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Archived: Princess Lodge Care Centre Good

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Reports


Inspection carried out on 30 January 2018

During a routine inspection

We inspected this service on 30 and 31 January 2018. Princess Lodge Care Centre is a residential setting which means people receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service comprises of three floors, this includes a recently introduced designated end of life unit and a unit for people living with a dementia. Princess Lodge Care Centre is registered for up to 85 people. On the day of our inspection 61 people were living at the service.

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 ser

Inspection carried out on 7 January 2016

During a routine inspection

We inspected this service on 7 January 2016. This inspection was unannounced. Princess Lodge Care Centre is a care home with nursing providing care and accommodation to 85 older people older people requiring personal care. On the day of our inspection 66 people were living at the service.

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.

People were not always protected against the risks associated with the management of medicines. We identified the amount of medication in stock did not always corresponded correctly to stock levels documented on Medicines Administration Records.

The environment was safe and clean. There were enough staff on duty to meet people’s needs. People were assisted promptly and with no unnecessary delay. Staff and people told us there were sufficient numbers of staff on duty to meet people’s needs.

There was a recruitment system in place that helped the management make safer recruitment decisions when employing new staff. People were cared for by staff that were knowledgeable about their roles and responsibilities and had the relevant skills and experience. Staff received regular appraisals and they told us they were well supported by the provider.

People told us they felt safe. Staff were knowledgeable about how to recognise signs of potential abuse and aware of the reporting procedures. There were appropriate assessments in place that identified risks to people. These were supported by management plans to manage any risks, ensure people’s safety and promote their independence.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The MCA is the legal framework that protects people’s right to make their own choices. DoLS were in place to ensure people’s liberty is not unlawfully restricted and where it is, that it is the least restrictive practice.

People’s care needs were met and there was a calm and relaxing atmosphere at the service. People were supported by staff who respected their privacy and dignity and promoted their independence. Staff spoke about the people they cared for in a professional manner and they built positive, caring relationships with people.

People were supported to eat and drink enough to meet their nutritional and hydration needs. People told us they were happy with the food provided and commented positively on the quality of meals.

People’s care documentation provided the details staff required to enable them to meet people’s individual needs. This included people’s wishes and preferences related to the activities.

The people we spoke with said they knew how to make a complaint if required and would feel comfortable speaking to staff if they had any concerns. The registered manager ensured when complaints had been raised these had been investigated and resolved promptly and in a timely manner.

The registered manager had quality assurance systems in place to monitor the safety and quality of the service.The registered manager ensured there were opportunities for people and their relatives to provide feedback about the service.

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

Inspection carried out on 2 March 2015

During an inspection looking at part of the service

At an inspection of this service in July 2014 we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We issued the provider with three compliance actions and five warning notices stating that they must take action. We shared our concerns with the local authority safeguarding adults and commissioning teams. The local authority placed an embargo on new admissions to the home.

On the 18 September 2014 we inspected the service to follow up three of the warning notices. Some of the actions had been completed. Changes had been made to address the concerns but the inspection also highlighted further areas for improvement and we issued further compliance actions.

We carried out an unannounced comprehensive inspection of this service on 9 December 2014. Further improvements were noted but three breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to continue making improvements to meet the legal requirements in relation to care and welfare of people who use services, maintenance of accurate care records, supporting workers and staffing levels.

We undertook this focused inspection on 2 March 2015 to check that the provider had followed their action plan and to confirm that the service 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 Princess Lodge Care Centre on our website at www.cqc.org.uk.

People had care records that provided sufficient instructions to staff on how to support them and these were regularly reviewed to reflect people's changing needs. Records relating to people's care were completed when care took place to reflect an accurate record of care received.

There were enough skilled and experienced staff to meet people’s needs. This meant people were able to get up, be supported with personal care and receive their medicines and meals in a timely way.

Staff had more time to interact with people. People were encouraged and supported to take part in social activities. People in their rooms benefitted from more interaction with staff. 

Staff were supported to improve the quality of care through training and the supervision and appraisal process.

Although the required improvements had been made we have not changed the overall rating for this service because we want to be sure that the improvements will be sustained and embedded in practice. We will check this during our next planned Comprehensive inspection.

Inspection carried out on 9 December 2014

During a routine inspection

We visited Princess Lodge Care Centre on 9 December 2014. Princess Lodge Care Centre is registered to provide accommodation for 85 older people who require nursing and personal care. At the time of the inspection there were 65 people living at the service. The home consists of three floors and is arranged into four units; Phoenix, Robin, Nightingale and Kingfisher. This was an unannounced inspection.

At our inspection in July 2014 we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These were relating to respecting people who use services, care and welfare of people who use services, meeting nutritional needs, staffing levels, supporting workers, safeguarding service users, records and assessing and monitoring the quality of service provision. We issued the provider with three compliance actions and five warning notices stating that they must take action. We shared our concerns with the local authority safeguarding adults and commissioning teams. The local authority placed an embargo on new admissions to the home.

