Archived: The Lodge Care Home

The Lodge Care Home can provide accommodation and care to a maximum of 20 older people, some of whom may be living with dementia. Due to concerns about the quality and safety of the service, the local authority was not funding placements. At the time of this inspection there were eight people living in the home.

The home is operated by a partnership, with one of the partners being the 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.

At the last full inspection of this service on 21 August 2015, we found widespread and serious issues throughout the service. The registered persons were in breach of nine regulations. We issued warning notices in respect of three of these, telling the registered persons that they must make improvements in those areas. The warning notices set out improvements that were required to staff training, person- centred care, and to systems for leadership and governance. We inspected the service again on 1 December 2015 and found that the warning notices had been complied with but we did not reassess the overall rating from 'Inadequate.'

The provider told us how they were going to improve to meet the remaining six breaches of regulations. These included protecting people from abuse, recruitment practices, safe care and treatment, and dignity and respect. Improvement was also needed because the provider had not notified us of deaths or other incidents happening in the home as required by law. At this inspection, we found that some improvements had been made. However, there remained concerns about the way the service was operating and the safety of people using it. Improvements were not always consolidated and sustained.

People's safety within the home was compromised. Risks to their welfare were not always properly assessed and mitigated. They were exposed to risks in the way the premises was operating, for example in relation to fire safety and from inadequate measures to reduce risks associated with the spread of infection. They received their medicines safely and as the prescriber intended. However, arrangements for disposing of medicines no longer needed were unsatisfactory and presented a risk of misuse or misappropriation. They were not in accordance with the provider's expected systems.

Improvements had been made to staff understanding and awareness of the risk of harm or abuse. The way that staff were recruited had improved so that there were better checks to ensure they were suitable to work in care services. People were satisfied that staff were able to attend to them promptly although there were consistent concerns from some family members that they were not always deployed appropriately.

The effectiveness of the service had improved. There were significant improvements to the training staff had received to ensure they were competent to meet people's needs. This included an improved awareness of how they needed to seek people's consent and what to do if people found it difficult to make decisions so that their best interests were taken into account. Concerns about people's health and welfare were referred to health professionals for advice but the guidance given to staff was not always consistently implemented.

Staff were aware of the importance of respecting people's dignity. However, there was a lack of consideration given to easily avoidable triggers for people experiencing distress and anxiety. Improvements had been made to the way that people's choices and preferences were taken into account in the way their care was planned and delivered. Staff made efforts to support people with their hobbies and interests. The way people's likes, dislikes and backgrounds were recorded was improving so that staff were able to engage more meaningfully with people.

Most people were experiencing a degree of memory loss and needed assistance from staff or family members to raise complaints or concerns about their care. There was a lack of confidence in family members regarding the approach of staff and the registered manager in responding openly and transparently to concerns or queries.

There was a lack of leadership within the service. The registered manager had improved some of the systems for assessing the quality and safety of the service but had not sustained these. Clearly identifiable risks to people's safety and welfare were not assessed and mitigated. They had failed, despite previous requirements, to tell us about events happening in the service as required by law. They did not have a good understanding of best practice in residential care and were struggling to maintain standards of care.

The service remained in breach of two regulations and had not sustained improvements in complying with a third one. People were still not consistently receiving safe care and treatment. The registered persons had again failed to tell us about events happening in the service. Previous improvements to systems for monitoring the quality and safety of the service were not sustained. This meant they did not effectively identify failings, manage risk and ensure prompt action to make improvements.

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.

The service people received remained 'Inadequate' in safety and leadership at this inspection. The overall rating of this service is 'Inadequate' and therefore it remains in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We have not changed the overall rating for this service as a result of this inspection, which was only to follow up our enforcement action. The service remains inadequate and in special measures. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Lodge Care Home on our website at www.cqc.org.uk

The Lodge Care Home provides accommodation and support to a maximum of 20 older people, some of whom may be living with dementia. At the time of the inspection there were 15 people using the service.

It is operated by a partnership with one of the partners being registered as manager. That person is referred to as the registered manager throughout the report. 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.

At our last inspection people were being supported by staff who had little or no training to ensure they were competent to meet people's needs. At this inspection we found that staff had completed a range of training to help them understand and meet people's needs including those people who were living with dementia.

At our last inspection people's needs and preferences were not taken into account in the way the service was delivered. Institutional routines had developed and people were being woken to get up from 3.15am. There was little opportunity for people to engage in recreational and social activities. At this inspection we found that people were not assisted to get up before 6am unless it was their expressed wish and were supported with better regard to their preferred routines. Staff were able to spend more time with people just talking or offering more activities.

The registered manager had improved the way that the quality and safety of the service was monitored and had identified where further improvements should be made.

People told us that staff respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that staff members were responsive to the needs of people and that they were given the support and attention they needed. We saw that people had a positive experience of being included in conversations, decision making and activities.

We found that plans of care were being reorganised and reviewed to ensure that they contained the information staff members needed to promote and protect the health and safety of people.

People spoken with and their relatives told us that people were safe, provided with the care and support they needed and that the staff were, 'Wonderful and kind.'

Medication was administered, recorded and stored accurately and safely.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

Quality audits were being carried out to ensure the views of people were gathered on the quality of the service provided, that people were safe and that policies and procedures were being followed.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

The plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People who used the service and their relatives told us that people received the care and support they needed and that staff were very kind.

Staff we spoke with showed us that they knew how to ensure that people were safe and how to access the information they needed to ensure people received the care and support they required.

People using the service and relatives told us that people received the care and support they needed but that sometimes there were not as many staff available as usual.

Complaints were dealt with appropriately and people were able to access and use the complaints system in a format that met their needs.