Archived: Fitzroy Lodge

Fitzroy Lodge is a residential care home providing accommodation and personal care for up to 24 people in one adapted building. The service provides support for people living with a range of health care needs, including people living with dementia. There were no people living at the home on the day of our inspection.

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

There were no people living at the home at the time of the inspection. We found that the provider was undertaking extensive redevelopment and improvements to the décor and safety systems within the home. Due to the scope of the work being completed, the premises were, at the time of the inspection, not fit to operate and safely provide care and support to people. Risks posed by the environmental changes had not fully been considered when the home had supported a person. This put the person at risk. Redecoration and redevelopment did not allow effective and essential cleaning to be completed throughout or ensure that the whole environment was of a hygienic standard to safely support people.

The provider was taking action to make essential changes to the environment to allow people who may be admitted to receive safe support.

The provider had recruited a new manager to the home. They were being supported in their role by the provider and an independent care consultant to improve and develop quality assurance systems.

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 inadequate. (published 22 February 2022)

This service has been in Special Measures since 22 February 2022. As we carried out a targeted inspection, we only looked at part of the key questions within the safe, effective and well-led domains. The ratings of the key questions have not been changed and the service remains in special measures.

Why we inspected

At the last inspection, we found a high number of serious concerns and raised safeguarding alerts for people with the local authority, while the police also undertook an investigation. Due to the high level of safeguarding concerns, the local authority undertook urgent and immediate reviews of people’s care. During the inspection, CQC issued an urgent notice of decision (NOD) to suspend the service. As a result, a decision was taken, in conjunction with the local authority and the provider, to move all people out of the home

Although the suspension on the service ended on 21 February 2022, CQC has since received information from the provider that they had admitted a person to the home following the lifting off the suspension. Immediately prior to our visit to the home, the service confirmed that the person who had been admitted for a period of respite was no longer at the home.

Due to serious concerns raised at the last inspection about the safe management of the environment, together with whistleblowing concerns received by CQC, we made a decision to undertake this targeted inspection to check on the suitability of the premises and whether the provider was fit to operate. We checked that the person’s needs had been assessed prior to their admission, and that they had received safe support during their stay. We also checked whether staff had been recruited appropriately and that they had the skills to support people.

CQC use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 Fitzroy Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

Follow up

The overall rating for this service remains ‘Inadequate’ and the service remains in ‘special measures’. The rating of home has not been changed, as we have only looked at part of the key questions we had specific concerns about. 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.

Fitzroy Lodge is a residential care home providing accommodation and personal care for up to 24 people in one adapted building. The service provides support for people living with a range of health care needs, including people living with dementia. There were 15 people living at the home on the first day of our inspection, this had reduced to 11 people on the third day of our inspection because some people had moved to other services.

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

There were wide spread concerns about the quality and safety of the service. People were at risk of abuse and neglect. Staff did not recognise or respond appropriately to signs of potential abuse. We raised safeguarding alerts for people with the local authority who took immediate action to make people safe and a police investigation began.

There were widespread failings in the management of the service. The provider did not have effective systems in place to ensure they retained oversight of the service and this had allowed a closed culture to develop. We took urgent action to impose conditions on the provider’s registration to address management issues.

Risks to people were not always assessed and monitored effectively and people were at risk of harm. Some people were at risk of choking but were not receiving the support they needed. Risk assessments and care plans were not comprehensive. Some people had health conditions and the impact and associated risks had not been considered. This meant that staff did not have all the information they needed to provide safe, effective care in a personalised way. The provider was relying on the use of agency staff who did not know people well, this increased the risks to people. There were not always enough suitable staff deployed to support people’s needs.

Systems for managing medicines were not effective. There were not always staff on duty who were trained and competent to administer medicines. Records relating to medicine administration and disposal of medicines were not accurate. This meant the provider was not able to account for some medicines. People were prescribed creams for skin conditions, but these were not being consistently applied and some people had developed sore and itchy skin as a result.

Infection prevention and control measures were not effectively managed. Staff were not clear about testing arrangements for COVID 19 and the lack of records meant that the provider could not be assured that tests had been completed consistently. There was no system in place to check the COVID status of staff before they came into contact with people and other staff in the building. The poor condition of the environment throughout the property meant that it was difficult to ensure cleanliness was maintained.

