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Inspection carried out on 29 May 2018

During a routine inspection

We inspected Gordon Lodge Rest Home on 29 May 2018 and the inspection was unannounced.

At the last inspection in March 2017 we found two breaches in Regulation. 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 Effective and Well-Led to at least good. At this inspection improvements had been made and the breaches in Regulation had been met. Staff now met with a manager for regular one to one supervision to aid their personal development. Checks and audits were in place and records were accurate and complete.

Gordon Lodge Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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. The service is in a quiet residential area and provides accommodation, care and support for up to 33 older people. There were 24 people living there when we visited.

The provider was also the registered manager and was supported in the day to day running of the service by a manager. A registered manager is a person who has registered with 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.

People said they felt safe living at the service. They were protected from the risks of abuse, discrimination and avoidable harm by staff who had been trained about keeping people safe. Risks to people were assessed, identified, managed and reviewed. People received their medicines safely and on time. Accidents and incidents were monitored and reviewed.

People were supported by a regular staff team who had been safely recruited. Staff knew people, their needs and preferences well and were trained and knowledgeable.

The service was clean and tidy and regular checks were made to make sure the environment and any equipment was safe and well maintained.

People were involved in planning their care and their physical, mental health and social care needs were assessed before they moved to the service to make sure that staff would be able to provide the right support. People were offered the support of an advocate if they required additional support to help them make decisions about their care.

People were supported to maintain a healthy diet and encouraged to drink plenty. Staff worked with health care professionals to make sure people stayed as healthy as possible. They followed any guidance given to them.

People had access to communal areas of the service and to the garden. They could choose if they wanted to spend time with others or if they wanted to be alone. Their choices were respected by staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People said the staff were kind and caring. Staff knew people well and spoke with them in a compassionate way. Staff treated each other kindly and supported each other.

People’s privacy and dignity were promoted and respected by staff. Records were stored securely to protect people’s confidentiality. People were supported to remain as independent as possible. People’s friends and relatives were able to visit when they wanted to and were made to feel welcome.

Care plans gave staff the guidance they needed to provide people with the right support in the way they preferred. People were encouraged to stay active and to take part in organised activities. People and their relatives knew how to complain and told us they had no complaints. They were confident the registered manager would handle any concerns appro

Inspection carried out on 10 March 2017

During a routine inspection

The inspection took place on 10 March 2017 and was unannounced.

Gordon Lodge Rest Home is a large detached house in a quiet residential area. It provides care and support for up to 33 older people, some of whom are living with dementia. There were 24 people living at the service when we visited.

The provider was also the registered manager at the service and was supported in the day to day running of the service by a 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.

We last inspected this service in September 2015. There were no breaches of the regulations identified at that inspection and the service was rated Good. We carried out this inspection sooner than we planned as we had received concerning information about how people were being treated and cared for.

Risks to people were identified but staff did not always have the guidance required to manage the risks and keep people safe. People had care plans in place but these were not consistent, some care plans contained people’s life histories, what people could do for themselves and how they preferred to be supported, others did not. Some people’s care plans contained information about other people and there was a risk people could receive the wrong support. People’s health needs were responded to quickly by staff, but care plans did not give guidance about signs for staff to look out for when people’s health deteriorated.

Staff did not have regular supervision meetings with their line manager and did not have all the training they needed. Although staff offered people day to day choices, the registered manager and staff did not always understand how the Mental Capacity Act (MCA) 2005 was applied. Decisions made for people without capacity were made in their best interests; however some of the mental capacity assessments needed updating to reflect people’s fluctuating capacity. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for DoLS authorisations; however applications had been made for everyone including people who did not require them.

The management team did not have a clear oversight of the service; audits had been completed but did not identify the shortfalls found at this inspection. Records were not always available or completed fully. Staff said although the management team were accessible, they did not always feel valued or listened to. The registered manager told us that no complaints had been received. However, concerns had been raised but there were no records of what they were or how they had been responded to.

