Scaleford Care Home

We found the following examples of good practice.

Staff understood and followed effective infection prevention control (IPC) procedures. Personal protective equipment(PPE) was stored safely and was easily accessible to staff. Staff used PPE in line with current guidance.

People living in the home had been supported to isolate in line with current guidance when required. The home was spacious with a variety of communal areas which helped ensure people could maintain safe distances from others.

The provider ensured visitors followed current guidance in relation to visiting the home.

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

People living in Scaleford Care Home told us they were happy with their care and enjoyed living in the home. Staff told us they enjoyed working in the home and felt they were part of a family.

Relatives told us they felt their relations were safe in the home. We found people had not always been safe. Two people had moved into the home without proper pre-admission or risk assessments being completed. One person, known to be at high risk of falls was in a bedroom with uneven floor coverings. There was a risk they would trip when mobilising. Some bedroom furniture had broken handles which could injure people.

Staff received regular training and supervision, people told us the staff knew how to support them.

The service had not always been well-led. There had been a lack of oversight by the registered manager and provider. In part this had been related to them working remotely during the pandemic. All staff we spoke with said it would be better if the registered manager was on site.

Rating at the last inspection and update

The last rating for this service was requires improvement (published January 2020) there were breaches of the regulations in relation to safe care and treatment and good governance. We returned to inspect to review the safe and well-led domains to check whether enough improvement had been made. During the inspection, we identified concerns in relation to the effective domain and extended the inspection to include this. At this inspection the service remained requires improvement overall and has deteriorated to inadequate in the well-led domain. This service has been rated requires improvement for the last three consecutive inspections.

We looked at infection prevention and control (IPC) measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified continued breaches in relation to safe care and treatment and good governance. We have identified a further breach in relation to person-centred care. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Scaleford Care Home is a residential care home providing personal care to 21 people aged 65 and over at the time of the inspection. The service is registered to support up to 32 people.

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

Environmental risk and infection control processes were not always suitably managed. Staffing levels had improved. Staff had received training in reporting and responding to abuse and were confident they could report any concerns.

Some medicine procedures were not consistently followed. We have made a recommendation about the management of medicines.

The service was not always well-led. Systems and processes for managing risk were sometimes ineffective. The registered provider did not have appropriate oversight on the management of the service to ensure safe care was provided. Breaches of Regulations were still ongoing, and we could not be assured lessons had been learned and changes sustained from previous inspection findings.

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 15 November 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of the service. As a result, we carried out a focused inspection to review the Key Questions of Safe and Well-led only. We reviewed the information we held about the service. No new areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same, requires improvement. This is based on the findings at this inspection.

Due to inspection taking place soon after the previous inspection visit, we found evidence the provider had started to make changes but still needed to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Scaleford Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Scaleford Care Home is a residential care home registered to provide personal care for 32 people aged 65 and over. At the time of the inspection 23 people lived at the home. The care home accommodates 32 people in one adapted building.

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

Environmental risk and infection control processes were not always suitably managed. There were no formal processes in place for reviewing staffing levels at the home. Staff had received training in reporting and responding to abuse and were confident they could report any concerns. Medicines were stored and managed in line with good practice.

The service was not always well-led. Systems and processes for managing risk were sometimes ineffective. The registered provider did not have appropriate oversight on the management of the service to ensure safe and effective care was provided. We identified breaches of Regulations and could not be assured lessons had been learned from previous inspection findings.

The service was not always effective. Signage used around the home was not always accurate and could contribute to people’s confusion. Whilst there was some work taking place within the home to improve living standards, we found areas noted for improvement at previous inspections had still not taken place. Staff told us they were happy with the training was provided and people considered staff to be appropriately trained. We received positive feedback about the choice and quality of food provided.

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 supported this practice.

People and relatives told us on the whole staff kind and caring. Observations made during the inspection confirmed people were treated with dignity and respect. We observed staff enquiring about people’s comfort and welfare throughout the visit.

