Archived: White Lodge

Updated 12 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection of White Lodge commenced on 24July 2017 and was unannounced.

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about management of risk of unsafe equipment and unsafe moving and handling. This inspection examined those risks.

The inspection was carried out by two inspectors.

The provider had not completed a Provider Information Return (PIR) as the inspection had taken place sooner than planned. 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. We reviewed the records we held about the service, including details of any statutory notifications sent by the provider. Statutory notifications are reports of events that the provider is required by law to inform us about.

We looked around all areas of the service and talked to people who lived there. During our inspection we observed how staff spoke with and engaged with people. We did not use the Short Observational Framework for Inspection (SOFI) as people were able to speak with us.

We spoke with staff, the registered manager and provider. We received feedback from other health and social care providers before and after the inspection.

We looked at how people were supported throughout the inspection with their daily routines and activities. We reviewed five care plans and associated risk assessments. We looked at a range of other records, including safety checks, staff files and records about how the quality of the service was monitored and managed.

We last inspected White Lodge in October 2016 when there were no breaches of regulations.

Updated 12 September 2017

This inspection took place on 24 July 2017 and was unannounced. The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident.

However the information shared with the Care Quality Commission about the incident indicated potential concerns about the management of risk of unsafe equipment and unsafe moving and handling. This inspection examined those risks.

We received information that potential risks to people’s safety including moving and handling had not been assessed consistently and staff did not have detailed guidance to follow to mitigate risks to people. Care plans were not up to date and did not reflect people’s needs, there was a risk that people were not receiving safe and effective care.

White Lodge is a residential care home for up to 27 older people who require personal care. On the day of the inspection there were 20 people living at the service. The service is in the residential area of Cliftonville and provides accommodation and communal areas over three floors. Some bedrooms have en-suite facilities, with shared bathrooms and toilets for the rest of the rooms.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 day to day running of the service was managed by the registered manager and the provider. We were supported by the registered manager and provider during the inspection.

People told us that they felt safe living at the service. However, the provider had not consistently completed checks on the environment and equipment to ensure people remained safe. There was a fire risk assessment but there were no personal emergency evacuation plans (PEEP) for each person, to inform staff how to evacuate people safely. There was no evacuation equipment in place to support people to leave the building in an emergency. External fire doors were locked with keys, one door did not have a key available and the other keys were not stored securely to reduce the risk of them being lost. We informed Kent Fire and Rescue Service of our concerns.

There was no gas safety certificate or records of checks being completed on electrical equipment available at the inspection. The provider supplied gas certificates following the inspection but some of the electrical certificates supplied were not up to date. Windows on the first and second floors, that people had access to, did not have restrictors to stop them opening fully to help keep people safe. Following the inspection, the provider told us they were purchasing restrictors for each window and had completed risk assessments for the people in the rooms to ensure their safety.

People told us that they received their medicines when they needed them. However, medicines were not consistently managed safely. There were audits of the medicines completed but these had not identified the shortfalls found at this inspection.

There were no systems or processes, with the exception of medicines, in place to check the quality of the service provided. Feedback from staff and relatives had been sought and used to improve the service. The registered manager told us people had refused to complete surveys, but no other options had been considered to record people’s thoughts about the service.

There was not an open and transparent culture within the service; staff were not informed of events within the service so they could learn and improve practice. Staff did not always feel they were able to approach the registered manager with their concerns and felt they were not always listened to. The registered manager and provider were responsible for the day to day management of the service.

People were not always protected from the risk of possible harm. Risks to people had not been consistently recognised and assessed; staff had not always been provided with guidance on how to reduce risks. Accidents and incidents had been recorded and analysed, action had been taken to reduce the risks of them happening again.

Each person had a care plan; the care plans had not been consistently reviewed and did not always reflect people’s needs and preferences. Staff knew people well and understood how people preferred their care to be given.

Staff knew about abuse and knew what to do if they suspected any incidents of abuse. Staff were aware of the whistle blowing policy and the ability to take concerns to agencies outside of the service.

The provider had a recruitment policy; however, this had not been followed consistently. There were sufficient staff to meet people’s needs.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff understood how the Mental Capacity Act (MCA) 2005 was applied. People were encouraged to make choices and staff gained consent from people before supporting them. People’s capacity had not been assessed and documented consistently. When people did not have capacity, best interests meetings had not been documented to show how decisions had been made. We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these are agreed by the local authority as being required to protect the person from harm. The registered manager had applied for DoLS authorisation as required.

Staff received training appropriate to the role and they understood their role and responsibilities. Staff told us that they did not always feel supported by the registered manager and provider. The staff had not always been informed of developments within the service and this had made staff feel unsettled and uninformed.

People enjoyed a choice of healthy meals and told us they had enough to eat and drink. People’s health was assessed and monitored and staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received effective care.

People told us they were happy in the service and that their privacy and dignity were respected. Staff spoke with people in a patient, kind, caring and compassionate way. People told us that they were supported in the way they preferred. People’s religious and cultural needs were recorded and respected.

People knew how to complain and told us they had no complaints about the quality of the service or the support they received from the staff team. The provider’s complaints process was not up to date and did not give people clear instruction about how to make a complaint, who to make it to and when they would receive a response. Checks had not been completed to make sure that complaints had been fully investigated in an open and transparent way and that people were satisfied with the response they received.

There were limited activities available; an activities organiser was being recruited to improve the range of activities available. People’s friends and family could visit when they wanted and there were no restrictions on the time of day.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We found four breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have made a recommendation about recording of capacity assessments and best interests decisions. You can see what action we told the provider to take at the back of the full version of this report.

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.

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