) is provided for a maximum of twelve people. Residential care for people using the service who do not require nursing care is provided on the first floor. Nursing care is provided on the other two floors.

This inspection took place on 28 July and 10 August 2015 and was unannounced. At our previous inspection in August 2014 the service was meeting the regulations we looked at.

At the time of our inspection a registered manager was employed at the service. 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.

The staff of the service had access to the organisational policy and procedure for protection of people from abuse. They also had the contact details of the London Borough of Islington which is the authority in which the service is located. The members of staff we spoke with said that they had training about protecting people from abuse, which we verified on training records and staff were able to describe the action they would take if a concern arose.

We saw that risks assessments concerning falls, healthcare conditions and risks associated with skin care and the prevention of pressure sores were detailed, and were regularly reviewed. The instructions for staff were clear and described what action staff should take to reduce these risks.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately and making the necessary applications for assessments when these were required.

People were supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home each week, but would also attend if needed outside of these times. Staff told us they felt that healthcare needs were met effectively and we saw that staff supported people to make and attend medical appointments, for example at hospital.

It was clear that significant efforts were made to engage and stimulate people with activities, including people who remained in their rooms. Two full time activities co-ordinators were employed and we were informed this team would soon be joined by a third. We saw a range of activities on offer, not only within the home but also trips out to parks and places of interest. A trip to Buckingham Palace was planned and people who mentioned this to us were looking forward to the visit. One to one time was also provided for people who were unable to leave their room to join in group activities.

Everyone we spoke with who used the service, and relatives, praised staff for their caring attitudes. The care plans we looked at showed that considerable emphasis was given to how staff could ascertain each person’s wishes including people suffering with dementia and to maximise opportunities for people to make choices that they were able to make. We saw that staff were approachable and friendly towards people and based their interactions on each person as an individual, taking the time needed to find out how people were feeling and what they could do to help.

Staff views about the way the service operated were respected as was evident from conversations that we had with staff and that we observed. We saw that staff were involved in decisions and kept updated of changes in the service and were able to feedback their views at handover meetings, staff team meetings and during supervision meetings.

The service complied with the provider’s requirement to carry out regular audits of all aspects of the service. The provider carried out regular reviews of the service and regularly sought people’s feedback on how well the service operated.

At this inspection there was one breach of regulation relating to regulation 18, which was in relation to staff appraisals not have been carried out in over a year. Please refer to the “Effective” section of this report for details. You can see what action we told the provider to take at the back of the full version of the report.