Archived: Blacklake Lodge Residential Home

Blacklake Lodge Residential Home is a residential care home which provides accommodation and personal care to a maximum of 37 older people. On the day of our inspection, 23 people were living at the home, most of whom were living with dementia.

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

Environmental risks were not managed safely and the provider had failed to protect people against the risk of scalding. People had been placed at risk of harm because staff did not follow good infection control practices.

People’s medicines were not always safely managed by staff, resulting in some medicines not being stored at the correct temperatures. People’s medicines were not always monitored so staff did not know how effective they were. The staffing arrangements at night were not always maintained at a safe level, which put people at risk of not having their needs safely met.

Following our previous inspection, we had imposed conditions which the provider had not fully complied with and they had not informed us of staffing issues at night. The provider had not driven improvement in the quality and safety of the service, which had put people at risk of harm.

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

Rating at last inspection

The last rating for this service was inadequate (published 31 December 2019).

At this inspection improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We had previously carried out an unannounced comprehensive inspection of this service on 25 October 2019. Breaches of legal requirements were found and we imposed conditions on the provider’s registration.

This inspection was prompted in part due to the provider not having suitable insurance for the home. We undertook a focused inspection to review the key questions of safe and well-led and to look at any improvement the provider had made since our previous inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blacklake Lodge Residential Home 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 people’s safety, medicines, staffing, leadership and governance at this inspection.

Please see the action we have taken at the end of this report.

Blacklake Lodge Residential Home is a residential care home providing personal care to 34 people aged 65 and over at the time of the inspection. The service can support up to 37 people in one adapted building.

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

There was a lack of clear governance in the service and the provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant poor care was not identified and rectified by the provider.

The provider and manager had not consistently worked with professionals to ensure people's needs were met. The manager did not have sufficient knowledge to carry out their role effectively.

People had been placed at risk of harm because medicines were not administered in a consistent and safe manner. Risks to people’s health and wellbeing were not consistently identified, managed or followed to keep people safe. There were not enough staff deployed effectively to provide direct care to people and the provider’s staffing tool was ineffective.

Improvements were needed to ensure incidents of suspected abuse were investigated and reported to the local authority when required. Improvements were needed to ensure people were consistently protected from the risk of infection and cross contamination.

Improvements were needed to ensure training received was effective and competency based. Referrals to health professionals were not always made in a timely way to ensure people were supported in line with their changing needs.

People were not consistently supported to have maximum choice and control of their lives, because the policies and systems in the service did not always support this practice. However, staff supported people in the least restrictive way possible and in their best interests.

People told us the staff were caring towards them and they had choices in the way they wanted their support provided. Staff treated people with dignity and their right to privacy was upheld.

Staff understood how to support people in line with their communication needs. People had the opportunity to be involved in activities within the service. People understood how to complain and told us these had been acted on. Plans were in place to give staff guidance on how people wished to be supported at the end of their life.

The rating from the previous inspection was on display and notifications had been submitted as required. The manager had started to undertake learning to develop their knowledge and was receptive to feedback received from professionals.

Some improvements to the environment had been made and the provider had plans in place to make further improvements.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published 07 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Prior to the inspection we were made aware of concerns from the local authority. The areas of concern related to medicine management, risk management, staffing levels and governance.

We found concerns during the inspection and there were breaches in regulations. We rated the key questions safe and well led as inadequate. The key questions Effective, Caring and Responsive were rated Requires Improvement. The overall rating is Inadequate.

Enforcement

We have identified breaches in relation to the way people’s risks are monitored and mitigated, medicines management, staffing and governance systems at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve the support people receive. We will work with the local authority to monitor progress.

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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. At this inspection we found that improvements had been made to meet the regulations. However, some further improvements were needed.

Blacklake Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Blacklake Lodge accommodates up to 37 people in one adapted building. There were 34 people using the service at the time of the inspection.

There was a newly appointed registered manager at the service. 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.

