Archived: Fallings Park Lodge

There were 35 people living at the home; 32 people were present with three people in hospital. We spoke with 13 people using the service, 2 senior care staff, seven care staff, and two visiting relatives. We looked at the records for six people and also reviewed the records in relation to accidents, staffing, medicines, and quality assurance. The findings of this inspection was provided to the senior care. Following the inspection we also advised the acting manager and provider of our findings by telephone.

Below is a summary of what we found.

Is the service safe?

We observed that people were safe in relation to their immediate health and care needs being met. The omissions in care observed at our previous inspection in July 2014 had been addressed. We saw people received the care and support they needed in relation to their continence needs, and were moved regularly to prevent harm to their fragile skin. A person living there said, 'It is better, seems to be less rushed now I'm quite happy staff look after me well'.

The provider had continued to maintain the increased staffing levels since our last inspection in July 2014. This meant there were more staff to meet people's needs. A staff member told us, 'There have been improvements since you were last here. The main improvement has been more staff; it's nice to know someone is helping us'. We saw that people at risk of falls were supervised, an improvement on our last inspection. There was a clearer delegation of staff in the homes communal areas to ensure people had the supervision they needed to keep them safe, however care plans and risk assessments had not been updated to show the support people needed.

We saw that improvements had been made with regard to managing people's medicines. People had their medicines when they needed them and medicines were ordered, stored securely and administered safely.

We saw that external environmental risks had been managed which included fencing off scaffolding poles and covering and draining the garden pond. However such potential risks should have been identified by the provider with timely action taken to ensure people's safety. The management of the service with regard to improving people's safety is therefore not proactive.

Is the service effective?

There were no short term care plans in place to guide staff in caring for people who were poorly or to reflect recommendations from other health care professionals. Where people's care needs had changed further assessments had not taken place and care plans and risk assessments were not updated with changes to effectively guide staff in meeting people's needs.

We have asked the provider to tell us how they are going to do to ensure people's care plans and risk assessments are updated with changes to effectively guide staff in meeting people's needs.

We heard from people that they generally enjoyed the meals; people were very satisfied with the quality of the food which they said was 'tasty' and 'hot'. Some people told us that teatime and supper time choices were limited to sandwiches. The improved staffing levels meant people had the support they needed to eat their meals.

Staff had more time to meet people's needs effectively, for example supporting their continence needs and moving them regularly to prevent harm to their fragile skin. We noted that some people were more alert and responsive, smiling and communicating with staff.

A visitor told us 'Staffing issues are better', and a person who used the service said, 'It does seem better more staff around less rushed'.

People were engaged in activities and we saw staff sit and spend time with them. There were less people sleeping and more staff interaction. This meant people were experiencing a more stimulating and meaningful lifestyle.

Is the service caring?

We observed staff spent more time with people, and we saw that staff were kind, attentive, and comforted people. People looked happier; smiling and were more alert, and responsive to staff. One person said, 'I feel so much better, the staff are very good to me'. A visitor told us, 'The staffing issues are better'.

Is this service responsive?

We heard from people, relatives and staff that the delivery of care to people had improved because there was more staff to respond to people. Staff told us it was, 'Less rushed', and there was, 'More time to care for people properly'. We saw the daily routines were more personalised to people's needs which meant people could go to the toilet when they needed to.

Is this service well led?

This report states Mrs Jacqueline Denise Whatling is the registered manager, they were not managing this location at the time of the inspection. Their name appears because they were still identified as the registered manager on our register. The provider has advertised the vacant deputy manager post. The acting manager has stated they are in the process of submitting an application for the registered manager post.

The service has a history of not meeting regulations and sustaining improvements. Because of this we looked at the quality assurance systems and found these had not improved sufficiently to manage potential risks to people's welfare reoccurring.

The lack of a management team due to the vacant deputy post is a risk factor and limits the capacity of the acting manager to make all the required improvements as well as introduce and maintain a rigorous auditing system. People who lived at the home and visitors told us they had noted recent improvements; a senior staff told us the provider had been 'supportive' and morale had 'improved'. Although the provider was taking action they had not produced an action plan to show how they intend to address the shortfalls in the service and sustain improvements made.

We have asked the provider to tell us what they are going to do to provide an effective quality assurance system to monitor, identify and improve shortfalls in the service.

Two inspectors carried out the inspection on 30 July 2014, 39 people lived at the home although one person was in hospital. We spoke with 12 people using the service, the deputy manager, three seniors, seven care staff, a visiting relative and a health care representative. We looked at seven people's care records and also reviewed the records in relation to accidents and staffing levels.

Due to the serious concerns we found to the safety and welfare of people using the service, the local authority made provisions on 30 July 2014, to suspend further placements at the home. The local authority instructed the provider to utilise agency staff in order to improve and maintain safe staffing levels. This was done with the provider's agreement and arrangements to increase staffing levels were made on 31 July 2014.