People were not always receiving the support they needed with food and drinks. Several people had unplanned weight loss but there was no record of actions taken to address these concerns. Record keeping was inconsistent, and this meant the provider could not be assured that people were receiving the food and fluids they needed. The quality of food was poor with mainly frozen food and a lack of fresh fruit and vegetables.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good practice. Some people had conditions placed on their authorisation to deprive them of their liberty. There was no system in place to ensure these conditions were met and staff did not know or understand their responsibilities to comply with these conditions. Records did not identify that people had consented to restrictions or how decisions were made in people’s best interest if they lacked capacity.

Most people and relatives said staff were caring and they liked them. However, some people told us staff were not always kind to them. A person told us how a staff member, “Told them off,” and described them as being unpredictable saying, “They are alright sometimes, if they are in a good mood.” A relative raised concerns about how staff spoke to people and to them. Not all staff knew people well and some staff did not support people’s dignity. The language used in daily records suggested a culture where people were not always respected, and their needs were not well understood.

People were not receiving care and support in a personalised way. Staff did not know people well and care plans did not provide enough detail to enable staff to care for people in a personalised way. Staff were not always responsive to changes in people’s needs. There were few opportunities for social stimulation. One person told us they spent their time waiting for their family to visit. Complaints from people or their relatives were not always recorded and addressed.

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 (published 1 October 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 enough improvement had not been made and the provider was still in breach of regulations. The rating for the service has deteriorated to inadequate.

Why we inspected

The inspection was prompted due to concerns received in relation to safeguarding people, and the management of the home. A decision was made for us to inspect and examine those risks. 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.

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 multiple breaches at this inspection in relation to people’s safety and well-being, management of risks, food and drink, seeking consent, staffing, treating people with dignity and respect and the management and oversight of the service. We took urgent action to ensure people’s safety.

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

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.

Fitzroy Lodge is a residential care home providing accommodation and personal care for up to 24 people in one adapted building. The service provides support for people living with a range of health care needs, including people living with dementia. There were 22 people living at the home at the time of our inspection

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

People were not always protected from avoidable harm; medicine administration was not consistently managed safely in accordance with the provider’s policy. Although the service had not experienced an outbreak, infection prevention and control (IPC) guidelines were not always followed to protect people from the COVID-19 pandemic. Recruitment processes were not in line with the provider’s policy and best practice.

The provider did not always understand their legal obligation to send notifications to CQC of alleged safeguarding incidents within the service as they are required to do.

Staff received safeguarding training and demonstrated their responsibilities in relation to reporting concerns internally or to the local authority. People told us they felt safe, one person said, “I feel safe, when I was at my flat, I had lots of falls, I wasn’t eating properly, it wasn’t great but it is now.”

People were supported by caring staff, one staff member told us, “I like talking to the residents as I'm going around, I pay a lot attention to them. We look at photos and talk about their histories.” When asked what they enjoyed the most about working at Fitzroy Lodge, one staff member said, “It’s the residents, they are all different.”

People were supported to make decisions and were asked for feedback on the service. One person told us, "Staff are brilliant. The staff know how many sugars people have, if they like their tea milky etc. but always ask too.” One person described how they enjoyed being taken to the seafront by staff for a coffee.

Quality assurance systems and processes were in place and where internal audits highlighted areas for improvement, action plans had been created.

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

The last rating for this service was good (published 21 July 2018).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of infection prevention and control practices, care provision and the previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This enabled us to look at the concerns raised and review the previous ratings.

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.

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 safe care and treatment, staffing, good governance and notifying of other incidents at this inspection.

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

Follow up

We will request an action plan from 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.

Risks associated with people’s care, the environment and equipment had been identified and managed. A planned schedule of maintenance, improvement and additional work was carried out as necessary. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People’s care was enhanced by adaptations made to the service. People were cared for in a clean and hygienic environment and appropriate procedures for infection control were in place.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. Notifiable events and actions had been reported to the CQC in a timely manner.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included, bingo, arts and crafts, trips into town and themed events, such as karaoke, massage therapy and visits from external entertainers. However, feedback from people was not routinely positive in relation to the activities on offer. We have made recommendations about the provider seeking guidance in relation to the provision of meaningful and person centered activities, and about systems being implemented to comply with the Accessible Information Standards (AIS).

A registered manager was 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.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as the treatment of specific infections and palliative care (end of life).

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. Staff had received supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

There were visits from local churches, so that people could observe their faith and people were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views and said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where the registered manager was always available to discuss suggestions and address problems or concerns.

