Archived: Braemar Care Centre

Victoria Lodge Residential Home provides accommodation for up to 24 older people who require personal care. It also cares for people who have a diagnosis of dementia. At the time of the inspection there were eight people using the service. The home is situated in Edenthorpe, near Doncaster.

There was a manager in post who had applied to register with the Care Quality Commission and this application was in progress at the time of the inspection. 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.

The environment was homely and welcoming. People were content in the home and staff were attentive to their needs. People had good relationships with staff who were knowledgeable about their individual needs and personal preferences. Staff promoted people’s dignity well in all interactions and were respectful when speaking with or about people.

Individual risks to people were not fully assessed and information in people’s care plans did not sufficiently illustrate how care should be managed safely.

Staff felt supported by the manager and there was evidence of training and supervision, however training was not all up to date or effective. There were only three qualified first aid trained staff altogether and this meant they were not always on duty.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff sought people’s consent for all aspects of care and support.

People enjoyed their meals and staff had an understanding of people’s nutritional needs, although risks around people's nutrition were not effectively monitored. There were snacks and drinks available throughout the day.

Activities were person-centred and meaningful to individuals and staff had a good insight into people’s backgrounds, interests and hobbies.

Care plans showed where people’s care had been discussed with other professionals and reviewed. However, documentation to support people’s care and the running of the home was not all up to date, clear or concise, which meant information was fragmented and not easy to locate.

There were continued weaknesses in the systems and processes for assuring the quality of the service and issues identified through the inspection process were not routinely picked up on within the audits.

We noted the manager and the staff team were working hard to address the concerns raised at the last inspection and they had made positive changes, particularly in relation to people’s dignity and activity provision. The manager was very responsive to matters raised at this inspection and took measures to address the issues we raised. However, there were continuing concerns at this inspection in relation to the oversight and management of risk, documentation to support people’s care and the running of the home and governance.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that although some improvements had been made, there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

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.

You can see what action we told the provider to take at the back of this report.

We have placed the service into 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.

Victoria Lodge Residential Home is a care home providing accommodation for older people who require personal care. It also accommodates people who have a diagnosis of dementia and can accommodate up to 24 people. At the time of the inspection there were ten people using the service. The service is situated in Edenthorpe near Doncaster, close to local amenities and public transport links.

The registered manager had left their post in June 2016. A new manager had been recruited in July 2016, and both the new manager and the provider gave CQC assurances that this manager would have begun their application process to register with CQC by August 2016. However, at the time of the inspection in December 2016 they had failed to commence this process. 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.

During the inspection we found that staff appeared to know people and their needs and preferences well, but failed to ensure people’s dignity and privacy was always upheld.

The provider was failing to act in accordance with the requirements of the Mental Capacity Act and was not taking the legally required steps where people lacked the capacity to consent to their care.

Peope told us they enjoyed the food at the home, but we found that food was not served or stored safely, and people’s needs in relation to food were not always met.

There was an audit system in place but it was ineffective as it did not identify shortfalls in the quality, safety or effectiveness of the service provided.

We found that the management of medicines had improved, as had the way staff supported people to move around the home, although further improvements were required.

We checked people’s care plans and risk assessments and identified that where people were at risk of harm, the provider was not taking appropriate steps to reduce the risk.

The provider ensured that people had access to external healthcare providers where required, and regularly reviewed people’s care. However, the reviews were not always effective as they didn’t effect the required changes.

We are taking enforcement action in relation to this inspection, and will report on it at a later date. Additionally, we also placed the service into 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. We imposed a condition restrict admissions to the home without the prior approval of the CQC.

The inspection in February 2016 was a focused inspection, which we undertook in response to concerns we had received about the service. During this inspection we identified concerns in relation to the safety of equipment and premises, the safety of people using the service, and found the provider did not have adequate systems in place to manage medicines safely. As this was a focused inspection which only looked at part of the service, we did not provide a rating for the service on this occasion, and the home’s overall rating therefore remained inadequate.

You can read the reports from our previous inspections, by selecting the 'all reports' link for Victoria Lodge on our website at www.cqc.org.uk

Victoria Lodge Residential Home is a care home providing accommodation for older people who require personal care. It also accommodates people who have a diagnosis of dementia and can accommodate up to 24 people. At the time of the inspection there were 12 people using the service. The service is situated in Edenthorpe near Doncaster, close to local amenities and public transport links.

The registered manager had recently left their post. However they had not cancelled their registration at the time of the inspection and therefore remained registered. A new manager had been recruited but they had not yet registered with CQC. 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.

At this inspection we found that the provider had failed to make significant improvements in the way the home was run. The provider had introduced a new system of auditing the quality of care provided. However, this was ineffective, as it did not identify shortfalls or areas of concern. The provider had described this system as “robust” and had failed to identify its inadequacies.We asked the provider to complete a Provider Information Return (PIR) before the inspection but they failed to do so. This is a form that asks the provider to give some key information about the service, what the service does well, and improvements they plan to make. The home’s most recent rating was on display in the home, but the provider had failed to add it to their website, which is a legal requirement.

