Archived: Princess Lodge Care Centre

At the last inspection in January 2016 the service was rated requires improvement in safe domain and rated Good overall.

At this inspection we found the service improved, was Good in all areas and rated as Good overall.

There was 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.

During our last inspection we found concerns around medicines stock control and that some of the topical medicines, cream, had no opening date recorded which meant it was not always clear whether these topical medications were still safe for use. At this inspection we found the provider addressed these concerns and the medicines were managed, stored and administered safely.

People remained safe at the service. Staff knew how to recognise safeguarding concerns and what to do if they suspected any abuse. The provider had relevant safeguarding policies and systems in place and the staff were familiar with the local authority’s safeguarding procedures.

Risk assessments were carried out to promote people’s well-being and recognise people’s individual abilities. The environment was clean and well maintained and staff adhered to infection control guidelines.

There were enough staff to keep people safe and people were assisted promptly and without unnecessary delay. The provider followed safe recruitment procedures. Staff were knowledgeable, skilled and had the relevant skills and experience. Records confirmed staff received regular supervision sessions and they told us they were well supported.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. 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. People’s rights to make their own decisions were respected.

People were supported to access health professionals when needed and staff worked closely with various external professionals to ensure people’s health needs were met. The service remained responsive to people's needs and ensured people’s changing needs were recognised and appropriate changes to support were implemented promptly. People knew how to complain but told us they never needed to as any small concerns were being addressed promptly.

The service continued to support people in a caring way. People were treated with kindness and as individuals. People were involved in decisions about their care needs and the support they received. People’s dignity, privacy and confidentiality were respected, and they received person centred care that included access to information that met their needs.

The service was well-led by an experienced and motivated registered manager who ensured staff put people at the forefront of the service delivery. There was an open and positive culture that valued and engaged people, relatives and staff. The registered manager had good systems to monitor the quality of the service provided and ensured new ideas were explored to sustain high standards. The service worked well with various external professionals who were very positive about how the service was run.

Princess Lodge Care Centre is registered to provide accommodation for 85 older people who require nursing and personal care. The home consists of three floors and is arranged into four units; Phoenix, Robin, Nightingale and Kingfisher.

When we previously inspected the home on 10 July 2014 we identified a number of areas where improvements were needed to ensure that people were receiving care that was safe, effective, caring, responsive and well-led. Following our visit we issued the provider with five warning notices stating that they must take action to address the issues we had raised. We also issued three compliance actions and raised our concerns with the local authority safeguarding adults and commissioning teams. The local authority placed an embargo on new admissions to the home.

We told the provider they must take action to address the issues we had raised in three of the warning notices by 31 August 2014. We carried out this inspection to check the improvements had been made. These warning notices were issued against the regulations for respecting people who use services, care and welfare of people who use services and meeting nutritional needs. We did not follow-up on the other two warning notices or areas of non-compliance at this time as the home was still in the process of implementing improvements in these areas. We have worked In partnership with the local authority safeguarding and contracts teams to monitor the home's action plan to ensure that we are satisfied that it is taking action to meet the relevant standards, and that outcomes for people who use services has improved.

The inspection team who carried out this inspection consisted of two inspectors and an Expert by Experience, who had experience of people living with dementia. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

On the day of our visit there were 66 people living at the home. We spoke with 8 people who used the service, 4 of their relatives and 10 staff. We observed care and treatment and looked at the weight charts and wellbeing records for all residents in the home. We also carried out a short observational framework for inspection (SOFI). A SOFI is used to capture the experiences of people who used the service who may not be able to express this for themselves.

Below is a summary of what we found at this inspection. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service well led?

Since our last visit the provider had taken action to address all the concerns raised by CQC. They had employed a new manager for the home and had implemented an extensive improvement plan. The plan included the recruitment of additional care and managerial staff, which was still underway when we visited. The management team were taking appropriate steps to improve the service and lead its development, however it is too soon to be able to see if these changes are embedded and sustained. The new manager had a clear understanding of the changes that were required and staff recognised that improvements were taking place.

Is the service safe?

The provider has taken action and continues to make changes to improve the safety of people living at Princess Lodge. We have asked the provider to tell us what they are going to do to continue with their safety improvement plan.

Is the service effective?

We spoke with people and their relatives and asked them if improvements had been made to the care they received since our last inspection. One person told us 'I think staff have a different attitude towards their work since the problems were highlighted'. Another person said 'there's a lot of smiling residents here, that's a good sign'. One relative said 'things are much better than they used to be and people [staff] are trying much harder'.

People's health and care needs were assessed, monitored and were reviewed more regularly.

Since our last inspection improvements had been made to the breakfast service and people were now served breakfast in a timely fashion. However, we found the lunchtime dining experience needed improvement. We have asked the provider to continue to make improvements to the mealtime experience. Further work is also required to ensure people on specific diets are offered appropriate choices.

Is the service caring?

