Archived: Cleveland Lodge

Updated 27 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook a focused inspection of Cleveland Lodge on 29 November 2017. This focussed inspection was carried out to assess whether the provider had taken action to ensure they were meeting all of the regulations and adhering to conditions imposed on their registration.

We inspected the service against three key questions we ask about services: is the service safe, is the service effective, and is the service well-led. This is because the service was not meeting some legal requirements in relation to those questions.

The inspection was undertaken by two inspectors, a specialist nurse adviser 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.

Before our inspection we reviewed the information we held about the home, this included monthly updates the provider had sent us and any notifications received. Notifications are information about specific important events the service is legally required to send to us.

We used a number of different methods to help us understand the experiences of people who use the service. This included talking with eight people and three visiting relatives about their views on the quality of the care and support being provided.

We looked at documents that related to people's care and support and the management of the service. We reviewed a range of records, which included eight care and support plans, daily records, staff duty rosters, complaints, staff meeting minutes and staff files. We looked around the premises and observed care practices.

We spoke with the registered manager, the owner, one senior carer, three care staff and the chef. We received feedback from one health and social care professional who worked alongside the service.

Updated 27 February 2018

At the comprehensive inspection of this service in February 2017 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with a Notice of Decision, imposing conditions on their registration for two of the breaches. This was because records of medicines management were not always completed correctly and staff had not received the necessary supervision and training to enable them to carry out their duties. We also found a sufficient number of staff were not deployed in order to meet the needs of people using the service and keep them safe at all times. We issued a requirement notice for one breach, stating they must take action. This was because the service did not make every reasonable effort to provide opportunities to involve people in making decisions about their care and treatment, and support them to do this. We shared our concerns with the local authority safeguarding and commissioning teams.

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

We undertook an unannounced focused inspection of Cleveland Lodge on 29 November 2017. We inspected the service against three of the five questions we ask about services: is the service well led, is the service safe and is the service effective. This is because the service was not meeting some legal requirements.

Cleveland Lodge is a care home which provides accommodation and personal care for up to 18 older people who are living with dementia. At the time of our inspection 13 people were living at Cleveland Lodge.

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.

Medicine administration systems were not safe. Procedures were not in place for medicines to be taken "when required" (PRN). Medicine Administration Records (MAR) showed people were receiving PRN medicines. We also found missing signatures on peoples MAR’s and not all staff who administered medicines were competent to do so. An audit completed by the provider had identified shortfalls, but sufficient action was not taken to address these issues.

The service was not consistently meeting the requirements of the Mental Capacity Act 2005 (MCA). The service was liaising with Wiltshire Quality Assurance team and had received advice on the implementation of the MCA.

We found lessons were not always learnt and the registered manager had no action plan in place on how they were making improvements to the service and monitoring the outcome of accidents and safeguarding incidents.

Where people were losing weight or was at risk of dehydration, food and fluid intake was monitored and consumption was recorded daily. However, we found the monitoring forms had no information about the target the person should reach each day and the actual total of their food and fluid intake. This meant staff would not be able to identify if there were any concerns about a person’s food and fluid intake.

We found where people had been losing weight, options such as a fortified diet had not been considered.

Where people had specific dietary requirements, for example coeliac disease, there were clear instructions regarding the need for a gluten free diet both within the care plan and a record kept in the kitchen.

The registered manager worked alongside staff, which gave them an insight into staff practice. However, that left no time for the registered manager to manage the service. The registered manager told us “residents” had to come first.

Staffing levels had improved and staff were more visible and available to people. A new senior carer was due to start soon and the registered manager told us they would be able to step back and spend more time managing the service.

The registered manager observed staff performance; however staff had not received formal supervisions or appraisal. Staff felt supported by the registered manager. Staff told us they had received the necessary training to complete their role. However, they felt they could benefit from further training about the management of behaviours that could be seen as challenging.

People who were able to tell us, said they felt safe living at Cleveland Lodge.

Staff told us they knew the processes they needed to follow should they suspect abuse had taken place. Staff said they would report abuse if they were concerned and were confident the registered manager would act on their concerns.

The building was easily accessible for people living with dementia. There were coloured walls, pictorial signage on bathroom and toilet areas and clearly named room doors to help people find their way around independently.

People, relatives, staff and visiting professionals spoke positively about the registered manager. The registered manager and owner told us they were continuously looking at improving the service. New ideas from staff were encouraged.

We found two repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The Notice of decision, imposing conditions on the provider's registration remains and they continue to send us monthly updates. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.