Archived: Teesdale Lodge Nursing Home

We found the following examples of good practice.

• Systems were in place to prevent visitors from catching and spreading infections. Systems were in place to allow safe visiting.

• Staff promoted and practised safe social distancing throughout the home. Effective systems were in place to isolate and shield people should outbreaks occur.

• Stocks of personal protective equipment (PPE) were in place and staff were trained in its use.

• Clear systems were in place to admit people safely into the home.

• People and staff were regularly taking part in the Covid testing programme.

Further information is in the detailed findings below.

Teesdale Lodge Nursing Home is a residential care home providing personal and nursing care to up to 40 older people, younger adults and people with a physical disability. 23 people were using the service when we inspected. People were supported in one purpose-built building.

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

People received kind and caring support and were treated with dignity and respect. Staff ensured people’s voices were heard.

Medicines were managed safely. Risks to people were assessed and actions taken to reduce them. People received support from stable staffing teams, who had been safely recruited.

Staff were supported with regular training, supervision and appraisal. 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.

People received personalised support based on their assessed needs and preferences. Activities took place but we received mixed feedback on these. The registered manager and nominated individual said they would be reviewed. The provider had an effective complaints process.

The provider had effective governance processes, including a range of quality assurance audit. Feedback was sought and acted on. The service worked effectively in partnership with other 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 requires improvement (published 13 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service was last inspected in November and December 2017 and was rated requires improvement. At that inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance, staffing levels and the management of medicines. We took action by requiring the provider to send us action plans setting out how they would improve the service. We also met with the provider and registered manager after the inspection to discuss their plans. When we returned for this inspection we found that the provider was no longer in breach of regulation, though further and sustained improvement was needed in relation to medicines management, wound and skin care and good governance.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Teesdale Lodge Nursing 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. Teesdale Lodge Nursing Home accommodates up to 40 people. At the time of our inspection 21 people were using the service.

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.

We made recommendations on medicine management, skin and wound care and reviewing the mealtime experience at the service.

Staffing levels were based on people’s assessed levels of dependency. The provider’s recruitment processes minimised the risk of unsuitable staff being employed. Risks to people were assessed and plans developed to reduce the chances of them occurring. Plans were in place to support people in emergency situations. People were safeguarded from abuse. Systems were in place to keep the premises clean and tidy and ensure effective infection control.

Improvements had been made to make the premises easier to use and more comfortable for people living there. Staff were supported with regular training, supervision and appraisal. 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 were supported with food and nutrition. Staff worked with various healthcare and social care agencies and sought professional advice to ensure that the individual needs of people were being met.

People spoke positively about the support they received from staff, who they described as kind and caring. Relatives also praised staff and the quality of the support they provided. We saw numerous examples of kind and caring interactions during our visit. People were treated with dignity and respect. Staff supported people to maintain their independence and do as much as they could and wished to for themselves. At the time of our inspection one person was using an advocate. Policies and procedures were in place to support people to access advocacy services where needed.

Support was based on people’s assessed needs and preferences and were regularly reviewed. The registered manager and provider were working on improving activities provision at the service. Policies were in place to investigate and respond to complaints. Procedures were in place to provide end of life care where needed.

Governance processes had improved but further and sustained improvement was needed. Staff spoke positively about the management, culture and values of the service and said morale had improved since our last inspection. Feedback was sought from people and relatives. Since our last inspection the registered manager had worked to create and expand community links for the benefit of people living at the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications.

The service was last inspected in June and July 2017 and was rated ‘Requires Improvement’. At that inspection we identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, namely, Dignity and respect, Safe care and treatment, Good governance and Staffing. These breaches related to medicines management, risk assessments, fire safety, good governance, staffing levels, training records, treating people with dignity and respect and preventing social isolation.