Improvements were needed to ensure medicines were consistently managed safely to protect people from potential harm.

Records were not always accurate and up to date. Improvements were needed to ensure the systems in place to monitor the service people received were imbedded and sustained.

We have made a recommendation about the environment for people living with dementia.

People were protected from the risk of abuse because staff how to recognise and report suspected abuse.

Risks to people’s health and wellbeing were managed and followed by staff who knew people well, which ensured people were supported safely.

There was enough suitability recruited and skilled staff to provide support to people. Staff had received training to ensure they had sufficient knowledge to carry out their role effectively.

People were protected from the risk of infection because the provider had policies and systems in place to control infection risks at the service.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005, which ensured people were supported in their best interests and in the least restrictive way possible.

People enjoyed the food provided and were supported with their nutritional needs. Action was taken to ensure people at high risk of malnutrition were supported effectively.

Advice was sought from health and social care professionals when people were unwell, which was followed by staff.

There were systems in place to ensure people received consistent care from staff within the service and external agencies.

People received support from staff that were kind and compassionate. People’s dignity was respected and their right to privacy upheld.

People were supported with their communication needs and information was provided in a format people understood which meant that people were supported to make informed choices.

People received care that met their preferences. People’s past lives, cultural and diverse needs were assessed and considered to enable individualised care that met all aspects of people’s needs. People had opportunities to participate in social activities, interests and hobbies.

The provider had a complaints policy which was available to people and their relatives.

People, relatives and staff felt able to approach the registered manager and feedback had been gained from people about their care.

The provider had recognised that improvements were needed and action had been taken to plan and implement changes to ensure people received a good standard of care.

The registered manager understood their responsibilities of their registration and worked in partnership with other agencies.

This inspection visit was unannounced and took place on 29 June 2017. At our last comprehensive inspection on 25 February 2017 the provider was rated as inadequate and this provider was placed into special measures by CQC.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We saw some improvements had been made, however the provider had not taken sufficient action to comply with the regulations recognising the importance of staffing, people’s consent and capacity, person centred care, safe care and treatment, and good governance. The provider sent us an action plan on 3 March 2017 explaining the improvements they planned to make. At this inspection, we found improvements had been made in some areas, however in other areas there was insufficient improvements where compliance actions had been identified.

The service was registered to provide accommodation for up to 37 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 31 people were using the service.

The service did not have 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. The provider had recruited a manager and we saw that they had commenced the process for registration with us. People and relatives told us that since the new manager had been employed they had seen some improvements.

The provider did not always notify us of events. Audits to monitor and evaluate the service were not completed to reflect on quality and drive improvements. The fire procedures and maintenance had not been completed; the provider has been advised by the fire service to make some improvements to meet the regulations.

Medicines were not always available when required to meet people’s needs and , the stock had not been checked and maintained access to as and when required medicine had not always been available to support people’s pain relief.

There was not always enough staff to support people’s needs and respond when they required support. Not all the staff were able to provide us with the assurance they understood how to protect people from harm and the reporting process. Staff had not all received training to enable them to support people and initial inductions had not been completed to cover the required levels of support for their role.

People’s capacity assessments had been completed to consider how the person can contribute to their decision making, however it was not clear how this assessment had been obtained. Best interest decisions had not been made with the relevant people to ensure the decision was the least restrictive. Some people were deprived of their liberty and the authorisations had been sought from the local authority.

People were able to make their preferences known, which had been documented in the care records. People were encouraged to be independent and make choices about how they spent their day. There was a complaints procedure and people felt able to raise any concerns.

People had established relationships with staff and felt cared for. People told us staff treated them with dignity and respect. Relationships and friendship that were important to people were maintained. Staff felt supported by the new manager and that things had started to improve.

We saw people had a choice of food and were able to make decisions about the menu and the meal experience. However it was felt more improvement could be made to ensure people received more hydration opportunities. When required support and advice around health and nutrition had been considered. Support from health professionals was requested and available when needed.

