The Lodge Residential Home

We found the following examples of good practice

People had individual care plans and risk assessments to ensure their individual needs were met in relation to the COVID-19 pandemic. For example, staff had strategies in place to encourage people living with dementia to socially distance.

When people were isolated due to being COVID-19 positive they had a designated staff team and activities co-ordinator who worked exclusively with them.

The local authority awarded the service a certificate for their work during the pandemic praising them for delivering ‘a person-centred approach that was flexible and put residents at the heart of home’.

The Lodge is a care home that offers care and support to 32 older people, some of whom are living with dementia. At the time of the inspection 17 people were living at The Lodge.

People’s experience of using this service

• People were very happy living at The Lodge. They felt safe and liked the staff who looked after them. Relatives told us the service had improved significantly since the new manager started in January 2019. They were very satisfied with the service the staff gave to their family members and they felt their previous concerns had been listened to and acted upon. Staff were motivated by the improvements that had been made.

• Everyone praised the manager who was approachable, helpful and provided strong leadership. The manager had built a strong management team of two deputy managers and senior care workers. All staff were involved in the improvements at the service.

• The provider employed enough staff so that they could meet people’s needs in a timely way. Staff went through a thorough recruitment process so that the provider knew they only employed suitable staff. The staff team included very experienced staff who had worked at the service for several years. Staff enjoyed working together and supported each other and the management team.

• The manager had made an impact since joining the service. They, the management team and staff were clear about improvements that had to be made at the service. They were proud of what they had achieved in a short period of time but understood that improvements had to be sustained and built upon.

• The manager had made improvements to systems that kept people safe from avoidable harm. They had reviewed and improved risk assessments that staff followed to ensure that people received safe care. Staff knew who to report any concerns to and assessments of potential risk ensured that people were as safe as possible. Staff undertook training that supported them to have the knowledge and skills to do their job well and effectively meet people’s needs.

• Staff knew each person well, including their likes and dislikes and their preferences about how they wanted staff to care for them.

• Staff gave people their prescribed medicines safely. The manager had improved the arrangements for the safe management of medicines. Staff followed good practice guidelines to help prevent the spread of infection. The premises were clean and fresh.

• The kitchen staff cooked a variety of nutritious meals, based on people’s choices and including special diets for those who needed them. External healthcare professionals supported staff to help people maintain or improve their health.

• People made choices in all aspects of their lives, including being involved in decisions about activities they wanted to participate in.

• Staff respected people’s privacy and dignity and encouraged people to be as independent as possible. People had opportunities to decide on the care they wanted and to review and change the care if it was not meeting their needs. Care records reflected their decisions.

• A staff member organised meaningful and stimulating things for people to do. They organised group and individual activities, outings and entertainments. People with faith needs were supported to follow them.

• People knew how to complain and were confident that the manager would resolve their complaints.

• The provider had complied with the conditions we imposed after our last inspection. After this inspection the service was no longer in ‘special measures’.

• The local authority had lifted a suspension on new admissions to the service.

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

Rating at last inspection

At the last inspection we rated this service inadequate (report published on 13 November 2018). That inspection followed one in April 2018 when we required the provider to make improvements and issued a warning notice. At our last inspection we found the provider was in breach of four regulations. They had not notified CQC of all of the deaths or notifiable incidents that occurred at the home. They had not identified potential abuse of people and staff with the right skills and knowledge were not always deployed to meet the needs of people. We placed the service into special measures.

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.

Following the last inspection, we asked the provider to complete an action plan to tell us what they would do, and by when to improve the service. We gave the provider until 7 September to make improvements in the management of the service; and the provider told us they would have completed their actions in relation to the other breaches of the regulations by early September 2018.

Before we undertook our inspection visit we received information of concern from Leicestershire Local Authority about the management of the service and people’s safety. The local authority had needed to safeguard people from harm; and the provider had not informed us of the safeguarding concerns which is their legal obligation to do so.

This inspection focused on two of the five key questions we ask of services. Is the service ‘safe,’ and is the service ‘well-led.’

The Lodge Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Lodge accommodates a maximum of 32 people in one building, with bedrooms on the ground floor and first floor. At the time of our inspection visit, 21 people lived at the home.

Since our last inspection, the registered manager had left the service. 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. On the first day of our visit a new manager had started work at the service, but left two weeks after our inspection visit.

There were not enough staff who worked at the home who knew people’s needs to provide safe care. Because of staff absences and vacancies, many staff who worked in the home were temporary agency staff. Some of the permanent staff did not have the skills and knowledge to support people safely with their care. This was the third inspection where staffing was raised as an issue and lack of improvements made to meet the regulation.

The Leicestershire County Council quality team had to support the provider in ensuring medicines were administered to people because staff considered trained in medicine management; did not know how to order medicines and had not always administered and recorded their administration correctly. At the time of our visit, there had been some improvements, but we continued to find errors. This was the third inspection where medicines had not been managed safely.