Staff knew people well and had built positive and caring relationships with them and their families. Throughout the day we heard laughter and joking between people, their loved ones and staff. People had access to a variety of activities which were based on people’s interests. Staff treated people with dignity and respect, taking time to listen to people and offer reassurance when needed.

People were supported to have a balanced diet; they had input into the menu and could choose what they ate each day. Some people had guidance from speech and language professionals around the consistency of their food and fluids to prevent choking. Staff followed this guidance and supported people safely. People’s fluid intake was recorded but the amounts were not totalled and there were no target levels for people to have each day. People’s medicines were managed safely.

The management team completed audits to identify environmental risks. Fire drills were completed and people had a personal emergency evacuation plan (PEEP) in case of a fire. There were enough

Inspection carried out on 16 and 18 September 2015

During a routine inspection

Gordon Lodge was inspected on 16 and 18 September 2015. The inspection was unannounced. The service provides accommodation for up to 33 older people who require personal care. There are communal spaces which include two lounges and a dining room. People have access to the garden. There were 29 people living at Gordon Lodge at the time of the inspection.

The registered provider was also the registered manager and they were supported by a team leader. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers 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.

People were protected from abuse and avoidable harm. Staff were up to date with safeguarding training and knew how to report abuse. There had been no incidents or accidents since our last inspection. The provider confirmed that previous accidents had been analysed to look for patterns or trends and action had been taken to minimise the likelihood of them reoccurring.

Any personal risks to people were identified and assessed when they moved into the service and these assessments were ongoing. People’s care needs were regularly reviewed, so that staff were able to manage risks and support people in ways that suited them best.

Regular checks of emergency equipment and systems had been completed and the fire risk assessment had been regularly reviewed. People had individual emergency evacuation plans.

The provider had safe recruitment and selection processes in place to make sure that staff employed at the service were of good character. There were enough staff with the skills, knowledge and experience to meet people’s needs safely. Staff were supported to develop their skills and knowledge by receiving training and supervision which helped them to carry out their roles and responsibilities effectively.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the DoLS. The provider understood when a DoLS application should be made and how to submit one.

People were asked for their consent in ways they could understand before care was delivered and staff understood the requirements of the Mental Capacity Act 2005 (MCA).

People were encouraged to follow a healthy diet. People were asked about their dietary requirements and were regularly consulted about their food preferences. When needed, people’s food and fluid intake was monitored to make sure they had enough to eat and drink.

Peoples’ medicines were stored and managed safely. People were supported to have regular access to the doctor, dentist and optician. All appointments with, or visits by, health care professionals were recorded and advice and recommendations were followed. People had the support they needed to manage their health needs. People’s physical health was monitored and people were supported to see healthcare professionals when they needed to. The service worked in partnership with the ‘over seventy five health care team’ and district nurses visited daily.

Staff spoke with and supported people in a caring, respectful and professional manner. Peoples’ diversity was recognised and encouraged in that individuals were supported to follow their beliefs and to live the life they chose. Staff had worked at the service for a long time and knew people well.

People had an assessment of their needs when they moved into the service which was reviewed regularly. As soon as people’s needs changed assessments were updated. People had the opportunity to be involved in their assessments and in the planning of their care. Care plans included details about people who were important to them, their likes and dislikes and information on how people liked to receive their care. The service had built links with the local community and people were visited by local groups who provided activities and entertainment. People could choose from a range of activities.

Peoples’ confidentiality was protected. Staff supported people to be as independent as they could be, and people were treated with respect and dignity their privacy was respected. There were no restrictions on people having visitors. People said that staff helped them to maintain their relationships.

There had been no complaints at the service since the last inspection. However, concerns were raised about the bath being broken and not being replaced. The provider told us that this issue had been addressed and a new bath had been ordered.

People said that staff met with them regularly to make sure their views about the service were heard. People, visitors, staff and relatives were asked for their opinions about the service. This information was used to develop and improve the service.

