White Lodge & St Helens

White lodge and St Helens is a residential care home providing personal care for up to 55 people aged 65 and over. At the time of the inspection there were 54 people living at the home. The service does not provide nursing care.

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

Staff spoke knowledgably about how to identify and report potential abuse. Staff were recruited safely with the service ensuring all necessary identity checks were completed before staff commenced their employment. The provider was running an ongoing recruitment programme for staff. There were adequate levels of staff available on each shift to ensure people were cared for safely.

Medicines were managed, stored and administered safely. People were supported to take their medicines safely by staff who had received the appropriate levels of training. A programme of medicine competency checks was in the process of being re-introduced.

People and their relatives told us they or their loved one enjoyed living at White Lodge and St Helens. They felt safe and received a good level of care and support. People were relaxed and comfortable with staff who knew them well and supported them in ways they preferred.

There was a clear risk assessment system in place. Risks to people’s health, safety and well-being were regularly assessed, reviewed and updated. Where appropriate, people and their families were included and involved in their care and 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.

There was an effective governance system in place. There were a variety of audits, policies, systems and procedures to monitor the quality and safety of the service. These ensured a culture of continuous improvement and learning took place and highlighted any potential shortfalls.

People, relatives and staff felt the service was well led. Staff spoke positively regarding the registered manager and the management team and felt well supported within their roles.

The service worked closely with a variety of health and social care professionals to ensure people received timely and effective care and support.

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 11 July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained at good based on the findings of 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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for White Lodge & St Helens 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.

White Lodge and St Helens is registered to provide accommodation, care and support for up to 54 people. 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.

There was a registered manager 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.

Our previous inspection of the home, carried out in February 2017 identified some areas where improvements were required. These included staffing levels and quality assurance systems. At this inspection we found the provider had made a large number of improvements to ensure compliance with the regulations. These improvements included an increase in staffing levels, an increase in the amount and type of activities available for all people and they had implemented a range of quality assurance systems to ensure the shortfalls previously identified were addressed.

People told us they were well cared for and said they felt safe living at the home. Staff were aware of what constituted abuse and the actions they should take if they suspected abuse. Relevant checks were undertaken before new staff started working at the service which ensured they were safe to work with vulnerable adults.

Staff had the right skills and training to support people appropriately. Staff had completed or were in the process of completing The Care Certificate, which is a nationally recognised set of standards for health and social care workers.

People told us and records and observations showed us there were enough staff available on each shift to care for people safely and well. Staff felt well supported by the management team and received regular supervision sessions. Staff told us they worked well as a team, they told us, “We work like one big family. It works well.”

Pre-admission assessments were completed prior to people moving into the home. People’s risks were assessed and plans developed to ensure care was provided safely. Accidents and incidents were monitored to ensure any trends were identified to enable action to be taken to safeguard people.

Medicines were handled appropriately and stored securely. Improvements were made during the inspection to ensure people had their medicines administered safely. Medicine Administration Records (MAR) were signed to indicate people’s prescribed medicine had been given.

People were referred to health care professionals as required. If people needed additional equipment to help them mobilise and keep them safe and comfortable this was readily available.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely. Staff had an understanding of the Mental Capacity Act 2005 (2005) and how it applied to their work.

Staff ensured people’s privacy and dignity was protected. People received personalised care from staff who were responsive to their needs and knew them well. Staff created a relaxed, friendly atmosphere which resulted in a calm, open and honest culture in the home.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries. The provider sought feedback from people and changes were made if required.

People told us they felt the service was well led, with a clear management structure in place. Relatives told us they were always made to feel welcome at any time and felt fully involved and consulted in the care of their relative.

There were improved systems in place to drive the improvement of the safety and quality of the service.

At the last inspection in April 2015, the service was rated Good. At this inspection we found the service had deteriorated to an overall rating of requires improvement.

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.

Some staff supported people in a caring person centred way whilst other staff were rushed or lacked person centred skills with people. Staff all told us they wanted to do the best job they could for the people they supported. However, the staffing levels at the time of the inspection were insufficient for people’s needs to be fully met in a caring and unhurried way.

At the time of the inspection the registered persons had not ensured the service people received was safe, effective or caring. We have made a requirement because the registered persons had not assessed, monitored and improved the experiences of people, as the needs of people living at the home had increased over time.

People told us they felt staff had the right skills and that they were supported to receive the health care they required. We saw mealtimes were a social occasion for some people and people told us they enjoyed the meals.