Care records were person centred and people were supported by staff who knew them well. End of life care had sometimes been addressed. During our visit we observed some activities taking place. People told us external entertainers sometimes visited the home. Concerns were proactively addressed by the registered manager. No one wished to raise any formal complaints as part of the inspection.

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

Rating at last inspection

The last rating for this service was good (published 09 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Scaleford Care Home is situated in a residential area of the Marsh in Lancaster and overlooks the River Lune. Bedrooms are situated over two floors. A stair lift is available to assist people with limited mobility to gain access to the upper floor. There are three lounge areas and a dining room. At the front of the home there is a decking area and maintained gardens. At the time of the inspection visit there were thirteen people residing at the home.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

We last carried out a comprehensive inspection of Scaleford Care Home on 07, 08 and 11 January 2016. At the inspection visit we identified no breaches to Regulation but made two recommendations. We asked the provider to review administration of medicines to ensure they consistently reflected good practice guidelines. Also, we asked them to review staff training to ensure there were no gaps in staff training.

At this inspection visit carried out in April 2017, we found the recommendations made had been acted upon. Suitable arrangements were in place for managing and administering medicines. Good practice guidelines were followed when administering medicines. The registered manager had a training and development plan for all staff. We saw evidence staff were provided with relevant training to enable them to carry out their role. When gaps in training were identified plans were implemented to ensure staff received the training in a timely manner.

We noted that refurbishment of the home was still in progress. Improvements had been made in a communal living area and dining area of the home. Refurbishment of bedrooms was ongoing and plans were in place for a new laundry area. We noted adaptations had been made within the home to make it more accessible and dementia friendly.

People and relatives told us care was provided to a high standard by a caring staff team. They repeatedly described staff as kind and caring. We observed positive interactions during our inspection visit which evidenced this.

We observed staff responding to people’s needs in a timely manner. Staff were not rushed in carrying out their duties. We observed staff spending time with people who lived at the home. Staff were patient with people.

People told us they felt safe. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. We saw arrangements were in place to protect people from risk of abuse.

The service ensured risk assessments for each person were completed and up to date to address and manage risk. When risks were identified we noted referrals were made to other appropriate agencies in a timely manner to manage the risk and prevent avoidable harm.

We looked at certification and maintenance records and found that premises and equipment were appropriately maintained.

Recruitment procedures were in place to ensure the suitability of staff before they were employed. Staff were provided with training and support at the beginning of their employment to provide them with the relevant skills to provide safe and effective care.

People’s healthcare needs were maintained by the service. We saw evidence of health professional involvement when appropriate.

Care plans were implemented for each person who lived at the home. They included support needs and personal wishes of each person. Plans were reviewed and updated at regular intervals.

We observed meal times at the home. Improvements had been made to the dining area environment to enhance the personal experience at meal times. People were offered a variety of meals to suit their needs and preferences. The cook worked alongside staff providing direct support to ensure people’s nutritional needs were addressed and monitored.

Staff understood the importance of providing person centred activities. We noted there was an array of items placed around the home to encourage and motivate people to participate in activities.

The registered manager had a sound understanding of Mental Capacity Act 2005 and the associated Deprivation of Liberty Standards (DoLS.) Staff we spoke with were aware of the principles should someone require being deprived of their liberty. Processes were implemented to ensure people were lawfully deprived of their liberty.

The registered manager had developed an auditing system at the home to assess the quality and safety of service provision. We saw evidence that regular audits took place.

We looked at how complaints were managed and addressed by the service. At the time of the inspection no one had any complaints about how the service was delivered and people were aware of their rights to complain.

Feedback was sought from people, relatives and professionals as a means to reflect on service delivery and to improve the quality of the service. We saw evidence of changes being made following suggestions being made.

People who lived at the home, relatives and professionals provided positive feedback about the senior management team. Staff were positive about ways in which the service was managed. They spoke highly of a recent management restructure and the introduction of a new care manager. All staff described the care manager as approachable and knowledgeable and said they had contributed to positive outcomes for the service.