Fitzroy Lodge is registered to provide residential care for up to 24 older people who may be living with dementia. At the time of our inspection, there were 19 people living at the home. The home is located in a residential area of Worthing close to the seafront. There was one lounge, another small sitting area and a separate dining room. A passenger lift provided access between the floors. On the ground floor was a private room, which was used when the hairdresser visited on a weekly basis. We also observed another seating area along the hallway on the first floor where people could rest and where dementia friendly activities were placed for people to engage in. People had their own rooms and had access to a large garden at the rear of the property, which had a summer building, named the ‘café’. The manager told us this is where people could relax, look out over the garden and have their drinks. The home was previously inspected on 24 February 2015 and no concerns were identified.

A new manager was appointed in April 2017. They had submitted an application form to the Care Quality Commission to be registered as a manager. Since our visit, they have been successfully registered with the Commission. 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.

We found that the systems in place to reduce risks associated with the environment were not always suitable for purpose or properly maintained and this exposed people to the risk of harm. Some rooms did not have working fire detectors; there was inadequate compartmentation between rooms that would result in a fire spreading. We contacted the West Sussex Fire and Rescue Service to report our concerns. A Fire and Rescue Inspector carried out an inspection on 28 July 2017, following this inspection a representative from West Sussex Fire and Rescue told us, the provider was in the process of working on recommendations made to make the building safe. These included ensuring areas of the building were made more fire resistant. The provider was informed a further visit from West Sussex Fire and Rescue would occur during or after November 2017 to ensure that the deficiencies found had been acted on and resolved. People told us and the staff confirmed that the majority of people preferred to use a shower, rather than a bath. However, out of the three showers available, the manager told us only one was in working order. We found that the one in working order was not suitable for purpose. This meant there were not a sufficient amount of bathrooms for the number of people using the service. We also found that radiator coverings were not fixed to the walls as intended, which could result in a person being injured. The bathroom and toilet facilities were not clean or properly maintained. People told us and staff confirmed they were unpleasant to use. Since the inspection the provider submitted sufficient evidence that demonstrated the bathroom, shower and toilet facilities had been refurbished and were in working order. The door from the laundry room was also unable to lock which meant the building was not secure. This meant people’s personal safety was not protected. Since the inspection the provider offered assurances that the laundry room door has been repaired.

Risk assessments and management plans were not always sufficiently well developed to mitigate or manage risk. We found the fire risk assessment was out of date and arrangements relating to how people would be supported to evacuate in the event of a fire were not sufficient and people were at risk in the event of an emergency. We also shared this with the West Sussex Fire and Rescue Service. One person who used a bed rail to protect them from falling from bed did not have a full risk assessment in place regarding its use. Risks to people's well-being such as falls, mobility, malnutrition, moving and handling or skin damage were identified and recorded. However safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced.

Staff were trained and understood the actions required to keep people safe. People had been safeguarded against the risk of abuse by staff who took prompt action if they suspected people were at risk of harm. However the provider had failed to notify CQC and the local safeguarding team of an allegation of abuse that had been made.

The systems to check the safety and quality of the service had not been properly utilised and as a result, opportunities to identify and address areas for improvement had been missed. We found that the lack of audits and gaps in records had impacted on the safety of the service people received.

All staff had a good understanding of the implications and requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards. Appropriate Deprivation of Liberty Safeguards (DoLS) had been made by the service; however conditions applied to DoLS had not always been met.

The colours and décor of the home did not always support people living with dementia to orient themselves in their surroundings. For example there was no clear signage indicating which room people were entering. The use of pictures of people and/or their interests would help them orientate themselves with their surroundings. As a result of our feedback the provider took action in the days following our visit and put this in place. The provider supplied us with photos of these actions taken. However, we will not be able to confirm if sufficient action has been taken until we next inspect the home. We did observe there were objects placed around the home for people to pick up and engage with. We observed people walking around with various items that were of interest to them, such as knitted items, which some people enjoyed holding and putting on.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

There were sufficient staff in place to meet people's needs, the manager used a dependency tool employed by the provider to assess staffing levels were based on people's needs, were up to date and reviewed monthly. Robust recruitment practices ensured that new staff were vetted appropriately and checks were undertaken to confirm they were safe to work in a caring profession.

