21, 22, 23 October 2014
During a routine inspection
This inspection took place on 21, 22, 23 October 2014 and was unannounced. At our last inspection the service was judged as compliant
Etherley Lodge provides accommodation for up to 38 people with personal care needs. At the time of our visit there were 28 people living in the home. The home is a large converted house and included three dining areas and three smoking rooms. The bedrooms were mainly single room accommodation. Bathroom and toilet facilities were shared, although we found the provider had installed toilet facilities in some rooms. Local amenities were accessible to the home.
Etherley Lodge had a registered manager in post. 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.’ Etherley Lodge has a registered manager in place
We found Etherley Lodge to be inadequate in all areas that we inspected. We looked at guidance for providers in mental health including the following:-
- National Institute of Clinical Excellence – Mental Wellbeing of older people in care homes published December 2013
- National Institute of Clinical Excellence - Quality Standard for service user experience in adult mental health published December 2011;
- Mental Health Act Code of Practice 2008
The provider had failed to take account of this guidance.
We saw other health and social care professionals had provided information about people’s care needs and any associated risks to the provider. This information had not been transposed into the provider’s care plans and there were no risks documented to ensure people were safe and their risks mitigated.
We found staff had not been safely recruited and where following a Disclosure and Barring check staff were found to have committed offences, these were not risk assessed to see if the staff were safe to work with vulnerable people.
We found the home was not clean and cleaning schedules did not demonstrate cleaning had taken place on a regular basis. We found a build-up of grease and grime in areas of the kitchen and the laundry area was cluttered with no segregation between clean and dirty areas. This increased the risk of cross contamination.
People on specialised diets were put at risk of potential health problems and kitchen staff
Kitchen staff were not aware of one person’s specific dietary requirements. There was a menu in place but people asked at each meal for alternatives and the provider did not have in place a method to monitor people’s nutritional input to ensure people were not put at risk of inadequate nutrition.
We found no provider assessments were in place as to the capacity of any of the 28 people at Etherley Lodge to make specific decisions in accordance with the Mental Capacity Act 2005. The provider therefore had not ascertained if people needed to be subject to Deprivation of Liberty Safeguards.
We found there were three smoking lounges throughout the home there was a constant smell of smoke. The provider did not have in place arrangements to offer people who did not smoke alternative living arrangements. Most people sat for the day in the smoking lounges and people were not protected from the effects of second hand smoke.
We asked two people about their care plan, one did not respond and the other person said, “What care plan?” We found there was no evidence that people using the service had been involved in the development of their plan of care and the plans did not reflect how to manage their diverse needs, current situation or discussion on future plans.
We discussed activities with people and were told they had asked for activities but none were provided. People were given a questionnaire to complete if they did not want to attend a residents meeting. We found the provider failed to respond to people’s comments.
The provider did not have in place people’s personal records which were accurate and fit for purpose. We found people’s records did not accurately describe their needs for example we saw assessments had been carried out by adult services one person required their day to be structured, the provider’s assessment did not include this and their care plan did not incorporate structured activities in their day. No information was given on how risks were to be minimised for people.
During the inspection we asked the registered provider and the registered manager for risk assessments for using wheelchairs and driving the home’s vehicle and there were none available. When these deficits were pointed out to the registered provider they responded by creating risk assessments on the day of our visit. This meant the management team had not been proactive in ensuring people’s safety.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.