Archived: K Lodge

People’s experience of using this service and what we found

People told us they felt safe within the service. Staff we spoke with were trained and knowledgeable in safeguarding procedures.

Risk were assessed to minimise risks present within people’s lives. Checks and monitoring processes were in place to keep people safe.

Medicines were stored and administered safely by trained staff.

Prompt action was taken as a result of any incidents, to ensure lessons were learnt.

There were enough staff working at the service to keep people safe and meet their needs. Staff were recruited safely and trained to provide care safely.

Audits and checks were in place to ensure the service remained clean and well maintained, as well as to ensure that records were being accurately kept, and people were safe and happy.

Staff felt well supported within their roles and felt able to approach management with any concerns or requests for support.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service was requires improvement which was published on 11 September 2021.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 22 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for K Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

K Lodge is a residential care home, providing personal or nursing care for up to 40 people, some of whom are living with dementia care needs. At the time of inspection, 35 people were living at the service.

People’s experience of using this service and what we found.

The cleanliness of the kitchen was poor. We identified unclean kitchen cupboards, flooring and cleaning equipment. Food had not always been appropriately stored.

Some windows in the home did not have the appropriate window restrictors fitted. A fire risk assessment had not been undertaken by a competent professional.

Risk assessments for flammable creams were not in place. Medication audits were not in place to monitor systems and processes relating to the safety of medicines.

A security risk was identified in the detached part of the home known as Garden Villa. This building was left unlocked throughout the day and night exposing people to risk.

Audits and checks were not robust and had not always picked up errors, or actioned improvements.

Staffing levels were sufficient, and the skill mix of staff had been considered. Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

The service was following good practice infection prevention and control guidance in relation to COVID-19.

Staff treated people with kindness, dignity and respect. We observed positive interactions between people and staff, and feedback from people about staff relationships were good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 4 November 2020) The service remains rated requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to person centred care and people's preferred times they wished to rise in the mornings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. Requires improvement. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for K Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safety, quality and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report..

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

K Lodge is a residential care home providing personal care to 35 people aged 65 and over at the time of the inspection. The service can support up to 40 people over one large adapted building and a smaller annexe.

People’s experience of using this service and what we found

Systems in place to monitor and improve the quality of the service were not robust. The provider had not identified the issues we found during inspection.

Staff did not always complete medicine administration records or report issues appropriately. We found people had not received their medicine as prescribed.

Information about specialist equipment was not recorded in people’s care plans. This meant staff could not be sure the equipment was being used properly.

Systems and processes to record information about people were disorganised. This meant that staff did not always take the correct action in relation to people’s health needs.

Appropriate recruitment checks took place before staff started work and there were enough staff available to meet people's needs. However, the registered manager did not always assess information staff had shared which may affect their ability to carry out their roles.

The home was well equipped, clean and tidy and good infection control practices were being followed.

People and relatives spoke positively about staff and the registered manager. People's care and support needs were met by staff who knew them well and enjoyed working with them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 17 January 2019).

Why we inspected

We received concerns in relation to the environment of the service, the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for K Lodge on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safety and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to notify CQC of incidents which occurred in the service during the course of, or as a consequence of, the delivery of regulated activity. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

K Lodge is a residential care home situated in Rushden, Northamptonshire. The home provides accommodation and personal care for up to 40 older and younger adults, including people with learning and physical disabilities and people living with dementia. On the day of our inspection 32 people were using the service.

At the last Care Quality Commission (CQC) inspection, the service was rated Good in all domains.

At this inspection we found the ratings under ‘Safe’ had changed to requires improvement. The overall rating remains Good.

Policies and procedures were in place for controlling the risks of infection. However, arrangements for keeping the home in a clean and hygienic state did not always follow best practice infection control guidance. At weekends care staff were required to attend to cleaning and laundry tasks. This had the potential to overstretch care staff, and negatively impact the quality of care provided for people and diminish standards of hygiene throughout the service. Following the inspection, the provider arranged for housekeeping staff to work weekends and confirmed they were recruiting an additional member of care staff to ensure sufficient cover was provided during evenings and weekends. The changes to the staffing arrangements now need embedding into practice.

People were encouraged to personalise their bedrooms. There was an on-going programme of refurbishment of the premises including the replacement of worn fittings and furnishings. The service provided care for people living with advanced dementia and visual impairments. The environment lacked features to help people negotiate the environment, to aid remaining capacity, and enable people to independently orientate themselves around the building.