Staff were kind and friendly in their approach to people, and people responded positively to this. However, records showed that people did not always receive the care they had been assessed as requiring. The mealtime we observed was a pleasant experience, where people obtained the support that they needed in a discreet and respectful manner, and appropriate equipment was provided to enable people to eat.

Staff had received updated training in moving and handling, although our observations showed that they did not always carry out these procedures in a safe manner, putting people at the risk of harm or distress. Improvements were required in the way medicines were managed; recording had improved, but medicines were not always administered when required.

We saw that there appeared to be staff in sufficient numbers to meet people’s needs. However, prior to the inspection the provider told us that they did not intend to increase staffing should the home be fully occupied. As there were only 12 people using the service at the time of the inspection, with the home having a maximum capacity of 24, this meant that the provider had not considered the dependency or needs of potential service users.

The provider had failed to ensure they obtained informed consent from people in relation to their care and treatment. Where people lacked the capacity to give informed consent, the provider did not follow appropriate procedures, as required by law.

The availability of activities had improved at the home. However, the arrangements for responding to people’s changing needs were not adequate, meaning that people’s care plans, and, accordingly, the care they received, did not always meet their needs.

We noted that some refurbishments had been carried out to the environment, including steps to make the home more dementia-friendly. However, additional work needed to be carried out as some fixtures and fittings were damaged.

This report only covers our findings in relation to the concerns. You can read the previous comprehensive report from our last inspection, by selecting the 'all reports' link for Victoria lodge on our website at www.cqc.org.uk

We undertook this focused inspection to determine people who used the service were safe and received care that was responsive to their needs. We did not look at other areas during this inspection. Changes to the overall rating will not be given at this inspection, as we have only looked at two areas. This will be reviewed at the next comprehensive inspection.

Victoria Lodge Residential Home is a care home providing accommodation for older people who require personal care. It also accommodates people who have a diagnosis of dementia and can accommodate up to 24 people over two floors, the floors are accessed by a passenger lift. The service is situated in Edenthorpe near Doncaster.

The home 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.

We found medication procedures had been improved, however we were not yet assured the Improvements had been embedded into practice and that the improvements made will be sustained. This was because at our last inspection in January 2016 we found the systems and processes to monitor the quality and safety of the service were not effective.

We found that people had care and support plans in place and these were reviewed and updated. However we identified these were not always person centred as many contained the same information. We saw risk assessments in place, but found the reviews were not always effective or accurate and staff did not always follow the care plans to ensure people’s needs were met. We also found effective care plans were not in place for people who received a respite service. This put people at risk of receiving inappropriate care that did not meet their needs

Victoria Lodge Residential Home is a care home providing accommodation for older people who require personal care. It also accommodates people who have a diagnosis of dementia and can accommodate up to 24 people over two floors, the floors are accessed by a passenger lift. The service is situated in Edenthorpe near Doncaster.

The home 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.

During this inspection we looked to see if improvements had been made since our last inspection in February and March 2015. Although some improvements had been implemented, we found these were insufficient. We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were not always enough staff deployed to meet people’s needs. People who used the service and their relatives told us this was in regard to lack of activities and stimulation during the day. They told us the care staff were too busy to be able to take people out or organise activities. We looked at the dependency tool used to calculate staffing numbers but the staffing levels at weekends remained the same as the week days and we could not see this took into account that care staff had additional duties at weekends including cleaning and laundry.

We saw recruitment procedures were in place however these were not always followed as we found not all information was available in staff files to confirm that all the required pre employment checks had been carried out. Staff received supervision, however, this was not in line with the provider’s policy and we identified some staff had not been appraised since 2012.

People were not protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines but these were not followed. The provider had systems in place to protect people from abuse and staff were aware of the procedures to follow. However, we identified some people had not received their medicines as prescribed and we made referrals to the local authority safeguarding team.

Staff we spoke with did not understand the legal requirements of the Mental Capacity Act (2005) Code of Practice and how it impacted on people they supported. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment. Deprivation of Liberty Safeguards (DoLS) are part of this legislation and in place so that where someone is deprived of their liberty they are not subject to excessive restrictions. We found the service was not compliant with the conditions of Deprivation of Liberty Safeguards that were authorised.

We found that people had care and support plans in place and these had all been recently reviewed and updated. They identified people’s needs and were updated when needs had changed. There were also risk assessments in place. However, we found staff did not always follow the care plans to ensure people’s needs were met.

A well balanced diet that met people’s nutritional needs was provided. However, we found people were not always supported appropriately to be able to eat and drink. We found best practice guidance was not always followed for people living with dementia in respect of aids for eating and adaptations to the environment.

Infection prevention and control had improved. However, some maintenance and renewal had not been carried out and some areas were not maintained to be able to be kept clean. We also found two trip hazards which although identified by the manager, no immediate action had been taken. This was addressed on the day of our inspection.

We found the systems in place to monitor and improve the quality of the service were ineffective. We also saw the audits did not cover all aspects of the service provision.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed people were treated with respect and staff maintained people's dignity.

Is the service effective?