In relation to the breach of Regulations 12 (Safe care and treatment) and 17 (Good governance), we took action by issuing warning notices requiring the provider to be compliant with these regulations by 15 August 2017. When we retuned for our latest inspection we found that the provider was still in breach of these two regulations in relation to medicines management and quality assurance processes. We found that improvements had been made in relation to risk assessments and fire safety, but that further and sustained improvements were needed in relation to risk assessment reviews.

In relation to the breaches of Regulations 10 (Dignity and respect) and 18 (Staffing) we took action by requiring the provider to send us action plans setting out how they would address these issues. When we returned on our latest inspection we saw improvements had been made in relation to addressing social isolation and training records. However, we identified that further and sustained improvements were needed. We also found that the provider was still in breach of Regulation 18 in relation to staffing levels.

Teesdale Lodge Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 25 people were using the service.

The service had a registered 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.

Medicines were not managed safely. Records were not always in place for the management of ointments and ‘as and when required’ (PRN) medicines. The provider was not effectively monitoring staffing levels and these were not based on the level of support people needed. Good governance processes were not in place. Action plans submitted following our last inspection had not always been completed and audits had not identified the issues we found at this visit. We made a recommendation about making the premises more dementia friendly.

Risks to people were assessed and plans put in place to reduce the chances of them occurring. Accidents and incidents were monitored, and plans were in place to support people in emergency situations. Infection control policies and procedures were in place. Policies and procedures were in place to safeguard people from abuse. The provider’s recruitment processes reduced the risk of unsuitable staff being employed.

Staff were supported with training, supervisions and appraisals. Decisions taken under the Mental Capacity Act 2005 were not always fully recorded. People were supported with food and nutrition. People's care records contained details of appointments with, and visits by, health and social care professionals involved in their care.

People and their relatives said staff were too busy to have any meaningful engagement with them. Staff told us they were committed to providing high quality care but did not always have time to get to know the people they were supporting. People and their relatives described staff as kind and caring, and spoke positively about the support they received. We saw that staff treated people they supported with dignity and respect. People’s confidential information was safely and securely stored. People were supported to access advocacy services where needed.

People had access to some activities at the service, but further and sustained improvements were needed. Since our last inspection the registered manager and staff had been working to improve and personalise people’s care plans. Policies and procedures were in place to respond to complaints. People were supported to access end of life care where this was needed.

Feedback was sought from people and their relatives. Policies and procedures were in place to investigate and respond to complaints.

Staff we spoke with gave mixed feedback on the management of the service and the provider’s culture and values. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

We found three on-going breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to safe care and treatment relating to medicine management, staffing levels and good governance. You can see what action we took at the back of the full version of this report.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' overall, or in any one key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The service was last inspected in June 2015 and was rated Good.

Teesdale Lodge Nursing Home is a 40 bedded purpose built, single storey care home. Personal care and nursing care primarily to older people is provided. All bedrooms are single rooms with en suite facilities. The home is situated close to a bus service and within a 10 minute walk to Stockton town centre. At the time of our inspection 32 people were using the service.

The service had a registered 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.

Risks to people using the service were not always effectively assessed or acted on. People’s medicines were not always managed safely. Fire drills were not regularly carried out. This meant effective plans and procedures were not always in place to support people in emergency situations. The manager did not effectively monitor staffing levels to ensure they were sufficient staff to keep people safe. Staff usually received the training they needed to support people but effective procedures were not in place to plan and record training. We saw examples of people’s privacy and dignity being compromised. We were not notified about a safeguarding incident as required by the service until inspectors asked the manager to submit the notification. Procedures were not in place to assess, monitor and improve standards at the service.

The provider’s recruitment processes reduced the risk of unsuitable staff being employed.

Staff were supported through regular supervisions and appraisals. People were not always effectively supported to access food and nutrition. People’s rights under the Mental Capacity Act 2005 (MCA) were protected. This meant the service did not always work effectively with external professionals to monitor and promote people’s health, for example in managing nutrition and pressure care.

