Humfrey Lodge

Humfrey Lodge provides accommodation and personal care support for up 48 people including people living with dementia. The service is provided from within a purpose-built building, with rooms and communal areas all on one level and located within a residential area. The service has a few courtyard gardens which people are able to access if they choose. On the day of our inspection there were 43 people living at the service.

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

When we last visited the service in October 2017, we found that care plans were not as informative as they needed to be and some recording of information was not always accurate.

On this visit we found that improvements had been made to care plans and information was accurate and therefore met peoples needs.

There were enough staff to keep people safe. The manager was working well with the staff team, morale was good and staff had the necessary skills to carry out their job role.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The manager promoted a person-centred approach to managing restrictions resulting from the COVID-19 pandemic. They communicated well with people and families to explain any restrictions on visiting.

Staff had received appropriate recruitment checks on their suitability to work at the service and there were enough staff on duty to meet people's needs.

Senior staff carried out regular checks on the quality of care and took action which directly improved the standard of care for people. Regular audits were undertaken.

For more details, please see the full report which is on the CQC at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published October 2017). At this inspection the service has been found good.

Why we inspected

We had received some anonymous concerns with regards to staffing levels in the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Humfrey Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Humfrey Lodge provides accommodation and personal care support for up 48 people including people living with dementia. The service is provided from within a purpose built building, with rooms and communal areas all on one level and located within a residential area. The service has a number of courtyard gardens which people are able to access if they choose. On the day of our inspection there were 47 people living at the service.

Humfrey Lodge had been through a period of instability with a change of three managers within the last three years. Since our last inspection, a new manager had been appointed and had registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At our last inspection in October 2016, this service was rated as Requires Improvement as we found that the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to provide and deploy sufficient numbers of suitably qualified, competent, skilled and experienced staff to make sure that they met people’s care and treatment needs. We also found the nutritional needs of people were not always being met, as there was inadequate monitoring of people at risk of losing weight and inadequate fluid intake. We asked the provider to take action to make improvements. They sent us their action plan which told us what steps they would take to improve and ensure compliance with legal requirements.

At this inspection, we found some improvement. Whilst the provider told us that the recruitment and retaining of staff continued to be a challenge, we found sufficient numbers of suitably qualified, competent, skilled and experienced staff available to meet people’s needs.

The monitoring of people’s food and fluid intake had improved. However, further work was needed to ensure where people gained excessive weight which could impact on their health and wellbeing, this was monitored and appropriate referrals made to specialists for advice and guidance.

We found some discrepancies with contradictory information recorded by night staff in relation fluid balance charts and repositioning records. We could not be assured that care and support recorded had actually been provided. Whilst care plans were person centred and detailed in places, some lacked specific information about people’s care. For example, care plans did not consistently reflect the needs of people who required staff to support them with moving and handling, safely using specialist equipment. In response to our feedback, the registered manager responded promptly to our concerns and by the second day of our inspection had taken immediate action to rectify the shortfalls we identified.

The registered provider had a system in place to ensure appropriate recruitment checks had been carried out before staff started working at the service. Staff received training to equip them for the roles for which they were employed.

Staff had received training to enable them to recognise signs and symptoms of abuse and said they were confident in how to report any concerns they might have. In relation to risk, we found the quality of information recorded in care plans varied.

People told us they felt safe living at Humfrey Lodge. They were satisfied with the way staff provided care and support and told us they were treated with dignity and respect. People’s needs and choices had been assessed and care and treatment delivered in line with people’s wishes and preferences.

Throughout our two day inspection, we observed staff asking for people's consent before providing them with care and treatment. People's capacity to consent to aspects of their care and treatment was documented in their care plans. Staff had been provided with training in understanding their roles and responsibilities with regards to the Mental Capacity Act 2005 (MCA) and related Deprivation of Liberty Safeguards (DoLS).

Medicines were managed safely and people received their prescribed medicines when they needed them. Staff were trained and verified as competent to administer medicines.

The service was clean, well maintained with infection control measures in place. Domestic and care staff had a good understanding of how to reduce the risk and spread of infection.

People were supported to be able to eat and drink sufficient amounts to meet their needs and were offered choice. People were supported to access health care when required, including access to specialists when required.