People’s needs were assessed and planned for. Care plans described the support or help people wanted or needed. They were regularly reviewed and updated to make sure staff had the right guidance. People were supported to access healthcare support when they needed to and medicines were managed safely. End of life care planning ensured a sensitive approach that acted upon people’s wishes and preferences.

There was a complaints system and other systems in place to make sure the environment, recruitment of staff, and medicines management were safe.

There were 49 people living in the home on the day of our unannounced inspection and we spoke with seven of them. The registered manager was not available during the inspection; however the provider had arranged suitable cover.

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 want to see the evidence that supports our summary please read the full report.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Where a need was identified a plan was in place to meet this need. For example, one person was cared for in bed and was at risk of falling from their bed and injuring themselves. We saw that the provider had installed bedrails after seeking the person's consent to ensure their safety and welfare.

The three people we pathway tracked had up-to-date risk assessments in place. The identified risks were addressed in people's care plans, which contained guidance on how to manage the risks safely.

People using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. We saw that staff spoke with people respectfully and that people looked relaxed with staff. All of the people that we spoke with told us that they felt safe in the home. We spoke with two members of staff who understood their responsibility to safeguard vulnerable adults. They received training about safeguarding vulnerable adults when they started working at the home and this was updated periodically.

People using the service were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements. We saw assessments had been completed in line with the requirements of the Mental Capacity Act 2005 to ensure this was in the person's best interest and was used the least restrictive measure possible.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. One application had been submitted; however the provider explained that due to the recent Supreme Court ruling, they were in the process of preparing DoLS applications to submit to the local authority. The provider had a policy and relevant staff understood how an application should be made.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their care plans. We spoke with seven people, who expressed positive views about their care. For example, one person said, "I have lived here a couple of years, it's very good here, they are very attentive." Another person told us "It's fine; we have a very good manager here." The care plans we saw were organised and contained clear instructions for staff to follow and staff were familiar with people's care plans and their particular needs. We observed that staff followed people's care plans and relevant records showed people received support in line with their care plans.

Is the service caring?

People were treated with consideration and respect and their privacy was maintained. We spoke with seven people. One person told us, "They are very kind and caring." Another person said, "They are nice and polite."

Staff communicated with people in a sensitive and considerate manner. For example, during the lunchtime meal we observed one person who was going to eat one of the condiments that staff had laid out. We saw a member of staff recognise this and sensitively explain to the person that it was not the meal. During another observation another person become upset, we saw a member of staff approach the person, comfort them and offer them a warm drink.

Is the service responsive?

People accessed the services of healthcare professionals as required. One person told us, "I get to see the doctor if I am feeling unwell, the chiropodist is booked to see me today." Records of visits from healthcare professionals were kept. For example, we found that visits from chiropodists, district nurses, opticians and GPs were documented.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of service that people receive. People who use the service, their representatives and staff were asked for their views about their care and treatment and these were acted on. The home's management ensured they tried to seek people's views on their care. They also kept in contact with people's families, seeking their views and involving them in people's care.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Learning from incidents took place and appropriate changes were implemented. There was a system of regular quality assurance checks, which also helped the provider to identify and manage safety hazards.

At this unannounced inspection we spoke with the manager, five members of staff, one relative and seven people who used the service.

All of the people and relatives we spoke with expressed satisfaction with the service provided. People told us that staff were "lovely". One person said "I have lived in a few care homes; this one is definitely the best". A visitor told us that they had "no concerns" about the care provided for their relative.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were protected from the risks of inadequate nutrition and dehydration.

People were cared for in a clean, hygienic environment.

The provider had systems for reviewing and monitoring the quality of service provided to people, but these had not always been implemented effectively to ensure that people were not at risk of unsafe or inappropriate care.

People living at White Lodge & St Helens were very positive about their experience of living at the home. No one had any complaints or concerns about how the home was run and managed.

People told us that they had good relationships with the staff, who were described as 'kind and respectful'. They told us that the home was kept clean and warm. People said there were activities to keep them occupied.

People told us that they were involved in decisions about how they were looked after and that they could choose how they wished to spend their day.

People who lived at White Lodge & St Helens benefited from thorough processes and procedures being followed when new staff were recruited, which meant they were protected from harm.

Medicines were prescribed and given to people appropriately.

We saw the home had a robust quality assurance system in place to ensure standards in the home were maintained.