On the 18 September 2014 we inspected the service to follow up three of the warning notices. The actions in relation to respecting people who use services had been completed. Changes had been made to address the concerns outlined in the warning notice in relation to care and welfare of people who use services and meeting nutritional needs but the inspection also highlighted further areas for improvement and we issued compliance actions.

At this inspection we found action had been taken to rectify the breaches in relation to meeting nutritional needs, safeguarding service users and assessing and monitoring the quality of service provision. There were continued shortfalls in relation to the regulations for care and welfare, staffing, supporting workers and care records.

People were not always supported in line with instructions in their care plans and some care plans did not provide sufficient instructions to staff on how to support people.

There were not always enough skilled and experienced staff to meet people’s needs. This affected the time people were able to get up and when they received their medicines. Staff did not always have the time to interact with people unless they were involved in providing a care task.

Staff were not always supported to improve the quality of care through training and the supervision and appraisal process.

There was a registered manager who had been in post since November 2014. 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. The registered manager had a clear understanding of the changes and improvements that were required. People, their relatives, visiting health professionals and staff recognised that improvements were taking place.

People told us they liked living at the home and were treated in a caring and friendly way. People and their relatives were complimentary about the permanent members of staff. People were supported with their personal care discretely and in ways which upheld and promoted their privacy and dignity.

Peoples nursing and health care needs were met. Staff were knowledgeable about people’s individual needs and preferences. People were supported to make decisions about their care and to maintain their physical health. Where required staff involved a range of other professionals in people’s care to ensure their needs were met. Staff were quick to identify and alert other professionals when people’s needs changed.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see the action we took and what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 18 September 2014

During an inspection looking at part of the service

At this inspection we found that people experienced care, treatment and support that met their physical and healthcare needs. There were some improvements that still needed to be made to meet peoples social, psychological and mental health needs. We will monitor the home and return to carry out another inspection to check the home has continued to make and sustained the improvements.

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.

Inspection carried out on 10 July 2014

During an inspection in response to concerns

We carried out this inspection because we had received concerns that people were not receiving care that was safe, effective, caring, responsive and well-led.

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.

Inspection carried out on 5 December 2013

During an inspection looking at part of the service

We last inspected Princess Lodge Care Centre in June 2013. We found the provider was not meeting two of the essential standards of quality and safety. On the 5 December 2013 we undertook a further inspection of Princess Lodge Care Centre. We observed care on three units of the home, reviewed nine care plans and spoke with five people and their relatives.

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.

Inspection carried out on 17, 21 June 2013

During a routine inspection

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.

Inspection carried out on 4 February 2013

During an inspection looking at part of the service

We did not speak with people as part of this inspection. However, we observed staff responding to people's needs promptly.

Inspection carried out on 28 June and 3 July 2012

During a routine inspection

We looked at the latest annual questionnaires to people who use the services. Two people said about the standard of care, "Top-class, I'm treated like a person, not just a body in a bed," and "they look after me really well." Another person said they had been invited to discuss their care plan "I like being there and able to have my say not just being told what is happening."

They were asked about dignity and privacy. One person said �yes, when giving me personal care they make sure no one can see me." Another person said "most people knock on my door before coming in but not everyone." A third person said "when I want to be left alone people do allow me to do this." A fourth person said "the patients can be left for long periods of time on their own when no member of staff is present but I myself don't mind that."

Inspection carried out on 8 April 2011

During a routine inspection

One person we spoke with said �there are so many nice people to help you� and �there are usually plenty of things to do�.

A relative said that they think Princess Lodge is a �super place� and never minds visiting because they are made to feel �at home�.

A person spoke about their partner visiting and how they are made to feel welcome. This person described the staff as very helpful and said they feel �safe at Princess Lodge� comparing it favourably to other care homes they had lived in.

Another person told us how they were given the names of two care homes to visit by their social worker. The person�s partner looked at both and chose Princess Lodge over the other home as they thought it was the �nicest�. The person told us that there had been a delay in their discharge from hospital but that the home had made sure they were welcomed with a meal before being settled into their room.

A person told us their �room is nice�.

People described the staff as �lovely� and �great with one person telling us how they relate to one particular member of staff that talks with them about football. Another person told us how they like to speak with a carer about photography. One of the people we spoke with told us that they perceive staff to be particularly quiet when assisting with personal care tasks. They said that it seems as if �staff find it difficult talking�.

One person told us that they like the food choices available and knew that they would be offered something different if they did not like the menu options. Another person told us that they like the food provided and feel that people are �fed well�. They also told us that they enjoy having breakfast in bed.

One person told us that they have never had cause for compliant but would speak to staff if they were unhappy. Another told us that if they had a general complaint they would speak with one of the �office staff�, referring to the manager, deputy and administrator, and if it was health related, to one of the nurses. A third person told us that they knew how to complain but �had never had cause to be unhappy, none whatsoever�.

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