We found that there was a clear management structure in place. Staff were aware of their roles and that of the management team. Staff, people who used the service, their relatives and stakeholders were all complimentary about the management team. They told us they found them approachable, engaging and had clear, person centred vision and values. There was an open culture where people felt comfortable to air their views and, provide honest feedback. The registered manager was a visible presence in the service. The registered manager and provider monitored the quality and safety of the service. Regular audits had been completed and any concerns addressed with action plans and timescales for actions planned.

Humfrey Lodge provides accommodation and personal care support to 48 people including people living with dementia. On the day of our inspection there were 47 people living at the service.

At the last inspection the service was rated as requires improvement. The provider sent us their action plan where they told us what they would do to meet regulatory requirements. At this inspection we identified several areas of improvement. However, as further action was required to ensure the provider met requirements the service remained as requires improvement.

Since our last inspection in February 2016 the previous manager has left the service and a new manager employed within the last four months. The current manager had applied to be registered with the Care Quality Commission (CQC) and their application was currently being processed. 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 provider had systems in place to ensure people were protected as far as reasonably possible from abuse. Staff were trained in identifying acts of abuse and knew what steps to take to reduce the risk of people experiencing abuse. Staff had been provided with procedural guidance in steps they should take to report issues of concern through safeguarding and whistleblowing processes in place.

Improvements had been made with the implementation of systems in place to audit, risk assess and protect people from the risk of cross infection. Actions had been taken to improve the standard of hygiene appropriate for the purposes for which the premises were being used, in line with current legislation. However, further work was required to ensure the risks of acquiring health related infections were mitigated through a regular audit of mattresses and bedding to check cleanliness and ensure replacement of items took place as and when required.

The provider had established and operated effective procedures for the management of people’s medicines.

The provider had system in place for safe staff recruitment processes such as disclosure and barring checks as well as references obtained from the most recent employer prior to their starting work at the service to reduce the risk of employing unsuitable staff. However, we found staff recently employed who were unable to speak, write and understand the English language. We observed this impacted on people’s ability to be heard, understood and put people at risk of not having their care and treatment needs met.

Staff were supported with regular supervision and staff meetings. Staff worked well as a team, and had a good relationship with the manager.

Since our last inspection staffing levels had been increased. However, there continued to be a significant number of vacant staffing hours. This meant there was a high number of agency staff in use. Feedback from staff and people who used the service told us this had the potential to put people at risk of not receiving consistent care from staff knowledgeable about people’s individual care and support needs.

Steps had been taken to make sure that people were supported to receive adequate nutrition and hydration, and that people at risk of weight loss and, or dehydration were monitored and had access to specialist advice. However, staff did not always accurately record the food consumed by people. This meant that monitoring of people’s nutritional intake was ineffective. However, people’s weight was regularly monitored and action taken to refer to people to specialists for advice and support.

The manager had a good understanding of their roles and responsibilities with regards to the Mental Capacity Act 2005 (MCA) and demonstrated an awareness of the requirement to assess people’s capacity to consent to their care and treatment and to consider people’s best interests when supporting them to make decisions.

Staff received training, supervision and staff meetings. This provided them with opportunities to discuss their work performance and plan their training needs. However, for newly appointed staff there was limited evidence to show they had received sufficient induction training to enable them to carry out the roles for which they were employed.

Staff were positive about the new manager and their leadership of the service. The manager demonstrated clear vision for continuous improvement and caring values which were observed in their conduct and discussions with staff, relatives and people who used the service. People told us they were confident to raise any concerns they might have with the management and the staff. The provider had systems in place to address any complaints in a timely manner with a system of audit recording outcomes and actions.

There were improved governance systems in place to regularly assess, monitor and mitigate risks relating to the health, welfare and safety of the people who used the service. However, the provider had recognised the need to sustain further improvement in the monitoring of the service and to sustain effective recruitment and retention of staff and to ensure sufficient staffing levels were maintained at all times.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We saw there were activities for people to take part in. One person said they would like more outings but said there was enough to do including musical entertainment.

We found that although staff worked long hours that this was their choice and it was monitored by the manager. Staff told us there were usually enough staff to provide care that was required. The manager told us that bank staff were used to cover gaps and more staff were being recruited.

There were appropriate arrangements for the management of medications and sufficient equipment for staff to provide safe care.

The manager had systems in place to check that the quality of the service was maintained, met appropriate standards and was responsive to people's views and changing care needs.