Stanley Lodge Residential Home

Stanley Lodge Residential Home is a care home which is registered to provide personal care for up to 23 people. Some of the people in the home lived with physical and mental health needs. At the time of the inspection the home was providing care and support to 17 people.

We found the following examples of good practice.

The provider had established systems to prevent visitors from spreading and catching infections. They had followed guidance on supporting safe visiting including by displaying notices at the entrance to the home advising people not to enter if experiencing symptoms of COVID-19. Arrangements had been put in place for testing and screening visitors for symptoms and their contact details were recorded to support the NHS Test and Trace service. The provider had established an area for facilitating safe visiting called a visiting pod. Technology such as video calling was used to facilitate contact between people and their relatives as well as medical professionals.

The home had adequate sitting areas for people to use. Seating had been arranged to support people to social distance. The provider had ensured the building had adequate ventilation to promote air circulation.

The provider followed best practice when people were admitted to the home. People had a negative COVID-19 test before moving into the home and self-isolated in their rooms for 14 days after moving in.

During our visit we observed the staff using Personal Protective Equipment, (PPE) safely. The provider had ensured sufficient stocks of appropriate PPE were available to protect people.

People living in the home and the staff were tested regularly for COVID-19. The provider had supported people and staff to receive the COVID-19 vaccine.

The home was clean and hygienic. Cleaning schedules were in place and frequently touched areas were cleaned regularly throughout the day to reduce the risk of infection. Staff had received training in infection prevention and control and the registered manager monitored staff’s well-being during the pandemic.

The provider had detailed and up-to-date infection prevention and control policies and procedures. They sought and acted on advice to further improve infection prevention and control procedures. They were aware of appropriate agencies to contact in the event of an outbreak of COVID-19.

Stanley Lodge Residential Home is a care home which is registered to provide personal care for up to 23 people. At the time of the inspection the home was providing care and support to 15 people. The home is a detached property which has been adapted. It has a stair lift for access to the first floor and several communal living areas and bathrooms.

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

People told us they received care to meet their needs. Improvements had been made to ensure person-centred care was always delivered. People confirmed they were able to make choices about their care and support. Although improvements had been made we noted person-centred care was not fully embedded within staff practice. We have made a recommendation about this.

we spoke with agreed the service was well-led. The registered manager had worked hard to make the required improvements identified at the last inspection. Auditing systems had been reviewed and embedded to ensure the service was safe and of a high quality. The registered manager had reviewed paperwork to ensure documentation was up to date, accurate and reflective of people’s needs. Although improvements had been made, we noted this was not consistently embedded. We have made a recommendation about this.

The registered manager had reviewed activities at the home and had developed community networks to combat isolation. People were positive about their experiences of living at Stanley Lodge Residential Home.

People told us they felt safe living at the home. Improvements had been made to ensure promote safety. Recommendations made at the last inspection had been acted upon. This included reviewing systems for managing medicines and addressing risk.

People told us care provided was effective. A comprehensive training plan had been developed and staff training was on-going. Staff told us they were happy with the training offered. Concerns identified at the last inspection regarding the living environment had been acted upon. For example, bathrooms had been repaired, carpets had been replaced and new windows had been fitted throughout the home.

People told us staff were kind and caring. There was a relaxed and happy atmosphere within the home. Staff treated people sensitively and compassionately with dignity and respect. 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.

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 requires improvement (published 03 August 2018) and we identified multiple breaches to 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 was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Stanley Lodge Residential Home 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.

Stanley Lodge is registered with the Care Quality Commission to provide accommodation and personal care for up to 23 residents. The home is situated in a rural area of Forton near Lancaster.

Stanley Lodge Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We last carried out a comprehensive inspection at Stanley Lodge Residential Home in May 2016. The home was rated good but we identified some concerns in relation to the environment. We carried out a focussed inspection in January 2017 to check improvements had been made. We found the registered provider had made the improvements required.

At this inspection visit carried out in May 2018, we found the registered provider had not met the fundamental standards. We identified concerns in relation to premises and equipment, person centred care, staff training and good governance.

There was a registered manager in place. 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 this inspection visit carried out in May 2018, we found the home environment was not always appropriately maintained. We found areas within the home which were in need of repair. For example, two toilets were out of use, only one bathroom was in use, two bedroom windows were secured with tape and a hole in a ceiling had been temporary boarded over but not repaired. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Because of the poor maintenance of the home, people were sometimes unable to have a bath when they requested it. This meant people’s preferences and wishes were not always met. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Staff did not always receive ongoing training and support to ensure them to carry out their roles safely. For example, only three staff who worked at the home had an up to date qualification in basic first aid. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Paperwork was not always suitably completed in order to ensure safe and effective care was delivered. We found paperwork was not always up to date and accurate. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Although people told us they felt safe we found risk was not always appropriately addressed and managed in a timely manner. We have made a recommendation about this.