Staff described teamwork as “Good,” and said there was regular communication between senior management and staff. They described the home as a good place to work and spoke proudly of their achievements.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe and comfortable at the home. One person said, 'I feel very safe and comfortable'. Another person explained, 'I feel very safe here. They keep an eye on me'.

Our discussions with staff demonstrated they understood the principals of providing care to people in a safe way. Care plans we reviewed showed people's needs were assessed and monitored. This meant Scaleford protected people from unsafe care because support planning and risk assessment was adequate.

The home had a safeguarding policy and set of procedures in place. Our discussions with staff demonstrated they had a good understanding of how to safeguard people against potential abuse.

We found Scaleford to be clean and tidy. One person said, 'It's clean and tidy here. The staff keep it well-maintained'. We noted some upkeep of the home had been undertaken. Although there was a smell of drains developing during our inspection, the provider assured us this would be addressed.

Due to staff sickness and turnover, we observed over the last six weeks Scaleford had periods of low staffing levels. The home provided care for up to 32 people, some of whom had severe, complex care needs. We were told the provider was trying to recruit new staff. However, this meant people were at risk because they were not always fully monitored.

Is the service effective?

The service had some recorded evidence of formal consent, but this was not evident in all care files we reviewed. Documents and observations showed people were consistently supported to make basic decisions about their care. We noted staff had a good understanding of consent and related principals. One staff member explained, "It's about your approach with people, taking your time and explaining things properly. You need to understand the resident properly".

Scaleford was not effective in properly applying for Deprivation of Liberty Safeguards (DoLs) for people who lived at the home. Records were limited, unclear and there were no capacity assessments. The provider had not notified the Care Quality Commission (CQC) about these approved applications. This meant people were at risk from unsafe care because the provider had not sufficiently undertaken its responsibilities.

Documents we reviewed showed support plans and risk assessments matched people's assessed needs. This demonstrated people were protected against ineffective care provision because people's needs were appropriately assessed.

Some records we reviewed were task orientated, which was not effective in meeting people's individual needs. However, we noted the provider was in the process of introducing a new care plan system. A visiting professional told us, 'The home have referred to us and engage with us well. It's hard work because their care has been task orientated, rather than personalised. But they're beginning to move away from this'.

Is the service caring?

People told us they found staff to be caring and compassionate. One person said, "The staff are caring and friendly. They treat me with respect and dignity". Another person said, 'The staff are lovely and caring. They help me keep my independence'.

Our discussions with staff showed they had respect and compassion for the people they supported. One staff member told us, "My approach is about caring for people as if they were my own family'.

Is the service responsive?

During our inspection we found Scaleford worked with the local community mental health team. They were provided with support and guidance to enable them to respond to people's mental health needs. This showed the service worked with other providers to ensure people were supported appropriately.

Staff had a good understanding of how to meet people's needs and to provide good levels of care. One staff member told us, 'We monitor residents and discuss as a team to make sure they have the right standards of care'.

Is the service well-led?

Scaleford had a range of quality audits in place to monitor service delivery. Appropriate policies and other regular processes underpinned this, such as satisfaction surveys, staff meetings and staff supervision. This meant people were protected against inappropriate support because the manager had systems to check the quality of care.

Care delivery was organised and there were clear lines of responsibility. One person told us, 'The manager is great, she runs the home well'. This meant care delivery was adequate and safe because Scaleford was well-led.

On our last visit, we found that the occupancy level was low creating budgetary problems for the home. At this visit we found numbers of residents had improved considerably. We found that resident care remained a high priority, people were well looked after, and both residents and their visitors gave us positive feedback. We found that medication was safely stored and administered. We found the registered manager had a hands on approach to quality assurance, and that both residents and visitors spoke highly of her style and approachability. She also conducted internal audits to ensure standards remained high.

We found a number of minor areas of non compliance where standards had slipped on the day of our inspection. These were resolved immediately after discussion with staff and management. We have not been able to test whether this compliance has been sustained.