Risk assessments and the associated care plans were not up to date (with some people’s care needs having changed significantly since the last update). This did not provide staff with accurate information about how to support people’s current care needs. This was the third inspection where risk assessments were not up to date.

People had not been safeguarded from harm because the lack of risk assessments and proper care planning contributed to staff not providing the right support to reduce the risk of people falling or skin being damaged from the lack of pressure area management.

The provider had a legal responsibility to inform the CQC of events which happen to people in the home. We had not received any notifications during a period where there were significant safeguarding issues being raised at the home.

Many of the actions detailed on the action plans submitted by the provider to the CQC to inform us of the improvements they were making to the service had not been acted on. The provider had not updated the CQC to inform us of this and the reasons why. Some of the concerns raised in our Warning Notice to the provider had not been addressed by the required due date of 7 September 2018.

The provider brought in a consultancy service to support them have management oversight of the home. The consultancy had identified many concerns at the service, but had not moved far in addressing them. There had been too much reliance in their action plans on IT software addressing the concerns raised, as opposed to making sure people with high dependency needs were protected by good auditing processes and systems.

During the second day of our inspection visit, we saw early signs of improvement; and the provider had further plans to improve the service. However, the changes were too recent to have had any meaningful impact on people who lived at the home; and the provider’s plans had not yet been fully put in place.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

At our last inspection visit on 21 August 2017 there were eight breaches of the legal requirements. These were for staffing; person centred care; safe care and treatment; safeguarding service users from abuse; notification of incidents; dignity and respect; receiving and acting on complaints; and good governance. During this inspection visit we found there continued to be breaches for staffing, safe care and treatment, and good governance.

The Lodge Residential Home provides care and accommodation for a maximum of 32 older people. Twenty nine people lived at the home at the time of our inspection. The home comprises of communal lounges and dining areas on the ground floor, and bedrooms on the first floor. The manager’s office is in one of the attic rooms.

The Lodge Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led, to at least ‘good’.

The home had the same registered manager as when we visited previously. 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 there continued to be concerns that staff were not responding to people’s needs in a timely way. There had been a high use of agency staff because a number of permanent staff had either left their employment or had been absent. Whilst the provider tried to ensure they booked the same agency staff, they were not as familiar with people’s needs as permanent staff. New staff had recently been recruited and the registered manager hoped this would lead to improvements.

The risks related to people’s care continued to not always be reviewed regularly to ensure staff could meet people’s needs safely. Whilst people received their medicines as prescribed; the recording and stock taking of medicines was inaccurate and did not follow good practice guidance.

The registered manager did not have a clear understanding of the Deprivation of Liberty Safeguards and as such applications to the safeguarding authority had not been made for some people who met the criteria. Staff had not received updated training on the Mental Capacity Act, and mental capacity assessments had not been undertaken to determine people’s abilities to understand the world around them.

The home continued to not always be responsive to people’s needs. As found during our previous inspection, people had designated ‘bath’ days because staff did not have time to offer alternative times or more than one or two baths or showers a week. People could not recall being involved in reviews of their care.

At our last inspection we found some staff were unkind to people. During this visit we saw staff being kind, and people told us staff were caring. People were treated with dignity and respect, although sometimes staff did not ask people their views.

Since our last inspection there had been an improvement in the activities provided to people. There were now daily activities available and regular external entertainment booked.

At our last inspection, complaints were not managed well. We found there had been an improvement in how the manager recorded and managed complaints from people and their relatives.

We found there had been some improvements since our last visit. However, there continued to be a lack of oversight and timely action taken to ensure records, designed to protect and keep people safe, were accurate and up to date, and were housed appropriately to maintain the person’s confidentiality.

The premises were clean and tidy. Checks were made to ensure gas, electric, water and fire systems supported people’s safety. Staff understood how to prevent and reduce the risk of infection.

People enjoyed the meals provided to them, and received a good choice of food at each meal time.

Visitors were welcomed at the home.

The ratings for the home were displayed in the reception area of the home. There had been some quality monitoring since our last inspection but this had not resulted in sufficient action to improve some of the areas which required improvement at our last visit.

This is the second time in succession the home has been rated as requires improvement.

At the last inspection in July 2016, the service was rated Good; at this inspection we found the service to require improvement in four areas and inadequate in the management of the home. We carried out this inspection following information of concern from members of staff and the public.

People’s experience in the home differed according to their ability to speak for themselves and their dependency on staff to help them to mobilise and receive personal care. The majority of people were happy at The Lodge Residential Home as they were mobile and could choose how to spend their day; they had built positive relationships with staff and received care that met their needs. However, there were not always enough staff to meet everyone’s needs and this had led to situations where staff were not always kind to a minority of people using the home. People’s dignity was not always maintained and people were not always treated with respect.

The registered manager had not followed the provider’s safeguarding policy as they did not always report issues of concern to the safeguarding authority or CQC. Staff had reported their concerns directly to the local safeguarding authority and CQC to safeguard people from potential harm, as the registered manager did not always respond to their concerns.

