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Archived: Gordon Lodge Nursing Home Requires improvement


Inspection carried out on 22 and 24 July 2015

During a routine inspection

This inspection took place on 22 and 24 July 2015. The visit on 22 July was unannounced and we told the provider we would return on 24 July to conclude the inspection.

We last inspected the service in August 2013 when we found no breaches of the regulations.

Gordon Lodge Nursing Home provides accommodation for people who require nursing or personal care. When we inspected there were nine older people using the service. People using the service had general nursing care needs and some people were living with dementia.

The registered provider, Mrs Andall, is also the registered manager of 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.

We found four breaches of the regulations. The provider did not always follow systems for protecting people who used the service. The provider did not always assess the risks to people using the service and did not always act on assessments of possible risks. Staff did not always follow systems to ensure that people consistently received their medicines safely and as prescribed. Checks and audits the provider / manager carried out did not identify issues that they needed to address.

You can see what action we told the provider to take at the back of the full version of the report.

People told us they were well cared for by staff who understood their needs.

The provider ensured staff completed the training they needed to work with people using the service.

Where people were not able to make decisions about the care and treatment they received, the provider acted within the law in people’s best interests.

People told us the nurses and care staff working in the home were caring and during the inspection, we saw staff treated people with kindness and patience.

There was no evidence of analysis or learning from accidents and incidents involving people using the service.

The provider had systems in place to monitor the day to day operation of the service but these were not always effective and there was a lack of clarity about the management of the home.

Inspection carried out on 7, 8 August 2013

During a routine inspection

We spoke with five people using the service, five members of staff, the home’s deputy manager and a visiting NHS professional. People told us they felt well cared for in the home and staff were kind and helpful. One person said “I can’t fault them, if I need help it’s always there.” Another person said “the girls do their best, they are very kind.”

People who use the service understood the care and treatment choices available to them. They told us staff always explained the support they provided and asked to make sure they understood what was happening.

We saw that people’s needs were assessed and recorded and they, or their representatives, were involved in reviewing and updating the care plan and risk assessments.

The provider had taken steps to provide care in an environment that is suitably designed and adequately maintained. We saw all communal parts of the home and some people’s bedrooms. The home was very clean and there were no offensive odours. Bedrooms were well decorated and people were supported to bring their personal possessions into the home with them.

Appropriate checks were undertaken before staff began work and staff were trained to care for people safely.

The provider had arrangements to monitor standards of care and treatment and took account of complaints and comments to improve the service.

Inspection carried out on 7 December 2012

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

We carried out this inspection to follow up issues that we identified when we visited in August 2012.

We found that the issues we raised had been addressed by the provider. Fire safety standards had improved and arrangements had been made to provide manual handling and safeguarding adults training for staff.

We spoke with some of the people using the service. Their comments included “I can choose what I like to eat, the food is good” and “they ask me if I’m alright and if there’s anything I need.”

Inspection carried out on 31 August 2012

During a routine inspection

Prior to this inspection we inspected Gordon Lodge on 10th February 2012. We had concerns because people were not given adequate opportunities to give their views about the service they received, including the food provided, or to make choices about what appears on the menu. A compliance action was made.

We also had concerns because the provider had not implemented a quality monitoring system to ensure that people received safe and appropriate care, treatment and support. A compliance action was made.

We spoke with four people who use the service and one relative. One person said “all staff are nice, young and old” and staff are “pretty good”. One person said they liked the home because it was small and there were ‘’not many residents’’.

People said they were not aware of menus but were asked about their preferences and there was an alternative. Three people commented on the food provided at the home. People said, “the food is wonderful”, “you cannot please everyone” and “the food is up and down”. We spoke to two members of staff who said that they gave people daily choices, for example choices on activities, clothing and the menu.

One person indicated that not all staff had the skill to talk with people in a caring way or manage some situations, for instance, if people who use the service were upset. Another person felt that staff were skilled in this area and always approached people in a calm manner. One person said they had observed staff moving people around and it “looked tough”.

The provider had implemented a method of obtaining people’s views and had introduced menus and had asked people about their daily preferences.

Two compliance actions have been made as a result of this inspection. The provider was not able to evidence that staff received an induction programme suited to the care sector, or that staff were skilled to provide moving and handling training. Staff do not receive regular supervision with a line manager or annual appraisal. The fire risk assessment had not been updated; there was no evidence of fire drills and fire alarm testing.

Inspection carried out on 12 March 2012

During a routine inspection

People who use the service told us that they felt safe and well looked after living at the home. They said that staff were caring and available when they needed them. People told us they could choose how they spent their time and that they could have privacy when they wanted it. They said that they were supported to obtain medical treatment if they became unwell.

People we spoke with told us that they were not asked for their preferences about meals or what they would like to see on the menu. They said that they did not know what meals were planned as there was no menu displayed for them to find out.

Reports under our old system of regulation (including those from before CQC was created)