Systems were in place to audit, monitor and review the quality of care provided. Records showed that the provider had analysed the outcome of the audits and had taken action to address any issues.

Inspection carried out on 22 May 2014

During a routine inspection

The inspection team was made up of one inspector. Time was spent in the home looking at care records, talking to staff and people who used the service. We looked at people's plans of care, staffing records and quality assurance processes. We set out to answer our five questions; 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, discussions with people using the service, the staff supporting them and looking at records.

Is the service safe?

The service was safe. Practices in the service generally protected people using the service, staff and visitors from the risk of harm.

Systems were in place to make sure that managers and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

Each person had a care plan detailing their support and care needs. We saw that there was guidance for staff to follow to reduce risks and implements strategies to make sure people were as safe as possible.

Is the service effective?

The service was not always effective. People told us that they were happy with the care that had been delivered and that their care needs were met but this was not always in a timely manner. One person we spoke with told us, “There are not enough staff; I have to wait a long time if I need something”. We saw that staff were attentive to people using the service but were not always able to respond promptly when needed.

People’s health and care needs were assessed with them and /or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person’s needs.

Is the service caring?

The service was not always caring. People were not always supported by kind and attentive staff. People we spoke with said they did not always feel that staff respected them or their privacy and dignity and staff were not always polite and caring.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led for most of the time. There were clear quality assurance processes in place. Staff told us they were not always clear about their roles and responsibilities but they told us they did feel supported by the management team. Systems were in place to ask people who used the service, relatives and staff for their views about the service. Audits of the care plans had been completed to assess the quality of the care being provided.

Inspection carried out on 15 August 2013

During a routine inspection

People who used the service told us that they were happy with their quality of care. One person told us "I feel well looked after here, the staff are friendly and offer help when I need it". Another person we spoke to told us, " The manager and staff are always approachable, if I don't understand something they take the time to explain things they couldn't be more caring".

The staff Knew what support people needed and they respected their wishes The support that we observed being given to people matched what their care plan said they needed. Care and support was delivered in a person focused manner and we saw that staff created opportunities for people to make daily choices and decisions. We found that the provider was in the process of updating the care plans of people who used the service and people told us that they were involved in the process.

We found that audits were completed regularly and we saw action plans to address any shortfalls that were identified. We saw evidence of regular audits in relation to documentation on accidents, infections, care planning and risk levels. We found that issues and discrepancies were addressed swiftly and effectively.

We saw minutes of regular staff meetings where changes or issues within peoples care were discussed. In addition, we saw evidence of meetings with people who used the service to ensure they were consulted and encouraged to contribute their ideas about the running of the home.

Inspection carried out on 25 January 2013

During a routine inspection

People told us they were happy living at the home and felt they received a good standard of care. Relatives of people who use the service we spoke to, told us that they were happy with the care provided for their relatives. One person told us "My relative is always happy and relaxed. All the staff are approachable and kind". We found that staff were knowledgable about the needs of the people who used the service and had received appropriate training along with regular supervision. The provider told us that both the manager and herself have an open door policy where people who use the service staff and relatives can approach them and discuss any issues or share their views.

Inspection carried out on 17 April 2012

During an inspection to make sure that the improvements required had been made

People told us that they were satisfied with the care they were receiving. They said that the staff were kind, polite and respectful.

They told us that the manager asked them regularly if they were happy with the service. They said she spoke to them individually and in small groups so that they had the opportunity to voice their opinion of the home.

People spoken with told us they did not have any complaints about the service but would not hesitate to discuss any issues with the staff or management team. They said that the staff were well trained and knew how to care for them well.

Inspection carried out on 20 December 2011

During a routine inspection

People told us they were happy with the service. They said the staff were kind and gave them the support and care that they needed. They said the staff were respectful and treated them with dignity and maintained their privacy.

Two people who had lived in the home for several years said they would definitely recommend the service. They said the home was always clean and tidy and they felt it was truly their home.

Relatives said they were satisfied with the service being provided and visitors were always welcome.