People could not be confident that their verbal and written complaints would be responded to in line with the provider’s policy, or that they could make a complaint without fear of reprisal. People had provided feedback about the lack of staff, reduced activities and the negative behaviour of staff but the registered manager had not taken any action to resolve these issues.

The provider had not recognised that the registered manager required support and supervision. Staff had not had all the training, supervision or support they required to carry out their roles. The registered manager had not developed good working relationships with staff or got to know people living at the home.

The provider and the registered manager failed to ensure there were enough systems and processes in place to monitor the quality of the service. They had not identified that people’s risk assessments and care plans did not reflect people’s current needs or that staff had enough information to provide people’s care.

People received food and drink that met their needs. However, there was not a reliable system in place to ensure that staff understood people’s dietary needs.

People’s health needs were monitored and responded to appropriately. People received their medicines as prescribed, but the systems required updating to ensure staff were competent to administer medicines.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 and people’s consent was recorded. People were protected from the risk of unsuitable staff through safe recruitment procedures. People lived in an environment that was safe.

There were eight breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one Regulation of Care Quality Commission (Registration) Regulations 2009. The action we have taken can be seen at the end of the full report.

At our inspection on 28 May 2015 we found that policies and procedures were not being consistently followed and people did not receive their medicines and creams safely or as prescribed.

While people were able to make choices about their meals, the required support needed for individuals to receive their food and liquid, was not always identified.

There was a planned activity schedule at the service, however, there was limited attendance at activities that took place at the service.

There were some environmental checks carried out at the service and annual environmental risk assessments had been completed. Risks to people had been identified but the actions taken to reduce and manage risks were not always effective. We found that control measures that had been identified to reduce risks to people were not sufficient to reduce the risks or had not always been put in place. Actions had not always been taken to reduce risks associated with people’s health and safety.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements and regulations relating to the standards under the Health and Social Care Act 2008. This report only covers our finding in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Lodge Residential Home on our website at www.cqc.org.uk.

Following the inspection on 09 and 10 June 2016 we found that all the regulations are now being met.

There was a registered manager in place. 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 and associated Regulations about how the service is run.

At the inspection of 9 and 10 June 2016, people who used the service told us that they felt safe. Relatives also said that they felt people were safe and protected. People told us that staff knew their needs and also the person’s choices on how they wished to be supported. They told us that they received their medication when it was required. We observed medication being administered safely and in line with national guidelines.

People accessed the local community and activities were regularly available.

Staff expressed a thorough knowledge of how to protect people from abuse and avoidable harm. They also knew what actions to take if they suspected or witnessed any issues that they felt were unacceptable. This meant that staff ensured any incidents of concern were dealt with and reported in a timely manner.

Checks had been carried out when new members of staff had been employed. This was to check that

they were suitable to work at the service. The staff team had received training relevant to their role

within the service and on going support had been provided.

Staff had the necessary training and skills to equip them with the knowledge they needed to support people appropriately. We reviewed the training programme that showed us that basic training was completed by all new staff during their induction and then further refresher training was regularly updated. An induction programme was in place for all new staff who were employed at the service. This supported staff to attain the same standards of knowledge and awareness of their role within the service.

Relatives and visitors told us that they felt they could discuss any concerns with members of staff. People were sure that any issues would be dealt with quickly and appropriately.

Healthcare professionals were contacted when this was needed and any directions were followed by staff. Care plans contained full details of a person’s individual conditions and how to provide the appropriate support. This was confirmed by our discussions with people who lived at the service and also by discussions with a visiting healthcare professional.

Staff we spoke with were aware of the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) 2008. Our observations and review of records showed that people were encouraged to make independent decisions and choices. People who lived at the service confirmed that staff asked before any support was provided and that they decided how they spent their day. Our observations at this time also confirmed that this was the case.

There were systems in place to assess and monitor the quality of the service. This included regular discussions with people who used the service. The provider issued questionnaires to gather the opinions and thoughts of individuals, the results were then collated and discussed as records showed.

We observed staff talking with and assisting people throughout the visit, this was done with the peoples' privacy and dignity in mind and showed the staffs' awareness of peoples individual support needs.

We spoke with staff and they demonstrated they were aware how to support and protect people from malnourishment. This was reflected in peoples support plans, risk assessments and other supporting paperwork we viewed. We also looked at how the staff were supported to undertake their caring responsibilities. We found that they are the subject of a continual training programme, backed up by individual and group meetings.

We also spoke to a visiting professional. They stated that they had confidence in the staffs' abilities to ensure peoples' health care was up to a good standard.

We found a general security issues when staff were administering medication, which did not protect people in the home.

We observed staff talking with and assisting people and this was done with the peoples' privacy and dignity in mind and showed the staffs' awareness of peoples' individual support needs.

We looked at the quality assurance and at the range of tests undertaken by staff and external contractors, to ensure people are cared for and live safely in the home.

We looked at how care and support is planned and how people are assisted to retain their levels of abilities, through good acre planning and other initiatives such as the music and movement classes.

We looked at the recruitment process and saw that there is a process in place to ensure staff have the appropriate checks in place prior to commencing employment.