Nene Lodge Retirement Home

Nene Lodge Retirement Home is registered to provide accommodation and support for up to 52 older people. At the time of our inspection, there were 28 people living at the service.

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

Guidance for staff about how to meet people’s individual care needs and mitigate known risks, had not been consistently reviewed, kept up to date or made available.

The provider used a dependency tool to determine staffing levels required. However, this did not consider the layout of the building and the staff rota showed occasions when care staff levels were below what was expected.

People spoke positively about the service they received and highly of the management and staff team. However, examples were given of long wait times for calls for assistance and how staff were constantly busy and lacked time to spend with people.

Medicines management did not consistently follow expected best practice guidance. However, no person had come to harm.

The service was found to be clean and hygienic. Staff had access to personal protective equipment. Clinical waste was not disposed of as required. We discussed this with the provider who agreed to take action.

People’s experience of visiting arrangements differed, with some people raising concerns about restrictions. The provider confirmed there were no restrictions and agreed to notify people and visitors of this.

Systems and processes that monitored quality and safety were not fully effective. Audits and checks were not always recorded to confirm checks had been completed and what the outcome was. This impacted on opportunities to continually develop and improve the service.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection, no person had a DoLS. However, we were concerned a DoLS was required for a person and asked the provider to submit an application.

Following the recent pandemic, resident and relative meetings had stopped. However, the provider was planning to introduce these again. People and relatives were confident they could raise any issues or concerns with the management team. Quality assurance procedures included an annual feedback survey for people and relatives to share their experience.

Safeguarding information was available to people. Staff had received training and understood their role and responsibility to protect people from abuse and avoidable harm.

Staff were positive about working at the service and the support they received. Visiting professionals gave positive feedback about their experience of working with staff to support people in their ongoing care needs.

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

Rating at last inspection

The last rating for the service was good (published 21 February 2020).

Why we inspected

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

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 has changed good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

We have identified two breaches in relation to the provider’s governance systems and processes and staffing at this inspection.

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

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nene Lodge Retirement Home is registered to provide accommodation and support for up to 52 older people. There were 36 people living in the home on the first day of our inspection.

The registered provider also provides day care in the same building as the care home. This type of service is not regulated by the Care Quality Commission (CQC).

People’s experience of using this service:

People were at the heart of the service and everyone with we spoke with told us of the exceptionally kind and compassionate care they received at Nene Lodge. One person said, “It feels like home. I am very happy here."

Staff understood people’s individual care needs and preferences and used this knowledge to provide them with flexible, responsive support. Staff worked in a non-discriminatory way and promoted people’s dignity, privacy and independence.

The provider involved people and their relatives in planning and reviewing their care and deployed sufficient staffing resources to meet people’s individual needs and preferences. People were provided with food and drink of their choice which met their nutritional requirements.

Staff worked together in a mutually supportive way and communicated effectively with a range of other organisations. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively.

Staff worked collaboratively with local health and social care services to ensure people had access to any support they required. Systems were in place to control and prevent infection. People's medicines were managed safely in line with their individual needs and preferences.

Staff were aware of people’s rights under the Mental Capacity Act 2005 and supported people to have maximum choice and control of their lives, in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. Staff recruitment practice was safe.

The registered manager provided strong, supportive leadership and was respected and admired by staff. A range of audits was in place to monitor the quality and safety of service provision. There was organisational learning from significant incidents and any concerns were well-managed. Formal complaints were very rare. The provider was committed to the continuous improvement of the service in the future.

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 26 April 2017). At this inspection we found some improvements in the quality of the service. The overall rating remains Good but with a rating of Outstanding in Caring.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers (‘the provider’) 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.

Following our last inspection in October 2014 we rated the home as Good. At this inspection we were pleased to find service quality had been maintained and the rating remains as Good.

One of the directors of the registered provider (‘the owner’) worked hands-on seven days a week and had a personal and highly principled commitment to caring for people with kindness and compassion. This was clearly understood by staff and reflected in every aspect of their work. Staff understood what was important to each person and worked closely with each other and other professionals to promote their well-being and happiness.

The provider had a rigorous approach to staff recruitment to ensure new care staff had the right values to work in a caring and person-centred way. Staff had the knowledge and skills required to meet people’s individual needs effectively and were actively encouraged to study for national qualifications. Staff demonstrated their understanding of how to support people who lacked capacity to make some decisions for themselves.

Both the owner and the registered manager maintained a visible, hands-on role within the home and provided staff with strong, values-led leadership. Staff worked together in a well-organised and mutually supportive way and were proud to work in the home.

The provider organised a programme of communal activities and events to provide people with physical and mental stimulation. People were provided with home-cooked food of good quality that met their individual needs and preferences.

The provider was committed to the ongoing improvement of the home and maintained a range of systems to monitor service quality. The provider sought people’s opinions through regular customer surveys and encouraged people to raise any concerns or suggestions directly with the registered manager or owner.

The provider assessed any potential risks to people’s safety and welfare and put preventive measures in place where required. Staff knew how to recognise and report any concerns to keep people safe from harm.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required.

People had been given accurate information about the fees they would have to pay. Records showed that people had been correctly charged for the facilities and services they had received.

People said that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

People were protected from the risk of infection because appropriate guidance had been followed and because good standards of hygiene were being maintained.

There were robust recruitment and selection procedures to help ensure that staff were trustworthy and caring people.

There were measures to check that people were being reliably provided with the facilities and services they needed.

People we spoke with told us care met their needs. A relative told us, 'They look after all mum's needs. If she has an episode they deal with mum first and then let me know.'

People told us they were involved in their care and records showed they had signed their care plans.

People we spoke with told us the staff worked hard. One person said, 'They are pretty good the girls here. They have always got plenty to do but they do a good job.'

We spent time observing the mid day meal and could see people were happy with the meal. One person told us, 'We have good meals.' Although there was no choice offered at the mid day meal people were aware they could request something different. The cook and care workers were aware of peoples food likes and dislikes.

We saw one person who chose to have a banana on their cereal for breakfast was not supported in this choice and purchased their own fruit.

The home was not maintained to an appropriate level of cleanliness and infection control methods were not always robust.

Medication was managed appropriately.