Background to this inspection
Updated
26 July 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
The first day of the inspection was carried out by two inspectors. The second day of the inspection was carried out by an inspection manager and one inspector.
Service and service type:
Garlinge Lodge Residential Home is a care home. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was also the provider of the service.
Notice of inspection:
The first day of the inspection was unannounced. We told the registered manager we would be returning for the second day.
What we did:
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed the information we held about the service including previous inspection reports. We also looked at notifications about important events that had taken place in the service, which the provider is required to tell us by law. We used all this information to plan our inspection.
We spent time with each person living at the service. We received feedback from four people. We spoke with six people’s relatives. Some people were not able to verbally express their experiences of living at the service. We observed staff interactions with people and observed care and support in communal areas.
We contacted health and social care professionals to obtain feedback about their experience of the service. These professionals included local authority commissioners and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. We received feedback from the local authority commissioners. The local authority told us there had been some telephone contact with the provider in the last year. The provider had advised the local authority that they had closed one floor of the service due to staff recruitment and retention difficulties.
We spoke with nine staff including; the cook, the housekeeper, care staff, senior care staff and the registered manager.
We looked at four people’s personal records, care plans and people’s medicines charts, risk assessments, staff rotas, policies and procedures and other management records including audits.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with contractors to check the information we had been supplied was accurate. We asked the registered manager to send us additional information after the inspection. We asked for copies of the staff training matrix, telephone numbers and servicing records. These were not received in a timely manner.
Updated
26 July 2019
About the service
Garlinge Lodge Residential Home is a small residential care home providing personal care to eight older people. The service can support up to 14 people.
People’s experience of using this service and what we found
Relatives we spoke with felt staff knew people well and understood their care and support needs. People appeared happy and content. They smiled and interacted well with staff and each other. People had formed friendships and saw the service as their home.
Risks to people’s health and welfare had not been assessed. People were at risk or harm because the provider had not adequately maintained the building to ensure it was fit for purpose. The fire alarm system, emergency lights, the lift, electrical equipment and gas equipment had not been serviced and monitored. The lift was faulty which increased the risks to people and staff. People were at risk of developing Legionnaires disease because the systems and processes in place to reduce the risks were not suitable.
Systems in place to check the quality of the service were not robust. The provider had not identified the concerns we raised in relation to risk management, the environment, mental capacity assessments, dignity and respect and providing care and treatment to meet people’s needs and preferences.
Not all accidents and incidents were recorded. Processes and systems to analyse incidents and accidents for trends or lessons learned had not been developed.
People liked the staff. Staff knew people well and treated them with kindness, dignity and respect. The provider had not always treated people with dignity and respect as they had failed to improve the service.
People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; however, the policies and systems in the service did not always support this practice. Mental capacity assessments were inconsistent and did not always follow the Mental Capacity Act 2005. Assessments made were not decision specific.
Although care plans were in place to describe the care and support people needed, they did not always include some important information individual to the person and failed to provide guidance to staff on how to meet their emotional needs. Activities offered to people were minimal; activities took place for one hour four days a week.
There were not enough staff deployed on shift at all times to ensure people’s care needs were met.
Staff had not always received appropriate training, induction and supervision. No new staff had been recruited since our last inspection.
Infection control practice within the service required improvement. We made a recommendation about this.
Medicines were stored, managed and administered safely. PRN (as and when required medicines) protocols were not in place to detail how people communicated pain, why they needed the medicine and what the maximum dosages were. This is an area for improvement.
Assessments were in people’s care records for various areas such as medicine, dependency, and nutrition. However, the provider was unable to tell us how assessments had translated to the care provided. This was an area for improvement.
People were not always given information in a way they could understand. We made a recommendation about this. People told us that they did not feel confident to raise concerns. A complaints policy was in place which was displayed in the service. The policy was not displayed at a height where it would be visible, and it was not in an accessible format.
Staff and the registered manager understood their responsibility to protect people from abuse. Staff spoken with could explain how any suspected abuse would be reported.
People received access to healthcare professionals.
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 at a comprehensive inspection which was carried out on 20 November 2018 (published 31 January 2019). The service received a focused, shorter, inspection on 20 February 2019 (published 19 March 2019) which showed there had been an improvement to the Safe domain but the overall rating remained as requires improvement.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. They told us they would make the improvements by 21 May 2019.
At this inspection we found improvements had not been made, the service had deteriorated and the provider was still in breach of multiple regulations. This service has not reached a rating of good for the last five consecutive inspections.
Why we inspected
The inspection was prompted in part due to concerns received about people’s safety because of the staffing levels at the service and training provided to staff. A decision was made for us to inspect and examine those risks.
We found evidence that the provider needs to make improvements to the whole service. You can see what action we have asked the provider to take at the end of this full report. The overall rating for the service has deteriorated to Inadequate. This is based on the findings at this inspection.
Enforcement
At this inspection we have identified seven breaches in relation to; person centred care, dignity and respect, need for consent, safe care and treatment, premises and equipment, good governance and staffing.
Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We planned to meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We also planned to work with the local authority to monitor progress and return to visit as per our re-inspection programme. However, the provider has closed the service and applied to cancel their registration.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.