Archived: High Peak Lodge Residential and Nursing Home

High Peak Lodge is registered to provide personal and nursing care for up to 39 people. It is situated close to Leigh town centre. All the rooms are for single occupancy and have en-suite facilities. There are gardens to the front and rear of the home and car parking is available. At the time of our inspection there were 27 people living at the home.

The home was last inspected on 18 and 19 February 2016, when we rated the service as ‘inadequate’ overall and identified six breaches of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing; safe care and treatment; person-centred care and good governance.

Prior to the last inspection in February 2016 we became aware of serious concerns with how the service was managing the needs of people at risk of pressure sores. During the inspection we saw that whilst the home had taken steps to address these concerns, there were still issues with the monitoring and documentation around pressure care and use of specialist equipment.

In June 2016, the Police commenced an investigation into concerns about the care and support received by a person using the service up to their death; this investigation remains on-going.

At this inspection we found the service had made improvements and was now meeting all regulatory requirements. We did not identify any current concerns with the care provided to people living at the home.

At the time of the inspection 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 saw the home was clean and had appropriate infection control processes in place. Five housekeepers were employed, one of whom was a supervisor who oversaw completion of the daily and weekly cleaning schedules.

People we spoke with told us they felt safe. Similarly relatives had no concerns about the safety of their family members and were positive about the level of care provided. The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

Staff and people using the service commented on the improvements in staffing levels and felt that the home had enough staff to meet people’s needs. The service was continuing to recruit additional staff, particularly nurses in order to remove the need for any agency staff on night shifts.

Both the registered manager and staff we spoke to demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We saw the service was working within the principles of the MCA and had followed the correct procedures when making DoLS applications. Although the majority of applications made were still awaiting assessment, the service had ensured on-going contact with the local authority had taken place, to request feedback on when these would occur.

We saw medicines were stored, handled and administered safely and effectively. All necessary documentation was in place and was completed consistently. Staff responsible for administering medicines were trained and had their competency assessed annually. Sterile water used for Percutaneous Endoscopic Gastrostomy (PEG) flushes along with thickening agents, which are used to thicken fluids, were stored securely in a locked cupboard in the dining area.

Staff spoke positively about the training available and confirmed that statutory sessions were refreshed on an annual basis. We saw all the staff had completed an induction programme, new staff had been enrolled on the care certificate and on-going training was provided to ensure skills and knowledge were up to date.

Staff confirmed they received regular supervision and annual appraisals, which along with the completion of monthly team meetings, meant they were supported in their roles. Staff were actively involved in the supervision process and the home had recently introduced out of session tasks linked to the supervision process. These focussed on challenging poor practice.

Observation of meal times showed these to be a positive experience, with people being able to make choices about where they sat and what they ate. Staff encouraged people to use the dining room, in order to promote engagement and involvement but abided by people’s wishes. Drinks and snacks, including fortified foods, were available in the lounge throughout the day and people were supported and encouraged to drink on a regular basis, with detailed monitoring in place.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect. Both people who used the service and their relatives were complimentary about the attitudes of the staff and the standard of care received.

We looked at six care files which contained detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, which helped ensure their needs were being met and their safety maintained.

The home employed an activity co-ordinator and had sourced specific training for other staff to enable them to provide activity support. Everyone we spoke with was positive about the activity options available. We saw the activity schedule catered for all interests and abilities and people were actively encouraged to participate in any way they could.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily and monthly basis and covered a wide range of areas including medication, care files, infection control, health needs and the overall provision of care. We saw evidence of action plans being implemented to address any issues found.

High Peak Lodge nursing home is registered to provide personal and nursing care for up to 39 people. It is situated close to Leigh town centre. All the rooms are single and have en-suite facilities. There are gardens to the front and rear of the home and car parking is available. At the time of our inspection there were 35 people living at the home.

We last inspected High Peak Lodge on 28 and 29 May 2015 when we rated the service ‘requires improvement’ overall and found two breaches of the regulations in relation to staff training and competency and in relation to staffing levels. At this inspection we identified six breaches of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing levels; medicines; assessment of needs; staff supervision and records. We are currently considering our options in relation to enforcement and will update the section at the end of this report once any actions have been concluded.

There was not a registered manager in post at the time of our 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 2008 and associated Regulations about how the service is run. The registered manager was working in a different position within the home and was in the process of cancelling their registration with CQC. There was an acting manager in post who was due to leave the service by mid-March 2016. The provider informed us they were in the process of recruiting a new registered manager.

