St Denis Lodge Residential Home

We found the following examples of good practice:

The home had a robust visiting procedure for relatives and professionals. Visits were by appointment and were time limited to reduce infection risks and enable thorough cleaning in between. Visitors temperatures were checked and recorded on arrival. A floor to ceiling screen was in place in a designated area of the home to support social distancing during visits. All visitors, apart from emergency services personnel, were subject to a lateral flow test before entry.

The home was visibly clean throughout and uncluttered. The cleaning schedule included general cleaning and high touch point areas such as light switches, keypads, handrails and door handles. Specialist cleaning products were used to minimise the risk of infection. Management spot checks were conducted to ensure infection prevention and control compliance including safe disposal of clinical waste and appropriate wearing of personal protective equipment (PPE).

The home was regularly testing residents and staff in line with the government’s testing programme. People at the home were currently Covid-19 free. Any new admissions including people on short stays were supported to isolate for 14 days as per government guidance. Policies around IPC and specifically Covid-19 were detailed, up to date and effective.

People and staff were supported to socially distance within the home. Seating was arranged to support this. Dining tables were also laid in a way that encouraged appropriate spacing between people. Only one staff member was allowed in the staff room at any one time to reduce the risk of cross infection.

The home understood the importance of helping people and staff to maintain their mental wellbeing. Activities staff provided one to one sessions in people’s rooms to ensure they had regular stimulation. Staff were encouraged to come forward if they were struggling and reasonable adjustments were explored with them. The registered manager and deputy manager felt very supported by the provider in every aspect of maintaining care quality and safety for people and staff during the pandemic.

St Denis Lodge Residential home is a residential care home providing personal care without nursing for up to 21 older people. At the time of the inspection 21 people were living at the home. Some people had limited verbal communication, so we captured some of their experiences through observations.

People’s experience of using this service and what we found

People told us they were happy living at the home and they felt safe. Systems to monitor the service had improved. However, in some areas not enough improvement had occurred since the last inspection. The new manager had already identified changes to put in place and was implementing them. It was not yet clear how sustainable these changes would be.

The management strove to be open and continually develop and improve the support people received. They were aware of their responsibility to notify the Care Quality Commission of certain events in line with their statutory obligations.

All people were comfortable in the presence of staff. People and relatives were positive about how safe their family members were. Medicines were administered and managed safely. Staff competency checks for medicine administration were improved during the inspection. Risks to people had been identified with ways to mitigate them in place.

People were supported by enough staff to meet their needs. Although staff levels had not always been good the management had recognised this and taken steps to resolve it. Staff had received a range of training and good induction when they started.

People’s care plans were in the process of being personalised. They already provided a range of information for staff to use to support people’s needs and wishes. There were good links with other health and social care professionals to meet the needs of people living at the home.

Staff were kind and caring and knew the people living at the home well. Staff respected privacy and dignity throughout the inspection. Links had been developed within the wider community which had a positive impact for people. Independence was promoted, as were the values of treating each person as an individual.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service had not always supported this practice. The new manager had ensured these were updated in line with current guidance.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 December 2018) and there were concerns about systems to audit the service and capacity and consent. Improvements were found at this inspection although it was not clear whether changes were now sustainable.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is registered to provide accommodation and personal care for up to 21 people. At the time of our visit there were 16 people living in the home.

St Denis 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.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 inspected the home against three of the five questions we ask about services: is the service safe, is the service effective, and is the service well led?

Systems and processes were not always effective. Audits and quality assurance processes were taking place but had not identified that people’s consent forms for areas such as care provision and bed rails had been signed by representatives without the necessary legal authority to do so. They also had not identified that risk assessments were not always personalised and one of the conditions of a person’s Deprivation of Liberty Safeguards (DoLS) was not being met. This meant that the service was not always working within the principles of the Mental Capacity Act 2005 (MCA 2005). The MCA 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff felt supported by management and enjoyed working at the home. One staff member said, “It is a joy to work here. We get along like a family.” Staff had regular, in-depth supervision where they received both praise and had opportunity to develop their practice. People, relatives and staff felt included and listened to. They had confidence that if they raised concerns with management action would be taken to resolve things. The home had established and maintained pro-active working relationships with health professionals which were helping people to stay well for longer and prevent unnecessary hospital admissions.

People were supported by staff who did not always have up to date training. People were supported to have a balanced and varied diet. People were supported by staff who understood the importance of working effectively with health and social care professionals to meet people’s needs. When people’s health deteriorated or fluctuated staff sought advice and guidance in a timely way. Support also extended to accompanying people to routine appointments, courses of treatment, or when receiving visits from health professionals.

People told us that they felt safe living at the home. Staff had a good understanding of how to safeguard people from harm and abuse. They understood what signs to look for and how to raise a concern. The home had robust recruitment processes to ensure that people were supported by staff who were suitable to work with them. People had risk assessments that staff used to help reduce the risk of avoidable harm. We recommended that they make these personalised as they were generic. Medicines were managed safely. Staff demonstrated confidence when supporting people with their medicines and had regular, formal observations to check their competency. The home conducted audits to ensure incidents or near misses were opportunities to learn from and reduce the chances of them happening again.

Further information is in the detailed findings below

St Denis Lodge Residential Home is a care home for up to 21 older people. At the time of inspection there were 17 people using the service. Some of these people have various stages of dementia so had limited verbal communication. There are two floors and there are bedrooms on both. The home has a number of communal spaces including a dining room, lounge and garden.

At our last inspection we rated the service good.

At this inspection we found the service remained good.

Why the service is rated good.

Since the last inspection the registered manager and provider had worked hard to ensure there were continual improvements at the home. These had been recognised by the home retaining its beacon status for end of life care.