Processes were in place to ensure medicines were suitably and safely managed in line with good practice guidance. However, we found these were not consistently embedded. We have made a recommendation about this.

On the first day of the inspection visit the registered manager told us they had recently introduced an electronic care recording system. They said however they had not had time to fully implement the system so staff were using two different care recording systems. We reviewed care records and found paperwork was disorganised and care records did not always reflect people’s needs. We fed this back to the registered manager who took immediate action. On the second day we were informed by the registered manager they had decided to revert to their original care recording system. They said they had taken immediate action and had reviewed all care records. We have made a recommendation about this.

During the inspection visit we were made aware the registered provider was having difficulties in recruiting staff. After the inspection visit we received assurances from the registered manager that action had been taken and improvements had been made to increase the number of available to work.

We saw evidence of multi-agency working to promote effective care. Health professionals praised the skills and knowledge of staff who worked at the home. Relatives told us the home was good at meeting the needs of people.

People, relatives and professionals told us there were enough staff on duty to meet individual needs. We observed staff encouraging and supporting people to take part in activities during our inspection visit.

People who lived at the home and relatives praised the caring and helpful nature of staff. From observations we saw staff were patient and respectful with people.

People and relatives told us that people’s nutritional needs were met by the registered provider. We observed meals being provided and noted there was sufficient quantities of food and flexible choice for people.

Systems were in place to safeguard people from abuse. Staff were able to identify types of abuse and how to report any concerns.

We reviewed infection prevention and control processes at the home. We identified some areas for improvement and made a referral to the infection prevention and control team so staff could access up to date professional advice to ensure infection prevention control processes at the home were consistent.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Consent to care and treatment was routinely sought. People had freedom to mobilise throughout the building.

Staff who worked at the home described it as a good place to work. They praised the skills of the registered manager and said the home was well-led. People and their relatives told us they also considered the service to be well led.

The registered provider liaised with health professionals when people required end of life care at the home to ensure people received care in line with good practice.

We looked at how complaints were managed and addressed by the registered provider. At the time of the inspection no one had any complaints about how the service was delivered. We were told by relatives the manager was approachable and would take time out to listen to any concerns they may have. Feedback from relatives about the home and how it was managed was positive.

Following the inspection visit we made a referral to the Local Authority Infection Prevention and Control Team and spoke with the Fire and Rescue service to provide feedback from our findings. Both the infection prevention and control team and fire and rescue service visited the home and carried out inspections in response to information shared.

This is the first time the service has been rated Requires Improvement.

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

This unannounced focused inspection took place on 21 November 2016.

Stanley Lodge Residential Home is a care home managed by Unlimited Care Limited. It is located in the village of Forton, South of Lancaster.

There was a registered manager in place. 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.

There were 23 people residing at the home at the time of the inspection.

The service was last inspected on 18 and 24 April 2016. At this comprehensive inspection we found the registered provider was not meeting all the fundamental standards. We identified a breach to Regulation 15 of the Health and Social Care Act 2014 as the registered provider had failed to ensure premises and equipment were suitable for use and appropriately maintained.

Following the comprehensive inspection in April 2016, we asked the registered provider to submit an action plan to show what changes they were going to make to become compliant with the appropriate regulations. The registered provider returned the action plan to demonstrate the improvements they intended to make. We used this focused inspection to look to check if the actions set out within the action plan had been completed and to ensure all fundamental standards were now being met.

At this focused inspection carried out in November 2016, we found the required improvements had been made.

Improvements to the living environment had been completed. Decoration within the building had taken place. Slips, trips and fall hazards had been reviewed and addressed.

Best practice guidance had been referred to and window locks had been fitted to all windows where there was risk of falls from height.

Electrical testing of all appliances had been carried out to ensure electrical appliances were suitable and safe for use.

Following the inspection visit we received confirmation that action was being taken to ensure infection control processes were consistently applied throughout the building.

Stanley Lodge is registered with the Care Quality Commission to provide accommodation and personal care for up to 23 residents. The home is situated in a rural area of Forton near Lancaster. There were sixteen people residing at the home at the time of inspection.

There was a registered manager in place. 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 service was last inspected on 09 January 2014. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

At this inspection carried out in April 2016, people spoke positively about the quality of service provision on offer. People told us staffing levels were conducive to meet their needs and they benefited from staff who knew them well.

The registered manager carried out a monthly assessment of peoples support needs to determine staffing levels. We observed staff being patient and spending time with people who lived at the home.