We found issues with the way the service was protecting people from the risks presented by the spread of infection. We saw one person had signs of an infection and had leaking bandages on their legs. They were sitting in communal areas without any shoes on and this placed them and others at risk of acquiring an infection. We also observed sterile water used to flush a feeding tube was left out on a table in the lounge on two occasions.

Prior to the inspection we had become aware of concerns in relation to how the service was meeting the needs of people at risk of, or who had pressure sores. We found some issues with the way the service was assessing and managing the risk of pressure sores. For example, care plans did not document the settings required for pressure relief mattresses. We also found some gaps in records of care in relation to pressure sores, such as records of skin checks and repositioning. The provider had carried out an audit of pressure care following a number of incidents where pressure sores had developed. Actions to improve care in this area, including the provision of training had been identified, and issues surrounding record keeping had been addressed with staff. The area manager told us they felt improvements were being made, but that progress was slow.

We found a range of health professionals were involved in people’s care as required. However, some of the care plans we looked at were lacking in details about the care required. This could lead to inconsistencies in the care delivered or result in the care being provided not meeting people’s needs.

Daily checks had been introduced to help ensure care records were being accurately maintained. However, we identified some on-going issues with the completion of care records. For instance, we found some food and fluid intake charts indicated a low level of intake that would have placed people at risk of dehydration. Staff and the area manager thought this was a recording issue and said people were regularly supported with drinks.

Most people told us staff were kind and caring, and relatives we spoke with told us their family member’s knew staff well. However, one person told us staff could be ‘curt’ and required more patience. We looked at minutes from a staff meeting, which also showed issues had been raised by relatives in relation to how staff addressed people living at the home.

An activity co-ordinator was employed to provide activities for 20 hours per week. We saw activities such as bulb planting had taken place. However, during the inspection we saw little in the way of activities or stimulation for people. Much of the interaction we observed from staff was task based, such as supporting people with meals, moving and handling and using the toilet.

Staff and people living at the home told us they didn’t think there were sufficient numbers of staff to meet people’s needs in a timely way. Some people told us they would have to wait long periods to be assisted to use the toilet and staff confirmed this was the case. We found a call bell took over nine minutes to respond to at one point in the inspection and there were also delays in supporting people to get up in the mornings due to availability of staff.

Medicines were administered safely and records of administration were being maintained. We found one person was self-administering a nicotine lozenge. Although we were confident from discussion with staff that they were able to do this safely, there had been no assessment to show any potential risks had been considered. At one point in the inspection we observed that thickening agent had been left unattended in the dining area, which placed people at potential risk of harm.

Staff had received training in a variety of topics including safeguarding, moving and handling and pressure ulcer prevention. We also saw that competency assessment had taken place in relation to areas of staff practice including medicines administration and PEG care. However, supervision of staff by a manager or supervisor had not been maintained. Supervision is another important way of ensuring staff are competent and well supported.

There were a limited number of adaptations to the environment to make it more accessible to people living with dementia. Adaptations included some pictorial and directional signage. There were no adaptations to help people identify their bedrooms and there had not been improvements in this area since our previous inspection. Staff had received basic training in dementia care.

A range of audits had been conducted and these fed into improvement plans. The area manager carried out a monthly visit to the service and had identified many of the same issues we found in relation to record keeping and other areas in their visit report. Many of these actions had not been signed off as completed. The area manager told us actions were revisited monthly and would only be signed off once they were confident any issues had been rectified.

The provider had chosen to implement a temporary restriction on admissions of people with complex support needs whilst improvements were made to record keeping and pressure care. We discussed this with the area manager and agreed this was a sensible and responsible decision.

There was no evidence of any recent residents or relatives meetings. Some people told us they didn’t feel informed about what was happening on the home or said they were not asked for their opinion of the service. Relatives told us communication with the home was good. Everyone we spoke with told us they would be confident to raise a complaint if required.

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 wi

At this visit in January 2014 we found that improvements had been made and people were now protected from the risks associated with medicines because the policies in place were being followed by staff. The people who we spoke with told us that there were no issues with their medicines and that they received them on time. We also saw that checks and audits had been completed by the manager and senior staff to ensure that the policies and procedures were being followed.

At our last inspection we found that the actions that had had been identified as a part of the quality monitoring programme were not always completed and that care records were not always accurate. At this inspection we found that both of these issues had been resolved.

We also found that people were involved in their care; that people were protected from the risk of abuse and that people's needs for suitable food and drinks were met.

The home had sufficient numbers of suitably qualified staff who had all been appropriately recruited. This also helped to ensure that people's safety was maintained.

We found that people were not protected against the risks associated with medicines because the home's policy for medicines handling was not consistently followed. We have asked the provider to make improvements regarding this.