People received exceptionally good care from staff who treated them like part of their extended family and knew them incredibly well. People were involved in decisions about their care and the staff continuously were finding ways to share the information with people. Feedback from people, relatives and visitors to the home informed us about how well cared for they felt.

Care and support was incredibly personalised to each person, which ensured they were able to make choices about their day to day lives in line with their needs, hobbies and interests. Information about people's preferences were gathered in detail by members of staff through life stories.

People were supported to have a dignified death and there was extremely good communication with other professionals to facilitate this. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People, or their representatives, were involved in decisions about the care and support they received.

The service provided to people was responsive to people’s individual needs. There were activities coordinators who ran the activities in the home with incredible passion. Staffing levels reflected the ethos that all staff were encouraged to support people with activities and in all aspects of their care. There was a range of opportunities for people and their families to participate in. Activities always considered people’s hobbies and interests and were personalised as much as possible.

The management were constantly looking at current research and trying to find innovative ways to support people in the home. There was a strong emphasis on community participation These provided opportunities for people to reminisce and promoted their well-being by being valued.

Complaints were fully investigated and responded to in a timely manner. The registered manager had a strong ethos of valuing any concern a person or their relative raised because they knew how important it was for them. There were opportunities for people to drive improvements within the home.

The home had an owner and management who strove to provide people with excellent care. People, relatives and staff told us the registered manager was excellent and had ensured the best care and support was provided. The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

The provider wanted to drive innovation and strive for excellence at all times. The management had created opportunities to recognise the quality care staff were delivering. Staff at all levels felt supported and were proud their work to improve the lives for people was recognised. They often went above and beyond to enrich people’s experience and value them as people.

There were suitable numbers of staff to meet people’s needs and to spend time socialising with them. Interactions were on a personal level and not just task based. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely. People were protected from abuse because staff understood how to keep them safe and were sure action would be taken if any concerns were raised.

The home continued to ensure people received effective care. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People who required special diets had their needs met and meal times were treated as a social opportunity. Staff had the skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to attend appointments. One health care visitor was very complementary about how the home supported the people they saw.

Further information is in the detailed findings below.

This inspection took place on 26 and 28 January 2016. It was carried out by one inspector.

St Dennis Residential Home provides residential care for up to 21 older people. There were 19 people living in the home at the time of our visit, some of whom were living with dementia.

There was a registered manager who had been in post for four years. 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 home had recently had building work completed and there was an orangery in place of the conservatory. This created more communal space. As well as being a place to sit it also provided more room for activities. There was direct access to the garden. A path was under construction to enable wheelchair access around the garden. There were activity organisers seven days a week who provided a varied programme of activities which included trips out, social events, crafts and quizzes as well as exercise. People who were unable to attend group activities received one to one time doing something that they enjoyed, for example jig-saws or reading. This meant people were engaged in meaningful activity.

People told us they were safe living in the home and had confidence in the staff. There were sufficient trained and competent staff to meet people’s needs. There was one vacant care worker position which had been advertised. There were processes in place to ensure staff were recruited safely. The registered manager monitored staffing levels to ensure there were enough staff to meet people's needs. The home did not use agency staff which meant people received consistent care from staff who knew them well.

Staff had received training in safeguarding adults and knew how to recognise abuse and what actions they would take if they suspected abuse was happening.

People and their relatives spoke highly of staff. They told us staff were kind and caring. They were treated with dignity and respect and had their privacy maintained.

Medicines were administered and stored safely. Medicine Administration Records (MAR) were signed to indicate that peoples prescribed medicine had been taken. Staff had received training and were competent to administer medicines. There were processes in place to ensure that people had received the right medicine at the right time.

Peoples had personalised care plans which were informative and indicated peoples likes, dislikes and preferences. People were provided with choices about all aspects of care and support they received. Staff were able to talk with us about people and demonstrated to us they knew people as individuals. People told us they enjoyed the food and were offered a choice at mealtimes.

People were provided with single rooms with an en-suite toilet and washing facilities. This helped ensure people had their privacy maintained. People had their own commodes if they needed them for use at nights. The process for cleaning the commode buckets was being reviewed by the registered manager to ensure the correct infection precautions were maintained.

There was a clear management structure. The registered manager was supported by a care manager and there were supervisors who organised the shifts so that people received the care they needed. There were systems in place for monitoring the quality of the service

Staff told us they had access to further training .The home was accredited with the Gold Standard Framework training which a nationally recognised training to ensure people received excellent end of life care. The home had good links with the GP surgery and staff attended their monthly meetings.

There were systems and processes in place to ensure there was good communication with people, their families and staff.

We found that action had been taken following the last inspection, and processes were in place to support appropriate recruitment and appointment of staff.

Medicines were kept and administered safely, and people received their medicines in the correct way. Appropriate arrangements were in place in relation to the recording of medicines.

The provider did not undertake sufficient pre-employment checks.

People were protected from the risks of unsafe care or treatment because there was an accurate record of people's needs.

We spoke with six people who lived at St Denis Lodge. They told us that they were happy living in the home. One person told us the staff were 'all lovely without exception' and 'so kind' explaining that they always come quickly in response to the call bells. Another person told us, 'I really cannot fault them.'

We spoke with the relative of one person who told us they were very happy with the care their family member received. The relative explained that the home had identified their family member as being at risk of developing pressure ulcers and had taken prompt action to alleviate the risk.

Training records showed that staff completed an induction followed by an ongoing programme of training with updates as required.

We saw that people using the service and their relatives had been able to give feedback about the service through annual satisfaction surveys and residents meetings. We saw that people using the service and their relatives had been able to give feedback about the service through annual satisfaction surveys and residents meetings.