People told us they felt safe and secure. Arrangements were in place to protect people from risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

Suitable arrangements were in place for managing and administering medicines. A designated staff member carried out audits of medicines to ensure systems in place were being followed correctly by staff. All identified medicines concerns were reported to the registered manager for investigation.

Recruitment procedures were in place to ensure the suitability of staff before they were employed. However these were not always consistently applied. We have made a recommendation about this.

People’s healthcare needs were monitored and managed appropriately by the registered provider. Guidance was sought in a timely manner from other health professionals when appropriate.

Care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Feedback on the quality of food provided was positive from both people who lived at the home and relatives. People were happy with the variety and choice of meals available to them. Peoples nutritional needs were addressed and monitored.

There was a variety of social activities on offer. The registered manager had established links with various community groups who frequented the home and provided entertainment. Consideration was taken to ensure people who chose not to interact within groups were supported on an individual basis. Cultural needs were recognised by the registered provider.

We found premises and equipment were not appropriately maintained. Action commenced after we highlighted these concerns and we were assured work was on-going to improve the living environment. This was a breach of Regulation 15 of the Health and Social Care Act (2008) Regulated Activities 2014.

The registered manager had a training and development plan in place for all staff. We saw evidence that staff were provided with relevant training to enable them to carry out their role.

Staff had received training in The Mental Capacity Act 2005 and the associated Deprivation of Liberty Standards (DoLS.) We saw evidence these principles were put into practice when delivering care.

The manager had implemented a range of assurance systems to monitor quality and effectiveness of the service provided. Work had been undertaken to restructure staffing as a means to improve service delivery.

Staff were positive about ways in which the service was managed. Staff described teamwork as “Good.”

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

We spoke with a range of people about the home. They included the manager, staff members, residents and visitors to the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Stanley Lodge.

We spent much of the time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support with personal care. Sufficient skilled numbers of staff were available to meet the needs of people. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "I feel at home. The staff are excellent and I am very happy."

During this inspection we assessed the progress made by the provider in relation to the concerns raised in previous reports. We found that some minor improvements had been made. However there were a number of issues still outstanding that had not been addressed.

Between 03 December 2012 and 17 December 2012, we had been contacted through a number of sources regarding concerns about continuing poor staffing levels at the home. In addition the provider contacted us on 17 December 2012, notifying us that she was experiencing problems with staffing the home.

The home was also visited by a Care Quality Commission Pharmacist Inspector on 10 January 2013. The visit was in response to concerns raised with the Commission about medication administration practices at the home.

We observed part of the morning medicines round and spoke with several people about their medicines. People we spoke with felt they received their medication on time. However, in one instance we found one persons medication had been administered after food when it should have been prior to food. In another instance the recorded stock of medication (inhaler) was incorrect. Also there was no evidence of formal arrangements in place to monitor staff competency in medication administration. This meant there were improvements required, to help make sure medicines were being managed safely.

The home currently provides accommodation for eighteen people. On arrival at the home at approximately 4.45pm, we found two members of staff on duty, one of whom was the manager. A relative of a person who lived at the home was assisting the staff by washing up the tea time pots.

We spoke with a range of people about the home. They included the home manager, people who lived at the home and a family member visiting their relative.

This home cares for people with a range of dementia conditions and conversation with some people who lived at the home was limited. However the people we spoke with told us they felt safe and well cared for.

Between 03 December 2012 and 17 December 2012, we had been contacted through a number of sources regarding concerns about continuing poor staffing levels at the home. In addition the provider contacted us on 17 December 2012, notifying us that she was experiencing problems with staffing the home.

The provider met with relatives on 17 December 2012 to make them aware of the staffing problems at the home. A relative we spoke with expressed their concerns about the situation and was anxious that staffing levels were not stable.

A meeting took place between the provider and the Care Quality Commission on the 19 December 2012. The Commission requested that the provider supply evidence of what action they would take to ensure the home would be suitably staffed during the Christmas and New Year Period.

Stanley Lodge cares for people with a range of dementia conditions and conversation with some people who lived at the home was limited. We spoke with a variety of people about the home. They included the senior person in charge, people who lived at the home and a family member visiting their relative. Staff we spoke with told us of their concerns that staffing levels were not consistent and they had found it difficult to manage at times.

Lancashire Fire Service was in attendance on the day of our visit carrying out a routine fire safety inspection at the home.

This home cares for people with a range of dementia conditions and conversation with some people who live at the home was limited. However the people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, 'It is homely here and I am very happy.'

We spent time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support. Staff treated people with respect and dignity.

We had been contacted prior to visiting the home with concerns about staffing levels and staff training. We found that there were occasions when there was not enough staff on duty to meet people's assessed needs. We also found that suitable arrangements are not in place to ensure that staff receive appropriate training in key areas.