You are here

Reports


Inspection carried out on 19 November 2020

During an inspection looking at part of the service

About the service

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.

Inspection carried out on 27 November 2018

During a routine inspection

This inspection took place on 27 November 2018 and was unannounced.

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.

Inspection carried out on 29 September 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 20 and 21 April 2016. One breach of legal requirements was found at that time. This related to a breach of regulation regarding safe care and treatment, specifically in relation to the safe management of medicines. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements.

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.

Inspection carried out on 20 April 2016

During a routine inspection

We carried out an inspection of Garden Lodge Care Home on 20 and 21 April 2016. The first day of the inspection was unannounced. We last inspected Garden Lodge Care Home in September 2015 and found the service was meeting the relevant regulations in force at that time.

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 (Regulat

Inspection carried out on 9 September 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 21 and 23 January 2015. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulation regarding Deprivation of Liberty Safeguards (DoLS) and record keeping.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the revised 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 on our website at www.cqc.org.uk.

Garden Lodge is a care home for up to 41 older people, some of whom may be living with dementia. At the time of the inspection 36 people were living at Garden Lodge. All bedrooms are located on the ground floor and the upstairs area is office space and a guest room. The ground floor has two units. 20 people live in the ‘residential’ part and 14 people live in the part of the building designated for people living with dementia.

A registered manager was in post at the time of the inspection. 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 and were no longer in breach of the relevant regulations.

Improvements had been made to the way staff supported people who lacked capacity to make complex decisions. The registered manager ensured each person’s capacity was assessed and decisions made in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Appropriate authorisations were sought from the local authority and these related to specific decisions and restrictions, such as not being able to leave the home unaccompanied. Staff’s awareness of the MCA and DoLS had been improved by the training they had received.

The standard of care planning and record keeping had improved. Care plans were person centred, accurate and up to date. People using the service and their relatives were involved in care planning arrangements and attended periodic reviews of their care.

Inspection carried out on 21 and 23 January 2015

During a routine inspection

This inspection took place on 21 January 2015. This was an unannounced inspection. This means the provider did not know we would be inspecting. A second, announced day of inspection took place on 23 January 2015. We last inspected Garden Lodge on 22 October 2013 where we found the provider to be meeting all the required standards.

Garden Lodge is a residential care home for up to 41 older people, some of whom may be living with dementia. At the time of the inspection 34 people were living at Garden Lodge. All bedrooms are located on the ground floor and the upstairs area is office space and a guest room. The ground floor has two units. 20 people live in the residential part and 14 people live in the part of the building described by the registered manager as for Elderly Mentally Infirm (EMI).

A registered manager was in post at the time of the inspection. 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.

Risks were managed and evaluated on a monthly basis as were care plans. We found that changes in care needs did not always lead to a new care plan or risk assessment being completed. This meant people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

We found that people’s consent had not always been recorded and where decisions had been made on people’s behalf their capacity to consent had not always been assessed and recorded.

People and their relatives told us they felt safe living at Garden Lodge. Staff were appropriately trained and were knowledgeable about how to report any concerns. Supervisions were completed regularly with all staff and we saw that everyone had received an annual appraisal in the past 12 months. Supervisions and appraisals are used to assess staff competency to care and support for people.

Accidents and incidents were appropriately recorded and investigated and all necessary action had been taken. This included referring people for medical advice and the use of assistive technology such as sensor mat’s to alert staff to when people were getting up so appropriate support could be provided.

People told us there were enough staff to meet people’s needs and everyone we spoke with told us staff had time to support them and they were not rushed. The registered manager brought additional staff in as and when needed and was able to increase staffing levels if people’s needs changed or as people moved in to Garden Lodge.

Recruitment procedures were robust and all staff had their Disclosure and Barring Check renewed every three years.

Medicines were managed safely and staff were well trained and supported in the safe administration of medicines.

People’s nutritional needs were well catered for and people told us how lovely it was to have “proper, home cooking.” Meal times were sociable events with lots of chatter and engagement. People received one to one support if they needed help with enjoying their meal.

Staff were observed to be knowledgeable about people’s histories and preferences and were seen spending time with people engaging with them in a caring and respectful way. Staff were conscious of maintaining people’s dignity and where support was needed they offered this in a discrete and private manner.

People told us they enjoyed the activities that were on offer, and were able to make suggestions about what they would like to do. There were lots of photos around the home of people enjoying themselves and socialising with each other.

Garden Lodge was well managed, and the registered manager was very active in supporting people and working alongside their team. This ensured a culture of good quality support. People told us the home was well managed and we saw that regular meetings were held with people, their families and staff to discuss any changes or suggestions for improvements.

There were audit processes in place to monitor and review the quality of the service and we saw that suggestions had been acted upon.

You can see what action we have told the provider to take at the back of the full version of the report.

Inspection carried out on 23 October 2013

During an inspection looking at part of the service

The provider had reviewed and updated people's care records to ensure they were appropriate for their current needs. Care plan evaluations contained sufficient detail to document the action taken by staff to respond to people's changing needs.

Inspection carried out on 11 June 2013

During a routine inspection

We found people who used the service were asked for permission before receiving care. One person commented, �Staff ask you what you want.� Another person commented, �This is an ideal place for people, staff are great.�

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.

Inspection carried out on 28 November 2012

During a routine inspection

People were supported in promoting their independence and community involvement. We saw from care records and from speaking with people that some people were accessing the community independently. We observed that people's diversity, values and human rights were respected and staff treated people with respect.

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.

Inspection carried out on 25 May 2012

During an inspection in response to concerns

People able to express a view told us they were very pleased with their care. One person said, �I love it, here, it�s a happy place. The staff are my friends, they are very kind. This is my home, now�. People told us they didn�t get bored in the home. Several people told us they thought there were enough activities.

Visiting relatives said that they were very happy with the standard of care in the home. One couple said, �We shopped around before coming here, and this was the best home�. Other relatives told us they and their relatives were treated with respect by the manager and her staff, and that there were no problems with the staff, who were described as �lovely�.

Opinions on activities varied. Some visitors said there were plenty of activities, and spoke highly of the home�s activity co-ordinator. Other visiting relatives told us they thought there could be more social stimulation.

Reports under our old system of regulation (including those from before CQC was created)