Staff received an induction into the service and senior staff checked competencies in a range of areas. Staff had received a range of training and many had achieved or were working towards a National Vocational Qualification (NVQ) or more recently Health and Social Care Diplomas (HSCD). Staff received formal supervision and annual appraisals from the manager.

People looked comfortable and happy moving around the home, some people stopping for rests or a nap, other people enjoyed having a late breakfast, doing a crossword or reading the newspaper. Staff were always visible to interact or sit with people. Staff said it was important they were also involved in ensuring people had something to do or someone to talk with.

People had sufficient to eat and drink and were supported by staff to maintain a healthy diet. Observations of meal times showed these to be a positive experience, with people being supported to eat a meal of their choice and where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom.

People were well cared for and treated in a respectful way. People were involved in planning and reviewing their care as much as they could, for example in deciding smaller choices such as what drink they would like or what clothes to wear. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on and listening to people's stories.

People's privacy was respected. Staff ensured people kept in touch with family and friends. Two relatives told us they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private.

People were assessed before coming to live at Fitzroy Lodge. People's care files gave details of the level of support required and people's wishes and choices. The service responded to people's changing needs. People and their families were involved in their care planning and reviews.

There was organised activities available. People were engaged in these activities in a meaningful way and told us they enjoyed what was on offer.

Complaints were listened to and managed in line with the provider's policy. Relatives told us that they felt welcomed at the service and people and relatives said that they would be confident to make a complaint or raise any concerns if they needed to.

People and their relatives were involved in developing the service through meetings. People, relatives, healthcare professionals connected to the service and staff were asked for their feedback in annual surveys. All responses were positive from the recent quality assurance questionnaire. People's views were acted upon where possible and practical. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them. Staff felt

On the day of our inspection, we were told that there were fourteen people who lived at the service. The manager told us that some bedrooms were being refurbished after recent storm damage. They also told us that no-one was cared for in bed, however, we observed one person who received support to eat their lunch in bed.

Care plans showed that comprehensive risk assessments had been completed and that these had been reviewed on a regular basis. One person told us that they had a relative who had lived there and, 'Although bedridden at the end', had 'generally good care'.

We spoke with staff who described the training they had received which enabled them to care for people at the service safely and effectively. One member of staff told us, 'I get all the training I need.'

The provider had arrangements in place to monitor the quality and safety of the service provided.

One person who used the service told us that, 'It's very good here' and that, 'They wouldn't change anything'.

We found that the home and grounds were clean and tidy. Areas which had previously posed infection control risks had been cleaned appropriately. In addition the home had implemented new checks and records related to cleaning and infection control which evidenced their compliance.

We saw that medicines were stored safely and in accordance with legislative requirements and best practices.

We used a number of different methods to help us understand the experiences of people using the service, because many of the people who used the service had complex needs which meant they were not able to tell us their experiences.

This included Short Observational Framework Investigations (SOFI) which involves observing the interactions between people who live in the home and the staff caring for them. This is a useful tool to assess the quality of care and interactions that occur in the home. We undertook SOFI observations during lunch time. The majority of people appeared to enjoy their meal however there was little interaction between the staff and the people who lived in the home. For example we observed one member of staff assisted a person with their meal quietly at a relaxed pace, smiling and encouraging them; whist another member of staff ed spoke over the person and did not engage or interact with them at all. We found that staff skills in caring for people with dementia varied and not all staff provided positive support to the people with minimal eye contact and little conversation.

We found that since our last inspection a new manager had been appointed. Many of the issues identified at the previous inspection were either in the process of being addressed or had been actioned. For example the care plans and records had all been updated, more staff had been employed and a programme of training was underway to ensure they had the skills to provide care and support to elderly people with Dementia.

However we identified further concerns relating to the safe administration of medicines and poor infection control practices.

We found that although people praised the kindness and dedication of the staff, their care and treatment did not always meet their needs. One person told us 'The staff are usually quite nice; they are willing to help you most times'. There was no evidence to support that staff were trained and supported to look after the people in the home. The home did not support people to engage in meaningful activities. We found that the quality of records and record keeping was poor.

During our tour of the home we noted the worn furniture and fixtures which presented a health and safety risk and did not provide a therapeutic environment for the people living in the home. The lift was broken and we were told had out of action for several weeks. We found there was a lack of hot water in many areas of the home meaning that people were unable to bath and have their hygiene needs met.

There was no evidence that the home had a robust Quality Assurance system in place to monitor, evaluate and improve the care and service provided.