We have made a recommendation about the provider seeking information on creating dementia friendly environments, based on current best practice.

Since the last inspection a new registered manager had been appointed and their application to register with the Care Quality Commission was completed in September 2018. 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.

Staff received training to enable them to recognise signs and symptoms of abuse and they knew how to report abuse. People had risk assessments in place that were regularly reviewed. Accidents and incidents were closely monitored and when things had gone wrong lessons were learned and communicated to staff to further improve people’s safety and welfare. People’s medicines were safely managed.

Effective recruitment processes were practiced, and staff received induction training and on-going training. The staff received support through regular supervision meetings and team meetings.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people. People were supported to maintain good health and nutrition.

People had positive relationships with staff. The staff were caring and treated people with respect, kindness and courtesy. They knew people well, and where people had the capacity they are involved in the planning of their care and support.

Care plans were developed with people and their families, to identify what support they required and how they wanted their care to be provided. People participate in activities to keep them active and entertained. People knew how to complain and there was a complaints procedure in place which was accessible to all. The provider took prompt action to address any concerns and make improvements to the service as and when required.

The provider was aware of the legal requirement to display the rating from the last inspection. It is a legal requirement that a provider’s latest CQC inspection rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We saw the rating from the last inspection was displayed within the service and on the provider website.

People continued to receive care that was safe. We saw that staff had been appropriately recruited in to the service and security checks had taken place. There was enough staff to provide care and support to people to meet their needs. People were consistently protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on-going professional development that they required to work effectively in their roles. People were supported to maintain good health and nutrition.

People told us their relationships with staff were positive and caring. We saw that staff treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. People knew how to raise a concern or make a complaint and were confident that if they did, the management would respond to them appropriately. The provider had implemented effective systems to manage any complaints that they may receive.

The service had a positive ethos and an open and honest culture. The registered manager and the care manager were present and visible within the home. People, their relatives and other professionals told us that they had confidence in the management to provide consistently high quality managerial oversight and leadership to the home.

We carried out our unannounced comprehensive inspection on 11 August 2015. After that inspection, we had received concerns in relation to the care people were receiving. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for K Lodge on our website at www.cqc.org.uk”.

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 2008 and associated Regulations about how the service is run.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People felt that they were able to develop positive relationships with staff members.

People were involved in their own care planning and were able to contribute to the way in which they were supported. Care plans reflected people's individual likes, dislikes, personal history and preferences.

The staff responded to people's individual needs, as and when required. People received the care and support they needed in a timely manner.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it and were confident that they would be responded to in a prompt manner.

This inspection was carried out in response to these concerns.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were being cared for in an environment which was clean and hygienic. People's needs had been assessed on admission to the home and risk assessments were in place.

Is the service effective?

It was clear from our observations that staff had a good understanding of the needs of the people who used the service. We found that care plans were written in a 'person centred' style which reflected people's personal needs and preferences.

Is the service caring?

One person who used the service told us 'They are very nice girls; you can have a laugh with them'. We observed positive interactions between staff and people who used the service. Staff showed patience and understanding and encouraged people to be as independent as possible.

Is the service responsive?

People's care plans were reviewed and updated monthly or more regularly if required.

Is the service well led?

Records showed that staff had attended training and were supported with regular supervisions by the manager. There was a registered manager in post.

People who used the service told us that they were well looked after and happy with the service received. They were positive about the staff that supported them.

We found that staff were attentive and had a caring attitude towards the people who used the service. One visitor we spoke with said, 'My relative receives care with love and affection, they treat all residents like family.'

The care records we looked at showed that people had been assessed before they began to use the service. People who used the service had a care plan in place which described the support they needed and how care staff would provide this support.

Care staff received the support they needed to enable them to meet the needs of the people who used the service. One staff member we spoke with said, 'The management is very supportive of our training needs. I have just commenced a nine month training course that will lead to a diploma in dementia care.'

There were systems in place to monitor the quality of the service.

At the time of this visit the provider told us that they had stopped providing domiciliary care service and supported living service to people that lived in their own homes although they were registered to provider this service. We have asked the provide to deregister this service with the CQC if they no longer intend to provide this service.