People were spoken to and care was delivered with dignity and respect. We observed staff interactions with people who lived at the home and saw this was friendly and caring. People told us they were happy living at the home. One person said 'I couldn't be anywhere better'.

Call bells and tables with snacks and drinks on were within the reach of people who remained in bed.

Is the service responsive?

Communication had improved in the home which meant staff sought medical advice promptly when people's health deteriorated. Specialist advice had been sought for people who had lost weight and their advice was being followed. We saw that most people were now maintaining or putting on weight.

Activities throughout the home had improved. More people were supported to spend time out of bed. We have asked the provider to continue to make improvements to the opportunities for social stimulation for some people.

Princess Lodge Care Centre is registered to provide accommodation for 85 older people who require nursing and personal care. The home consists of three floors and is arranged into four units; Phoenix, Robin, Nightingale and Kingfisher.

On the day of our visit there were 72 people living at the home. We spoke with 21 people who used the service, 12 of their relatives and 21 staff. We observed care and treatment and looked at ten care records. We also carried out a short observational framework for inspection (SOFI). A SOFI is used to capture the experiences of people who used the service who may not be able to express this for themselves.

The inspection team who carried out this inspection consisted of three inspectors and an Expert by Experience, who had experience of people living with dementia and end of life care. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of service. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was not safe. We found people who used the service were being put at risk because accurate and comprehensive information about their care was not always being recorded. There were not sufficient numbers of suitably qualified, skilled and experienced staff to carry out the regulated activities. People who used the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider understood their responsibilities under the Mental Capacity Act 2005 in relation to the Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

The service was not effective. Effectiveness relates to how well the planned care works for people. Records did not provide sufficient and accurate information that enabled care to be planned and delivered in a way that promoted people's safety and welfare. We found, people were not always supported to eat or drink enough to maintain their health. Staff had not always received training to meet the needs of people living at the home. We also found there were not suitable arrangements in place to ensure nurses and care workers were supported to deliver care through receiving appropriate supervision and appraisal.

Is the service caring?

The home was not consistently caring. People were positive about the care they received, but this was not supported by some of our observations. Care did not always take account of people's individual preferences and did not always respect their dignity. People were not always spoken to in a way that was respectful or caring. Tables with snacks and drinks on were not always within the reach of people who remained in bed. People who were in their rooms received very little attention. Call bells had been removed or were out of reach of people which meant they were not always able to alert staff when they needed assistance.

Is the service responsive?

The home was not always responsive to people's needs. We saw evidence that nurses and care workers sometimes recognised when a person's condition changed or their health had deteriorated and sought the help and advice of the medical team or other professionals. However, people that had lost significant amounts of weight had not been referred to a dietician and care records did not always show the most up-to-date information on people's needs and risks to their care.

There were not enough meaningful activities for people to participate in as groups or individually to meet their social needs; so some people living at the home felt isolated.

Is the service well-led?

The service was not well led. People were put at risk because systems for monitoring quality were not effective. We found that the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. In addition, there was not enough staff on duty at certain times of the day.

The service has not had a registered manager in post since April 2014. The interim management team told us that a new manager had been recruited but was not yet in post because they were undergoing relevant pre-employment checks.

We found staff interacted well with people. We also noted care and support was appropriately assessed and recorded. Care plans were person centred and we observed care and treatment being provided in line with people's preferences and wishes.

People were provided with a suitable and nutritious diet. We saw malnutrition universal screening tool (MUST) assessments which identified risks to people's nutritional needs. We observed how staff appropriately supported people with eating and drinking.

People told us they felt safe living at Princess Lodge. We saw records to confirm that staff had undertaken safeguarding training and were able to tell us how they would report concerns. However, we also found that people were not always protected from the risks of unlawful or excessive restraint because the provider had not always undertaken an appropriate capacity assessment or the held best interest meetings in relation to a Deprivation of Liberty Safeguards (DoLs) application.

We spoke with three people and three relatives. One person said 'staff really look after me well'. Another person said 'Staff care about me so much.' They said that staff treated them with dignity and respect and they respected their privacy. They told us that staff talked to them and sometimes 'they had a good old laugh'. One relative told us that they chose Princess Lodge because it was light, modern and the staff were all very friendly and worked well with the people living there.

People's needs were assessed and care and treatment was planned but it was not always deliverd effectively to meet people's needs. People and their relatives told us that they had been involved in developing their care plans and they had given their consent to care and treatment.

Some people told us that the food was very good and there was plenty of choice. They said that they were offered a variety of drinks throughout the day. However, we saw that sometimes people were not offered choices. There was a risk that people's needs in relation to food and drink would not always be met.

A relative said there were always enough staff on duty. We saw there were enough skilled and experienced staff to meet people's needs. There were qualified nurses and care staff had the opportunity to obtain care qualifications.

There was a complaints procedure. People told us that they had raised concerns and that staff had responded to these quickly and to their satisfaction.