The provider had an effective system to regularly assess and monitor the quality of service that people received. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted upon.

A relative we spoke with told us, 'The staff tailor the care and activities for the residents it is very individualised.'

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people. We observed a lively inclusive atmosphere.

Is the service responsive?

At our last visit the provider had implemented a redecoration programme. This had been commenced and a number of areas had been improved.

Is the service well-led?

The Manager was not registered with the Care Quality Commission they told us they had problems with the Disclosure and Barring Check, which was taking a very long time. They showed us evidence it was at stage four on 13 August 2014. Which meant it should be returned to them soon. They also said when it was returned they would immediately submit an application to become the registered manager.

The staff we spoke with said they worked well as a team and enjoyed working at Victoria Lodge.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity was maintained by the staff.

We found inadequate quality monitoring systems were in place. This did not ensure the risks to people were identified and reduced, to be able to continually improve.

We found that medicines had not been audited and were not always recorded or administered safely and appropriately.

Is the service effective?

People's health and care needs were reviewed, and they were involved in the reviews.

Audits and reviews had taken place, however shortfalls were not always identified so action was not taken. We found some areas of improvement that had been identified at our previous inspections still required attention.

We observed activities during our inspection, people were making Easter gifts. People told us they really enjoyed the activities and one person said 'The coordinator is brilliant'.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people. One person we spoke with told us, 'It is very good the staff look after me and the food is lovely.'

We spent time in the dining room observing lunch. We saw the experience was inclusive, calm, supportive and enjoyed by people who used the service. People were given choices and their preferences were respected. People were offered a second serving and most people had two puddings which they said they really enjoyed.

We observed staff giving appropriate sensitive support when required.

Is the service responsive?

The acting manager had been in post a year and we saw many improvements had been made. However some improvements were still required. We have since received a full environmental audit and a maintenance and renewal programme, which addresses the shortfalls and shows clear timescales for the works to be completed.

Is the service well-led?

A new manager was appointed in April 2013, but they are still not registered with CQC. They told us that they had sent off for their Disclosure and Barring service check and when this was returned would submit their application to register.

We did not speak to people who used the service regarding this outcome, however there were activities ongoing during our visit and people told us, 'I enjoy the activities and they are much better.'

We observed people joining in the activities and enjoying participating. People were laughing and joking and talking to each other.

Relatives we spoke with said they felt people were looked after well and activities had improved over the last couple of weeks. They told us the acting manager was approachable and listened to them and resolved any issues they raised.

Our SOFI found people did not always receive the support they needed to eat their meals. People were left for long periods without assistance and when staff were available interactions with people was minimal. However people told us they enjoyed the food, which we observed was well presented. People also asked for seconds at lunch time which was provided.

During our visit we noted the provider had carried out improvements to the environment since our last visit. They had provided new floor coverings in the communal areas and decorated a number of rooms. However we also identified some areas of inadequate maintenance and monitoring of the premises.

Although we found there was a system to regularly assess and monitor the quality of service provided. We found this system was not effective as it did not identify the risks and where improvements were required to be made

People were cared for in a clean, hygienic environment and there were effective systems in place to reduce the risk and spread of infection. Although some works had not been completed they were in progress and the provider had implemented a maintenance and renewal programme.

Care workers supported people to take their medicines in a variety of different ways and at times that met the individual needs and preferences of people living in the home. Most people living in the home had a diagnosis of dementia and did not know, or were unaware of what medicines they were prescribed. This meant that they were unable to talk to us about their medicines in a meaningful way; however nobody we spoke with raised any direct concerns about how their medicines were handled. One person we spoke with told us that the care workers were 'grand' and that 'they look after me well'.

During our visit we spent time observing in the lounge and dining room. We observed good interactions between staff and people who received a service. There were activities ongoing at the time of our visit and people were joining in and enjoying the activity and interaction.

People who lived in the home had a diagnosis of dementia and did not know, or were unaware of what medicines they were prescribed. This meant that they were unable to talk to us about their medicines in a meaningful way.

We looked at care records and found that people's personal records including medical records were accurate and fit for purpose.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. We found that people did not always receive care that met their needs.

People who used the service had a care plan, although not all aspects were in line with their individual needs.

People were not protected from the risk of infection because appropriate guidance had not been followed. We saw that people were not always cared for in a clean, hygienic environment.

Staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed.

We found that people received only basic care which met their physical needs. There was little evidence to confirm people's emotional and psychological needs were met. For example people lacked social interaction. We observed some people sat for long periods without any contact from staff.

We observed lunch and people told us that they had enjoyed their meal, However we noted that some people became agitated between their first and second course being served. This was because one person was shouting and was quite disruptive. One person left their table and went to ask staff if they could have their pudding.

We spoke with two relatives who were visiting the home. One relative who told us they were satisfied with the care provided. Another relative told us that her relative often told her that they had to wait a long time on occasions to get help to go to the toilet. She told us that she was not aware of the complaints procedure but said she had raised some concerns to the manager.

We found that some staff had not attended essential training to ensure people were moved and handled safely.