Earlfield Lodge

Updated 19 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was conducted by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Earlfield Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Earlfield Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the home since the last inspection. We requested feedback from the local authority quality assurance team and the safeguarding team.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 9 people who lived at the home and 2 relatives who were visiting. We spoke with 5 staff members, the registered manager and the trainee deputy. We looked at the care records of 3 people and multiple medicines records. We looked at the recruitment records of 3 staff and a variety of records relating to the management of the home, which included audits.

Updated 19 April 2023

Earlfield Lodge is a care home located in a large, detached property in a residential area of North Somerset. Accommodation is provided across 4 floors of the home. Each bedroom has ensuite facilities.

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

People were not supported to have maximum choice and control of their lives. The staff did not support them in the least restrictive way possible and in their best interests. We found evidence during the inspection of restrictive practice. Some people’s bedrooms were located in a secure corridor of the home. The registered manager told us this was to keep them safe. However, mental capacity assessments and best interest decisions were not in place to support these decisions. The appropriate DoLS applications had not been submitted to the local authority for two people who lacked capacity and were unable to leave freely without the staff.

Governance processes were not always effective. Although some improvements had been made to the audits in place, these had not always highlighted the shortfalls we identified during the inspection. Some actions recorded on the homes action plan had not been undertaken in a timely manner. For example, the redecoration of the home had not been completed, with many areas outstanding. Improvements had been made, but further work was required.

Improvements had been made relating to staffing levels at the home. A dependency tool was in place which had taken into account the environment. Staffing levels during the night had increased to three staff due to three floors being open. Half of the building remained closed; however, the provider gave us assurances they would continue to monitor staffing levels and increase them as the occupancy increased. People felt safe and medicines were managed well. People and their relatives told us the staff were kind and looked after them well.

Improvements had been made with monitoring risks within the home. The maintenance person carried out regular checks of the home’s fire doors and they tested the fire alarm weekly. Fire drills were taking place and a fire log was kept of the staff that participated in each fire drill. Each person had an individual personal evacuation plan in place. Environmental risk assessments were taking place monthly.

People were supported with foods and drinks they enjoyed. People were supported to access healthcare services and staff had good working relationships with external professionals. Each person had a care plan in place which was stored electronically. The electronic care records system had been fully embedded by the staff.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 June 2022). We found there were breaches of four regulations.

We found at this inspection that improvements had been made with two breaches met, however, other areas of concern was identified. Some other areas needed further improvement. This meant the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 April 2022. We identified several shortfalls. The provider completed an action plan after the last inspection to show what they would do and by when to improve the home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective, responsive and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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

Enforcement

At this inspection, we have identified breaches in relation to the requirements of the Mental Capacity Act 2005 not been adhered to, the environment and its decoration and the monitoring of the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the home, which will help inform when we next inspect.