Archived: Telford Lodge Care Limited

Updated 5 March 2020

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 8 and 9 May and was unannounced. The inspection was carried out by two inspectors, a member of the medicines inspection team and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we looked at the information we held on the service including the provider’s action plan from the last inspection, notifications of significant events and safeguarding alerts. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. We also contacted the local authority’s safeguarding and placement teams to gather information about their views of the service.

During the inspection we spoke with 15 people using the service, 11 relatives, six care workers, one senior care worker, one team leader, one catering worker, three healthcare professionals and the manager. Our observations included using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not speak with us. We viewed the care records of four people using the service and seven care workers files that included recruitment, supervision and appraisal records. We also looked at medicines management for people who used the service and records relating to the management of the service including service checks and audits. After the inspection we spoke with the GP.

Updated 5 March 2020

This comprehensive inspection took place on 8 and 9 May 2018 and was unannounced.

The last comprehensive inspection was in November 2017. The service was rated ‘Requires Improvement’ in the key questions ‘Is the service Safe, Effective, Responsive and Well Led?’ and overall. We found five breaches of regulations relating to person-centred care, safe care and treatment, premises and equipment, good governance and staffing.

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 rating of the key questions of ‘Is the service Safe, Effective, Responsive and Well Led?’ to at least good. At this inspection we found the provider had not been able to make sustained and measurable improvements to fully meet the regulations. In addition, we found three additional breaches of regulations

Telford Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection,43 people were using the service. They were mainly older people and people living with the experience of dementia. This is the only location for Telford Lodge Care Limited which is registered as a charity.

The service did not have a registered manager. 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 left the service in February 2018 and a member of Telford Lodge’s Committee had made an application to become the registered manager.

During the inspection we found care workers were not deployed effectively to meet the needs of the people using the service to supervise them as they go about their daily lives in the home and to help protect them from harm.

Incident and accident forms were not always completed and risk assessments were not always robust enough to minimise risks to people and others. This meant the provider was not assessing, monitoring and mitigating risks to people to help minimise their exposure to the risk of harm.

We also observed other unsafe practises that could put people at risk including a child regularly visiting the home who might not have had adequate supervision, a person using a wheelchair without the footplates and half full drinks containers that posed a risk of making people ill as it was not possible to ascertain how long they had been left out.

Medicines management was inconsistent and audits did not always identify discrepancies to help ensure people always received their medicines in a safe way.

The environment did not always meet people’s needs and we saw worn furniture in the home, unused equipment sitting on the floor, broken furniture in the garden and CCTV cameras that did not have signs to alert people they were being recorded both visually and with sound. Furthermore, the provider did not follow best practice guidance for dementia friendly environments so that people lived in surroundings suitable to their needs.

Daily fluid charts were not always completed to monitor people’s intake of drinks which meant they could be at risk of dehydration as records were not being maintained. Some weight charts were also incomplete which meant the provider could not effectively monitor people’s weight and nutritional status to identify any risks relating to nutrition so appropriate action could be taken in a timely manner to manage the risks and to meet people’s needs.

Care workers told us they had regular training but the manager did not provide evidence to confirm this. Supervisions and appraisals were not up to date which meant care workers did not always receive the support they required to develop their professional skills and knowledge.

We saw individual acts of kindness from staff, but people were not always treated in a person-centred manner. Mealtimes in particular were task orientated instead of meeting people’s individual needs.

People’s daily files were stored in cabinets in communal areas that were easily accessible and not secure. This indicated a lack of systems to help protect people’s confidentiality and ensure people’s privacy.

Care plans were not always competed in a timely manner or with up to date information. This meant there were risks that people may not have been receiving the care they required.

The home had a number of activities for people to join in, however these were not always meaningful and did not always meet their individual interests and preferences.

The service had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective. For example, record keeping was not always complete and contemporaneous, and some records were not available during the inspection.

We saw there were procedures for reporting and investigating allegations of abuse and whistle blowing. Staff we spoke with knew how to respond to safeguarding concerns. Safe recruitment procedures were followed to ensure staff were suitable to work with people.

People’s needs had been assessed prior to moving to the service and care plans included people’s likes and dislikes. There were also records of end of life wishes and Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) forms completed by the GP as appropriate.

The service liaised with other professionals and we saw evidence that people were supported to access healthcare services appropriately.

Care workers did not always have a good understanding of the Mental Capacity Act 2005 but the provider generally followed the principles of the Act.

Relatives were positive about the level of care provided and we saw examples of care workers being kind, patient and reassuring with people using the service.

There was a complaints procedure in place, however the service had not had any complaints since the last inspection.

The manager had submitted an application to CQC to become the registered manager and was attending a number of courses to develop their skills for managing a care home. Feedback from relatives and care workers indicated the manger was approachable and accessible.

We found eight breaches of regulations in relation to person-centred care, safe care and treatment, premises and equipment, good governance, staffing, dignity and respect, safeguarding service uses from abuse and improper treatment and meeting nutritional and hydration needs. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’

On the 13 July 2018 we served a Notice of Proposal to cancel the Registration of the provider Telford Lodge Care Limited so they can no longer provide a care home service at the location Telford Lodge Care Limited. This process has now been completed and Telford Lodge Care Limited has been deregistered and can no longer provide a care home service lawfully.