Lingdale Lodge

Lingdale Lodge is a residential care home providing personal care to 39 people aged 65 and over at the time of the inspection. The service can accommodate up to 48 people.

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

At our last inspection we found failings in the service which put people at risk of harm. At this inspection the provider had made the necessary improvements, and people were safe.

We were not fully assured any future shortfall would be acted upon promptly. The improvements made needed to embedded and sustained.

The provider and registered manager were open and transparent, and acknowledged the previous failings. They accepted improvements made needed to be embedded and sustained over time.

People were protected from harm and abuse, and relatives felt their family members were safe and well cared for. Staff were trained in safeguarding and knew how to report concerns to the relevant authorities if needed. Recruitment processes ensured staff employed were safe to care for vulnerable people.

Arrangements were in place to safely manage and monitor risks associated with people’s care. The service worked in partnership with healthcare professionals. Care plans and risk assessments were reflective of people’s needs, and people's medicines were managed safely.

Robust infection control procedures were in place with government guidance followed to ensure people were protected as far as possible from the risk of infectious diseases such as COVID-19.

Staffing levels were safe. Staff provided people with safe and compassionate care and were supported in their role. People and relatives were consulted on how care was arranged according to their wishes.

There was a positive culture at the service. People commented on a warm and friendly atmosphere at the service. When a concern was raised these were listened too and taken seriously.

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.

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 inadequate (published 15 April 2020) 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 we found improvements had been made and the provider had met some of the breaches of regulation. The provider remains in breach of one regulation. This breach of regulation will be reviewed at our next inspection.

This service has been in Special Measures since 15 April 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out a comprehensive inspection of this service on 5 February 2020. Breaches of legal requirements were found, and the service was placed in special measures. We imposed conditions on the providers registration. The provider completed an action plan to show what they would do and by when to bring about the improvements needed.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they are now meeting legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. This inspection was also prompted in part due to concerns received about staffing numbers, medicines and infection control.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used to calculate the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control 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.

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

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.

Lingdale Lodge is a residential care home providing personal care to 44 people aged 65 and over at the time of the inspection. The service can accommodate up to 48 people in one adapted building.

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

People were at risk of harm due to a failure to manage risks associated with hot surfaces, bedrails and the environment. Some people had sustained harm as a result of this. A failure to learn from incidents placed people at risk of harm. There was a risk people may not receive their medicines safely, when needed. Poor hygiene standards and a failure to follow infection control procedures meant people were at risk of infection.

People were, as far as possible, protected from the risk of abuse and improper treatment. Staff were recruited safely and there were enough staff to meet people’s needs and ensure their safety.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care was not always provided in line with legislation and good practice. There was a risk people may receive inconsistent support with health conditions as staff knowledge was variable. Some people were at risk of malnutrition, records did not evidence they were provided with specialist diets recommended by health professionals. The home was adapted; however, some adaptations were not safe. Signage in some areas of the home did not create a homely environment. People were supported by staff who had access to a range of training and support.

People’s right to privacy was not always respected. However, people were supported by kind and caring staff who knew them well and responded to their needs. People and their families were involved in decisions about their care.

People could not be assured that their concerns or complaints would be investigated and addressed as the provider did not follow their own policy. Overall, people received care that met their needs and reflected their preferences, their communication needs were met and they had been supported to think about and plan for their end of life wishes. People were provided with opportunities for activities and were supported to stay in touch with people who were important to them.

Systems to ensure the safety and quality of the home were not effective and practices were not based upon national good practice guidance and legislation. This had led to a failure to identify and safely address risks to people’s health and safety. The registered manager had not identified serious incidents that placed people at risk. There had been a failure to notify CQC of some events within the service. In contrast, we found the home had a positive atmosphere, people were happy with the service provided and staff felt valued. People, relatives and staff were involved in the running of the home and there were positive working relationships with partner organisations.

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 15 July 2017).