Is the service safe?

At our previous three inspections of October 2013, January 2014 and April 2014 we identified non-compliance in a number of areas. Although improvements had been made we found the provider was still not complying with the requirements within this regulation.

At this inspection we found people received care that was neither, safe or appropriate. There was a lack of assessment, care planning and delivery of care.

People who were dependent on staff for their continence needs had not been assisted for in excess of five hours. This placed people at risk of ill health and discomfort. People at risk of skin damage did not have a detailed plan in place to instruct staff about how often their positions should be changed to protect their fragile skin. We found that although care staff understood people's needs they were unable to deliver the care they needed. A staff member told us, 'Yes that's right, (Person) should have pressure relief every two hours but we haven't been able to do it'.

We saw that people's health and wellbeing was not monitored consistently where they were at risk of falling. Appropriate risk assessments had not been carried out to ensure correct seating. Arrangements had not been made for a person to see the speech and language therapist to support them with their eating and drinking.

The provider had reduced staffing numbers in April 2014 and failed to take into account people's dependency needs. The provider had not taken the layout of the premises into consideration when determining staffing levels. This impacted on staff capacity to supervise the communal areas and ensure people's safety. One staff told us, 'It's physically impossible to meet everyone's needs'. The provider had failed to make arrangements to deal with staffing shortages such as sickness or holidays. Staff had worked extra shifts. We were told, 'The girls are covering a lot of shifts. They are exhausted.'

Is the service caring?

The comments we received from people who lived at the home included: 'Staff are lovely, all of them.' Another person told us, 'I'm very happy here.' A relative told us, 'They could always do with more staff. They are busy. They seem to have lots to do. Sometimes if I want to ask a question of staff I can see they are busy so I wait up to 20 minutes before I speak with them.'

Staff were caring and knew people well but had little time to spend with them. Some staff were visibly upset about the limitations of the care they provided. People did not always receive the support they needed from staff when distressed or confused, because staff were not always available to respond to people and reassure them.

Is the service effective?

We saw that staff struggled to meet people's needs effectively, they recognised people were not consistently getting the care and support they needed. This was not an effective service as no action had been taken to address the staffing levels and ensure the welfare and safety of people.

People had no activities offered and spent the day sitting and sleeping in their chairs. One staff said, 'We struggle to meet people's basic needs so it's impossible to do activities, we do try and spend time and talk with people'. This meant people were not being offered a consistent stimulating and meaningful lifestyle.

Is this service responsive?

People did not have the support they needed at mealtimes when they needed it. Some people's meals were interrupted and delayed before staff could return to assist them.

Steps had not been taken to ensure a person had an appropriate assessment from the speech and language therapist and measures had not been put in place to take account of staffing levels to reduce the risk of falls.

Is this service well led?

There was no system in place to determine safe staffing levels to meet people's needs. The provider had not taken account of the impact of reducing staffing levels on the people living there. There was no system in place for covering emergency sick leave or holidays. There was evidence the staffing levels had fallen below acceptable safe levels. The manager who is still registered with CQC was no longer working in the home which impacted further on the staffing situation.

We found that people were put at serious risk from the lack of the basic care delivery, lack of arrangements to provide safe staffing levels and to safely manage people's needs and risks to their health.

There was evidence to show a lack of basic essential and appropriate care delivered to vulnerable people. We made a number of safeguarding referrals to the local authority to investigate because we had concerns about people's health and welfare.

During our previous two inspections of October 2013 and January 2014 we determined noncompliance in a number of areas which included, medicine management, care and welfare and quality monitoring processes. During this inspection we found that although some improvement had been made further improvements were needed.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that some systems had been put into place to promote learning from events such as accidents and incidents. This could reduce potential harm to the people who lived there.

People told us they felt safe. All people and relatives that we asked told us that they had not seen anything of concern. One person told us, 'The staff have never done anything to hurt me and they do not shout'.

Staff we spoke with knew of Deprivation of Liberty Safeguard (DOLs) processes. They confirmed that no DOLs applications were required presently. DOLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury.

We found that people's mobility needs had been assessed and were generally met. However, the management of day to day risks and safety should be improved upon. We saw that the external environment was not entirely safe which could place people at risk of harm. For example, the pond in the garden had not been secured and there were a number of other discarded items in the garden that could place people at risk of accident or injury.

We found that the management of medicines had improved but further efforts in the administration and recording of medicines were required to ensure that people using the service were safe.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

People's health and care needs were assessed but they were not always included in detail in their care plans. We found that short term care plans had not been produced for example, for a person who was suffering from an infection. This meant that care plans were not able to consistently support staff to meet people's needs.

Systems regarding involving the people in menu planning and the main mealtime experience process were not effective. Although a number of people told us that the meals were good, other people told us that they were not. Some people told us that meals lacked variety.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning and meal time experiences to ensure that the service is effective.