Risk assessments had been completed and guidance provided. The provider ensured appropriate checks before people worked at the service. We saw that the previous rating was displayed in the reception of the home as required.

We found 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.

This inspection visit was unannounced and took place on 28 February 2017. At our last inspection visit on 20 January 2015 we asked the provider to make improvements to the deployment of staffing, supporting people with their decision making and their stimulation. The provider sent us an action plan in April 2015 explaining the actions they would take to make improvements. At this inspection, we found improvements had not been made and we observed additional areas of concern. The service was registered to provide accommodation for up to 37 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 32 people were using the service. The overall rating for this service is Inadequate which means it will be placed 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. 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.

The service had did not have 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. The provider had employed a new manager; however they had left the service after less than a month. Another manager had been recruited; however they had not commenced their employment with the home until the end of March 2017.

We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that staff had not received recent training in safeguarding adults and showed limited understanding. The provider had not recorded accidents and incidents and documented the support people were getting after they experienced a fall. Risk assessment that had been undertaken were not in date or relevant to the current risk levels people had and we could not be sure the support reduced the risks for the people.

We found people's medicines had not been managed safety. Some people had not received their medicine and other people had not been supported when they refused their medicine over a period of time. The stock of medicines was not monitored and staff had not received the appropriate level of training.

The rights of people who did not have capacity to consent to their care were not consistently protected because the provider did not always follow the associated guidance. There was a significant shortfall in mandatory staff training. Staff competences were not checked regularly in various areas of practice including moving and handling and medicines administration.

People did not always have access to healthcare professionals as required to meet their needs.

Care plans did not demonstrated people's involvement. People and their relatives told us they were

not consulted about their care.

The service could not demonstrate how they sought people's opinions on the quality of care and service being provided.

People enjoyed the food, however they were not always offered adequate drinks throughout the day. People were not supported with meaningful daytime activities and we saw the lack of activity had an impact on some people’s behaviour.

Management systems in the home were not robust. The provider was not actively involved in the

day to day running of the home. There had not been a consistent manager for the last six months.

Care staff did not feel supported in their role. There were no quality assurance systems in place to identify areas that needed improvement.

The provider was not meeting the Care Quality Commission registration requirements. They did not send notifications to CQC for notifiable incidents, such as serious injuries.

People had mixed views about the staff and the level of kindness. Some people had their dignity compromised. We found the service had a policy on how people could raise complaints about care and treatment however there was no evidence to demonstrate how complains had been received and dealt with.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009.

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.

We had identified that people did not always receive the care and support they needed in a timely manner. Staff were caring and attentive but during busy periods some people had needed to wait until staff became free in order to have their own needs met.

As a result of our findings the service provided us with an action plan advising us how they intended to improve. The provider told us that they had implemented the action with immediate effect. We allowed time to see if the action plan improved experiences for people who used the service.

During this inspection we took the opportunity to see how the provider cooperated with the wider health community and with other services.

We spoke with four people who used the service and with the family of one person who used the service. We spoke with two members of staff and the registered manager.

We saw that there were sufficient suitably skilled and experienced staff available to meet people's needs. One person who used the service said, 'I'm not kept waiting at all'. A member of staff said, 'There has definitely been an improvement'.

We saw evidence of how the provider had cooperated with other services in assessing and transferring people between Blacklake Lodge and other services including hospitals and other care homes.

People who used the service were treated with respect and dignity, they told us they were happy living at Blacklake Lodge. One person said, 'I don't know how you could better this'.

People received care appropriate to their needs. Care plans and risk assessments were completed and these were reviewed regularly.

Systems were in place which ensured people who used the service were protected from abuse. Staff were aware of their responsibilities and people told us they felt safe.

People who used the service could not always be confident that their needs would be met in a timely manner, as there were not always sufficient suitably qualified staff available.

There were systems in place to enable the provider to assess and monitor the care provided to people who used the service.