Why we inspected

Although this was a planned inspection based on the previous rating, the inspection was prompted in part by two specific incidents. One incident resulted in a person using the service sustaining a serious injury, the other incident placed a person at serious risk of harm. These incidents are subject to further investigations. As a result, this inspection did not examine the circumstances of the incidents.

The information CQC received about the incidents indicated concerns about the management of risks from hot surfaces and missing persons. This inspection examined those risks.

We have found evidence that the provider needs 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.

Enforcement

We have identified breaches in relation to environmental safety, the safe use of equipment, decision making and governance at this inspection. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager in post. It is a requirement that the service has a registered manager. 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.

At our previous inspection on 1 & 2 February we found that improvements were required in all areas and the provider was not meeting three of our regulations. At this inspection we found that improvements had been made.

Staff understood their responsibilities about protecting people from abuse and avoidable harm. Risk was assessed and management plans were put in place. Staffing numbers and skill mix were sufficient to meet the needs of people who used the service. The provider followed recruitment procedures to minimise risks because they carried out checks before employment was offered

People received the right medicine at the right time because medicines were managed, stored and administered in line with current professional guidance.

Staff had received training and were supported to carry out their roles, and knew how to meet people's individual needs.

Consent was sought before the delivery of care and support. People had their capacity to make decisions assessed and staff were working within the principles of the Mental Capacity Act.

People were supported to eat and drink a varied and nutritious diet. They had access to the healthcare services they required.

Staff were caring and had developed positive relationships with people. People had their privacy and dignity respected and were involved in making decisions about their care and support.

Staff knew people well and understood their needs. Care and support was delivered in the ways that people preferred. People felt comfortable making a complaint and confident they would be listened to.

The culture of the service was open and inclusive. There was a clear organisational structure and staff understood their responsibilities. The quality of the service was monitored and changes were made to improve.

Lingdale Lodge provides accommodation, care and support for up to 48 people who require personal care. On the day of our inspection there were 47 people using the service.

There is a registered manager at the service. 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.

People felt safe at the service. Staff had a good understanding of the various types of abuse and knew how to report any concerns.

We found a number of areas around the premises that presented risks to people that used the service. Those risks had not been appropriately addressed.

People's risk assessments and care plans had not always been reviewed to ensure that they continue to meet people needs and protect them from harm.

There were enough staff on duty to meet people's needs. Staff commenced employment before pre-employment checks had been carried out. Staff had not always received sufficient training to enable them to carry out their roles.

People generally received their medicines as prescribed. People were supported to access healthcare professionals when they required them.

The information relating to the people's mental capacity was not decision specific and therefore did not fully meet the requirements of the Mental Capacity Act (MCA) 2005 legislation.

People were supported with drinks, snacks and meals throughout the day. There were limited opportunities relating to the dining experience for people to help themselves.

People and relatives told us that they felt involved in the decisions about their care and support.

People told us that staff showed concern for their well-being. However staff did not always respond appropriately to the needs of people with dementia. Staff had not identified that a person had sustained an injury.

People felt able to discuss any of their concerns. There was a complaints policy in place however it required updating.

People enjoyed the activities that were provided. Regular activity sessions took place.

Quality monitoring systems that were in place had failed to identify and address the concerns that we found. The provider had failed to act on feedback from the Fire Service. The provider had failed to ensure that people’s records were securely maintained.

We identified that the provider was in breach of three of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). You can see what action we told the provider to take at the back of the full version of the report.

Staff supported people in a dignified manner. One care worker in particular excelled at the way they supported people. Other care workers spoke politely to people and were attentive to their needs. We saw an example of poor practice by one care worker which we brought to the attention of the manager and which was quickly resolved.

We found that here were enough care workers on duty to attend to the needs of people. The home provided a safe and caring environment for people.

We saw care workers supporting people with activities and routines. People were engaged in meaningful activities. Those people who required support at meal times received support as did people who required support with their mobility. Care workers responded promptly to requests from people who used the service. Care workers we spoke with understood the care needs of the people they supported.