Is the service caring?

Generally, we found that people's preferences, interests, aspirations and diverse needs had mostly been recorded in their care records. Because of this care and support could be provided in accordance with people's wishes.

Overall, we saw that staff showed patience when supporting people. A relative said, 'The staff are good to my relative and other people in the home'. The majority of people we spoke with told us that the staff were good. One person said, 'The staff are kind'. However, a number of people commented that some staff were 'better than others'. One person told us, 'I feel that some staff rush to get the work done'. Another person told us, 'Some staff attitudes are better than others'.

We observed two people being moved with a hoist and their dignity and self-esteem were not promoted. One person referred to their hoisting experience as, 'Terrible'. We saw that after meal times staff did not pay attention to some people's appearance. At least two people had food around their mouths and on their clothes well after the meal times had finished.

People who lived there and their relatives had not previously been given the opportunity to complete satisfaction surveys. It had taken some time for the registered manager and provider to address this. The week before our inspection surveys had been given to people and their relatives to complete.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensure that the service provided is caring.

Is the service responsive?

On the day of our inspection a person who lived there became unwell. The staff noticed this and called an ambulance. Additional staffing were secured so that a staff member could accompany the person to hospital. This demonstrated responsiveness.

During our previous two inspections we found noncompliance in a number of areas. During our last inspection of January 2014 we found that improvement was slow/or there had been no improvement. During this, our most recent inspection, we found that some improvements had been made but further improvements were needed regarding as examples, safety and care planning. This did not give assurance that the service had been adequately responsive.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make in relation to listening to what is said to them and taking timely remedial action to ensure that the service is responsive.

Is the service well-led?

The manager told us that improvements had been made since our previous inspection concerning the leadership of staff. Overall, we found that this was correct but more improvement was needed. Our observations showed that staff did not always perform to the standard that was required when using the hoist or paying adequate attention to people's needs following mealtimes.

The service had basic quality assurance systems. However, records seen by us showed that they were not all completed adequately and some care plans relating to diabetes and dementia care were not in place.

We found that environmental risks (for example, garden safety) had not been incorporated into quality assurance systems and therefore risks to people were apparent.

We found that the main mealtime experience was not positive for the people who lived there. We found that processes were lacking concerning the involvement of people in menu planning. Meals provided were not always what people preferred to eat.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make in relation to the management of staff and quality assurance processes to demonstrate a well led service.

We found that people's care needs were assessed but they did not always receive the appropriate level of care or support. One care staff said, 'We do not have enough staff to care for people.' One person who used the service said, 'I expected a better service.'

The management of medicines was unsafe and placed people at risk of not receiving their medicines as directed by the prescriber.

The home had a quality monitoring system in place but this was not robust to ensure that people received a safe and effective service. One person said, 'My care plan has not been reviewed for a while and no one has asked me how I would like to be cared for.'

We found that records did not contain clear up to date information. This meant that staff were not provided with relevant information to support their understanding of people's care and treatment needs.

We found that people's consent for care and treatment was obtained before this was provided. One person said, 'The staff usually explain what they want to do and ask if this is OK.'

People's care needs were assessed but the care and treatment provided did not always meet their needs.

The management of medicines remained unsafe and placed people's health at risk.

There was a quality assurance system in place but this was not entirely robust to ensure people were not placed at risk of inadequate care and treatment. However, one person said, 'This is one of the better places to stay.'

We found that records did not contain up to date information about people's care and treatment needs and this could compromise the support they receive.

During this inspection we spoke with the registered manager, seven people who used the service, three visiting relatives and three care staff.

We found that people's consent for care and treatment was obtained and recorded. However, people were not always given the opportunity to make a decision about their daily care and the support they required.

Care plans did not provide sufficient information to support staff's understanding about people's care needs and how to meet them.

The management of people's medicines was unsafe and placed them at risk of not receiving their medicines as directed by the prescriber.

The provider did not have an effective quality assurance monitoring system in place to ensure people received safe and appropriate care and treatment.

We found that care records were not fit for purpose.

We found that where people had capacity their consent for care and treatment was not obtained. Best interest meetings were not carried out to ensure people who lacked capacity received the appropriate support and care.

We found that care plans provided insufficient information to support staff's understanding about people's needs and how to care for them. People were not involved in their care planning to ensure they received care and support the way they preferred. One person who used the service said, 'I had a care plan where I lived before, I'm suppose to have one here but I've never seen it.'

A safeguarding policy was in place and staff spoken with had a good understanding of their responsibility of protecting people from potential abuse.

We found that the management of prescribed medicines were unsafe and placed vulnerable people at risk of harm.

Staff were provided with various training to ensure they had the appropriate skills to care for people.

There were inadequate quality assurance systems in place to ensure people were protected from inappropriate care and treatment.