Archived: Garden Lodge Care Home

Garden Lodge is a residential care home providing personal care for up to 42 people. The service provides support to older people some of whom were living with dementia. At the time of our inspection there were 38 people using the service.

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

The service was generally safe however the documentation of ‘as and when required’ medicines was not in line with best practice guidance. Audits by the provider had not identified the failure to follow the medicines policy. The management team immediately acted to put the required documentation in place. Other aspects of medicines management was safe.

A number of notifications had not been submitted to CQC. Statutory notifications are specific pieces of information about events, which the provider is required to send to us by law. The provider had not identified missed notifications to CQC.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; although the documentation in place did not always support this. The registered manager took action to rectify this during the inspection. We have made a recommendation about this.

People were safe from the risk of abuse. Risks were assessed and regularly reviewed when people’s needs changed. The building was well maintained with appropriate décor, including dementia friendly interactive decorations.

There were sufficient staff employed by the service, staff were trained appropriately and recruited safely. Staff worked effectively with visiting professionals. Staff wore PPE to keep people safe. Infection control measures were in place, management had recently introduced some new infection control processes following advice from a specialist team.

Care records were person centred. People and relatives said they were supported to have choice in their lives. People were supported to eat and drink a balanced diet.

Feedback from relatives about the registered manager was very positive. Staff said the culture of the service was open and the management team were very helpful. People and relatives were involved in their care decisions.

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 good (published 15 January 2019).

Why we inspected

We received concerns in relation to staffing and safeguarding people. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Garden Lodge is a care home that provides accommodation and personal care for a maximum of 42 people who live with dementia or a dementia related condition. 36 people were accommodated at the service at the time of inspection.

We found the following examples of good practice.

• Staffing levels were safe. Staff had increased their hours to support colleagues who had to take time off work to isolate. There had been no agency usage and no staff working at the home from the provider’s other services.

• Staff wore PPE (Personal Protective Equipment) appropriately. Additional cleaning of high-touch areas had been introduced and feedback from infection control specialists had been acted on promptly.

• All visitors had to undergo a temperature check and had access to PPE and handwashing facilities or antibacterial hand gel. We gave the provider some advice about reviewing some of their visitor processes to minimise risk and ensure social distancing was more practicable.

• The registered manager was off work at the time of inspection. Their deputy and acting deputy demonstrated a good understanding of relevant infection control guidance and procedures. Staff and the provider were responsive to suggestions and signposting regarding good practice.

Further information is in the detailed findings below.

Garden Lodge is a care home that provides accommodation and personal care for a maximum of 42 people who live with dementia or a dementia related condition. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. 35 people were accommodated at the service at the time of inspection.

At our last comprehensive inspection in June 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good.

People said they felt safe and they could speak to staff as they were approachable. One relative commented, “Since [Name] came to live in the home we feel confident that the care and support they receive is excellent and we can now go away on holiday, something we were unable to do before.” People and staff told us they thought there were enough staff on duty to provide safe care to people. Staff knew about and followed safeguarding procedures. Staff were subject to robust recruitment checks. Arrangements for managing people's medicines were safe.

Risk assessments were in place and they identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. One person commented, “Staff help me with things when I need it but they always encourage me to do things myself.” Activities and entertainment were available to keep people engaged and stimulated.

There was a good standard of hygiene. The environment promoted the orientation and independence of people who lived with dementia.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice

Detailed records reflected the care provided by staff. Care was provided with kindness and people's privacy and dignity were respected. A relative told us, “[Name] is a new person since they came to live here.” Communication was effective to ensure people, staff and relatives were kept up-to-date about any changes in people's care and support needs and the running of the service.

People had access to health care professionals to help make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received a varied and balanced diet to meet their nutritional needs.

Robust auditing and governance systems were in place to check the quality of care and to keep people safe. People were encouraged and supported to give their views about the service. People were very positive about the changes being introduced by the new manager into the home.

There were effective systems to enable people to raise complaints, and to assess and monitor the quality of the service. People told us they would feel confident to speak to staff about any concerns if they needed to. People had access to an advocate if required.

Further information is in the detailed findings below.

We undertook this focused inspection on 29 September 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Garden Lodge Care Home on our website at www.cqc.org.uk.

Garden Lodge Care Home provides accommodation and personal care for up to 41 people, including people living with dementia. Nursing care is not provided. There were 36 people accommodated there on the day of our inspection.

The service 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.

We found the provider had met the assurances they had given in their action plan. People were happy with the help they received with medicines. Staff ensured medicine record keeping was accurate, stock control for boxed medicines was robust and the storage of topical medicines was safe. A photograph of every person who needed support with medicines was retained on the medicines file to ensure they could be easily identified and mistakes avoided.

Garden Lodge Care Home provides accommodation and personal care for up to 41 people, including people living with dementia. Nursing care is not provided. There were 31 people accommodated there on the day of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the 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.

People told us they felt safe and were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

The building was generally safe and well maintained. Water temperatures required attention to ensure they remained at a safe and comfortable level. This was resolved at the time of the inspection. The home was clean. Risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring.

We observed staff act in a courteous, professional and safe manner when supporting people. At the time of our inspection, the levels of staff on duty were sufficient to safely meet people’s needs. The provider had a robust system to ensure new staff were subject to thorough recruitment checks. There was a low turnover of staff.

Improvements were required to the way medicines were managed. Some records were not fully completed and external medicines (creams applied to the skin) were not stored safely. People received the support they needed to ensure they were taken as prescribed.

As Garden Lodge Care Home is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. Where necessary a DoLS had been applied for. Staff obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge was up to date. Staff were well supported by the registered manager.

Staff were aware of people’s nutritional needs and where people were at risk of dehydration or malnutrition appropriate support was provided. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to attend medical appointments.

Activities were offered within the home and people also accessed local community facilities and activities. We observed staff interacting positively with people. We saw staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidences were maintained. Staff understood the needs of people and we saw care plans and associated documentation was clear and person centred.

People using the service and staff spoke highly of the registered manager and felt the service had good leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people receiving care and oversight from external managers.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the management of medicines. You can see what action we told the provider to take at the back of the full version of this report.

People had their needs assessed and the information gathered was used to develop personalised care plans.

Medicines were only administered by senior staff that had completed relevant training. We found the provider had specific policies and procedures in place for the safe handling of medication.

Staff told us they were well supported by their manager and had opportunities to work towards additional training and qualifications. One staff member commented, 'I feel well supported, I can go at any time to talk to the manager or deputy.'

We found people and their relatives were asked for their views about the service. The provider had audit systems in place to ensure that any gaps in the service were identified and dealt with.

The provider had a complaints procedure which was available to people who used the service. People told us they knew how to complain and confirmed they were happy with the service they received. One person commented, "The staff are very fair, I have no grumbles.'

We found care records were not always accurate or fit for purpose. Care plan evaluations lacked sufficient detail to enable an understanding of action taken to respond to people's changing needs.

We observed care and support provided to people who were unable to communicate verbally with us. People who lived in the home looked well cared for and comfortable in their surroundings and with staff. There was a friendly atmosphere with staff finding time to provide activities and chat with people living at the home.

Staff had a good knowledge and understanding of safeguarding and how to keep people safe. All staff completed safeguarding training to ensure that they had the skills and knowledge to keep people safe.

We saw that people who use the service and their families were asked for their views about the service and their care and that this was used to influence and improve the service.