Background to this inspection
Updated
20 May 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.
This inspection took place on 11 and 13 April 2017 and was unannounced. It was carried out by one inspector.
Before the inspection we reviewed the information we held about the service. This included previous inspection reports, evidence the provider sent us about action they had taken since our last inspection and statutory notifications. These are notifications the provider is required by law to send to us about certain significant events that take place within the service.
During the inspection we spoke with two people who used the service, one relative of a person who used the service and two members of staff. We looked at four people's care plans and inspected the provider's audits and checks that were carried out since our last inspection. We observed staff caring for people and we used the Short Observations Framework for Inspections (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
Updated
20 May 2017
This inspection took place on 11 and 13 April 2017 and was unannounced. It was carried out by one inspector.
At our last inspection in September 2016 we found three breaches of regulations in relation to safe care and treatment, meeting nutritional needs and good governance. Because of the level of risk to people’s safety, we gave the service a rating of ‘inadequate’ for the question, ‘Is the service safe?’ We imposed conditions on the provider’s registration that meant they were not permitted to admit people to the home until the condition had been lifted. The provider was also required to submit evidence to us showing they had made the necessary improvements, which we received.
The purpose of this inspection was to check the improvements the provider said they would make in meeting legal requirements. In addition, our processes indicate that we should carry out a further comprehensive inspection within six months after a service is rated ‘inadequate’ in any key question. We found that the provider had made all the necessary improvements to address the concerns we identified at our last inspection in relation to the three breaches of regulations and so had met the requirements of the conditions we imposed. As a result of improvements made by the provider we have initiated procedures to remove the aforementioned imposed conditions on the provider’s registration.
St Mary’s Lodge is a care home providing personal care for up to 40 people, some of whom may be living with dementia. When we carried out this inspection there were 26 people using the service. There was a registered manager in post. 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.
At our last inspection, we found the service was not safe because hazardous chemicals were not stored securely, windows were not appropriately restricted, showers ran at dangerously hot temperatures, some risk assessments were missing or incomplete and unsafe materials were kept in a part of the garden where people could access them unsupervised. At this inspection we found the provider had made improvements to the safety of the environment and to people’s individual risk assessments. They had put systems in place to ensure hazardous chemicals were locked away securely when not in use and that hot water used for washing or bathing was maintained at safe temperatures. Upper floor windows we checked were appropriately restricted and the environment, including the garden, was free from hazardous materials and debris. People had access to alarms if they needed urgent assistance.
People had individual risk assessments and management plans, which were updated regularly or according to their needs. However, some details were still missing from some people’s assessments and the provider had not fully considered risks posed by the use of a collapsible ramp for staff to move loaded food and drink trolleys up and down a step. The provider assured us that they would address these issues.
At our last inspection we found people did not always have the support they required to eat and drink. Staff did not always make appropriate referrals in a timely manner when people were at risk of malnutrition. At this inspection, we found the provider had made improvements meaning people had access to the equipment and staff support they needed to eat and drink. Staff monitored people’s weight and made timely referrals to healthcare providers if they observed any significant changes or if people required support with any other aspect of their health.
We saw evidence that the registered manager had discussed the previous inspection findings at a staff meeting and used the discussion to ensure all staff were aware of their responsibilities in relation to the provision of safe care and treatment, good record keeping and other areas of concern we identified. This had helped them to make improvements since our last inspection in terms of governance and quality improvement. We found the provider’s audits and checks were now more effective and also more proactive as they had put in place new tools to assess and monitor several aspects of service provision and identify areas for improvement.
We also found at our last inspection that the provider did not always ensure people’s privacy was respected, particularly around the storage of confidential personal information. At this inspection we found this information was securely stored. Staff supported people in ways that respected their privacy and promoted their dignity and independence.
The provider had made improvements to care plans since our last inspection, by removing inaccurate or out of date information and ensuring that care plans were reviewed as regularly as needed. Care plans were based on people’s needs, preferences and their own views about their care and what was important to them.
There were enough staff to care for people safely and the provider had recruitment procedures in place to help ensure only suitable staff were employed. However, their recruitment procedures did not include always obtaining a full work history from new employees. The provider obtained this information during our inspection.
There were systems in place to protect people from abuse and medicines were managed safely.
Staff received appropriate training and support to carry out their roles effectively. The provider sought advice on best practice from appropriate sources and applied the guidance to their work.
Staff obtained people’s consent, where possible, before carrying out care tasks. There were systems in place to ensure that where people did not have the capacity to consent the provider acted in line with legal requirements to make decisions on people’s behalf. This included any decisions to deprive people of their liberty where they were unable to consent to being admitted to the home. We observed staff giving people the information and time they needed to make choices about their care. Staff shared information via care plans about how to support people to make choices, particularly those with more complex communication needs. They involved relatives and others who were important to people when making more complex decisions, such as those around end of life care. The service facilitated peer discussions on this topic for people’s relatives.
People had access to a variety of activities at the home. The service had recently employed an activities coordinator, who was in the process of developing a programme of person-centred activities to suit individual needs and tastes.
The provider continually sought feedback from people, their relatives and staff and used this to improve the quality of the service. The provider also had appropriate procedures in place to deal with complaints.