• Care Home
  • Care home

Archived: Carey Lodge

Overall: Inadequate read more about inspection ratings

Church Street, Wing, Buckinghamshire, LU7 0NY (01296) 689870

Provided and run by:
The Fremantle Trust

Latest inspection summary

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Background to this inspection

Updated 11 December 2021

The inspection

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors on day one and two inspectors and an inspection manager on day two. On day one the inspection the team was joined by an Expert by Experience, the day after the first day of the inspection another Expert by Experience made telephone calls to people’s relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Carey Lodge is a ‘care home’. 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.

The service did not have a manager registered with the Care Quality Commission. The provider was legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. 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 used all of this information to plan our inspection.

During the inspection

We spoke with 14 people during the inspection and contacted six relatives by telephone, to seek their views about standards of care. We spoke with 16 members of staff including the manager, operations manager two deputy managers, team leaders, support staff and staff responsible for activities and administration staff. We spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with the chief executive who had visited the service to meet with us on day two of the inspection.

We reviewed a range of records whilst on site and requested some to be sent to us. This included 25 people’s care records, some in part to look at specific areas. We looked at 14 people’s medicines records. We looked at five staff files in relation to recruitment and staff supervision. We looked at a range of records relating to the management of the service, these included, health and safety records related to fire checks and certificates for gas and electrical safety and incident reports. We looked at staffing rotas, staff allocation and handover records, complaints, and management audits carried out.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at records requested and sent to us from the service. We continued to seek feedback from professionals who regularly visit the service and staff. We received feedback from 15 staff who had responded to our requests for feedback.

Overall inspection

Inadequate

Updated 11 December 2021

About the service

Carey Lodge is a residential care home providing personal care and support for up to 75 older people some of whom are living with dementia. At the time of the inspection 52 people lived at the home. People's accommodation is located in six separate areas referred to as 'houses', located over three floors. Each house has individual bedrooms and communal dinning and lounge areas. The home had many seating options on each floor.

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

People were not routinely and consistently supported by a service that was well-led. People were placed at ongoing risk of harm as systems and processes were not in place to assess, mitigate and manage risk.

On day one of the inspection we had major concerns about people’s safety if a fire or emergency occurred. We found the manager and other staff could not be confident about how many people were in the building. We found records ranged from 45 to 56. An inspector was escorted around the building to carry out a physical head count of people so we could be confident who was in the building. Equipment which should be used in the event of a fire was stored inappropriately by the front door, not where is was needed on first and second floors. We found the service was ill equipped to deal with a fire, no fire grab bags were readily available. Due to the level of concern we had we made an urgent referral to Buckinghamshire Fire and Rescue Service. The fire service visited the care home following our referral. We have since been informed 11 immediate actions were identified and the fire service will be re-visiting to ensure those actions have been carried out.

People were not protected from the risk of infection. We found the home had many areas which needed cleaning or correct storage of hazardous waste. We routinely observed staff not following government guidance on the use of face masks, which put people at risk of contracting COVID-19.

We found people at risk of malnutrition and dehydration were not routinely supported to ensure their health did not deteriorate. We found people had routinely gone in excess of 12 hours without being offered any fluids. One person’s records showed they had gone 17 hours and 10 mins with no offer of a drink.

Risk assessments were completed by staff who had not received training on how to do this accurately. We found risk assessments were incomplete and failed to assess the level of harm to people. One person who was at risk of choking needed a soft diet and struggled to swallow a tablet had a risk assessment in place dated 23 July 2020. This had not been updated to reflect their current needs. One person had a sore on their back, there was no accurate risk assessment in place to prevent further deterioration in their skin.

People were not consistently supported with their prescribed medicines. Staff did not routinely have access to additional guidance on when, how and why they should administer medicine for occasional use. This put people at risk of receiving more or less than was needed to support them safely.

Records relating to people’s care and treatment were not routinely stored securely or accurate and did not always represent a complete and contemporaneous record of support provided. On day one we found confidential notes were laying on a table in a communal area. This could have been read by any unauthorised person.

People were supported by staff who had been recruited safely, but they had not always been offered or undertaken training suitable to their role. People and staff told us, and we observed the deployment of staff could have been improved. We found times when no staff member was present, and people were observed to be sitting alone in a lounge area.

The service had received complaints, these had not always been handled in line with the provider’s policy and we found some had not been acknowledged or responded to.

People were not routinely supported by staff who respected their dignity, we found staff routinely entered people’s rooms without knocking.

Systems either were not in place or were ineffective to ensure action was taken to improve people’s experience as a result of feedback. The provider had failed to ensure improvements had been made since our last inspection.

People were not routinely supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation in the report to ensure people were routinely supported in line with the Mental Capacity Act 2005.

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 24 February 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last comprehensive 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.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 and 9 January 2020. 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 safe care and treatment, compliance with the Mental Capacity Act 2005 and good governance. We issued a warning notice to ensure improvements were made. We carried out a targeted inspection on 28 and 29 October to check if the warning notice had been met. We found the provider was still in breach of regulations in the areas of safe care and treatment and good governance. Following the targeted inspection, a decision was made not to escalate any enforcement. We took into account the impact of the COVID 19 pandemic.

We undertook this focused inspection to check what action had been made since the targeted inspection and to confirm the service now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led.

The inspection was prompted in part due to concerns received about how well-led the service was and risks posed to people.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carey 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 management of risks, health and safety, deployment and support for staff, meeting people’s nutrition and hydration needs, management of complaints, good governance and meeting the requirements of notifying CQC of certain events.

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

Following the concerns we raised about the poor quality of care provided by The Fremantle Trust at Carey Lodge. The provider, The Fremantle Trust made a decision to close the care home. Carey Lodge has been removed as a registered care home.

Follow up

We will 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 will work with the 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.

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.