People and relatives spoke positively about staff at the service, describing them as kind and caring. However, we also saw that staffing levels at the service meant that staff were always very busy and there was very little time for them to have meaningful engagement with people. People were supported to access advocacy services and receive end of life care where needed.

People told us they were supported to access activities they enjoyed. However, during the two days of our visit we did not see any activities taking place. People’s activity preferences were recorded in their care plans but we were not shown any evidence of how these were used to plan and deliver activities people enjoyed. Care plan reviews and daily notes had not always identified changes to people’s nutritional support needs or pressure care. As a result people had not always received responsive care. Policies and procedures were in place to respond to complaints.

People, relatives and staff spoke positively about the management of the service. Feedback was sought from people using the service and staff through an annual questionnaire and at meetings.

We found four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to medicine management, risk assessment and response, fire safety, staffing levels, dignity and respect and good governance.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We looked at a range of records, spoke with the manager and five staff of varying roles. We also observed the interactions between staff and people living at Teesdale Lodge, spoke with three people and two relatives.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke to understood the procedures which they needed to follow to ensure that people were safe. One person we spoke with said, 'It is better here, I kept falling at home, I feel much safer here.'

People were protected against the risks associated with the use and management of medicines. They received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely. People told us that they had no concerns about their medicines.

People had their needs assessed in relation to fire evacuation and individual evacuation plans were in place. On the day of the inspection fire training was taking place, which included scenarios relating to fire incidents and evacuation.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately. Staff had received training within the last 12 months in relations to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

People were aware of the complaints procedure and there were systems in place for monitoring complaints. One person we spoke with said, 'I have never had to make a complaint but am confident that I could go to the staff and they would listen.'

Is it effective?

People all had their needs assessed and had individual care records which set out their care needs. People we spoke with knew about their care plans and told us they had been involved in discussions about their needs. A relative we spoke with also confirmed this. We saw evidence of how the information from people's care records were transferred into practice. Examples included the use of certain equipment, such a moving and handling equipment and how someone was cared for in bed.

It was clear from our observations and from speaking with staff that they had a good

understanding of the people's care and support needs and that they knew them well.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence of this during our inspection.

Arrangements were in place to administer medicines at the right time in relation to meals, or to meet the needs of people who required their medicines at specific times of the day.

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect and kindness. People commented, 'I get the help I need when I need it,' and 'I think the staff have a good understanding of my needs and my personality.' 'It is smashing here, the staff look after me well, they are wonderful.'

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided guidance to staff on what care and support was needed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

It is well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a registered manager, who was supported by the director. The home had a system in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and in the main were able to see that these actions had been addressed.

People who used the service, their relatives and friend have opportunities to attend regular meetings and also give feedback about the service via annual questionnaires.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

The manager described the improvements that had been introduced to support the safe handling of medicines since our last inspection and we saw evidence of this.

We saw that a system for regular quality assurance and monitoring of medicines management was in place. Action had been taken promptly when any discrepancies, or failure to follow procedures, had been identified.

At our last inspection of Teesdale Lodge of January 2014 we identified some concerns about people's care and welfare, medication, staffing and also with some of the record keeping. At this inspection we found that improvements had been made to all of those areas.

We saw that staff supported people to express their views and helped them to make choices in their day to day life in the home.

People and relatives felt that the staff supported them and were very caring, however our experience during the inspection was that staff were caring but people's care and treatment needs were not always being met.

We found that the provider worked in cooperation with others to provide supported care and treatment to people in the home.

Even though people living at Teesdale Lodge said they felt safe, they were not always protected from the risks of abuse because the provider had not always taken adequate steps.

We found that people living in the home were not protected by appropriate management of medication, including for example; safe storage and recording of medication.

We found that staffing at the home was adequately matched to the needs of the people living there and generally staff felt supported in their roles.

There was a shortfall in administration of records which meant people were not protected from the risks of unsafe or inappropriate care and treatment because inaccurate and inappropriate records were maintained.

We spoke with four people who lived at Teesdale Lodge Nursing Home and a relative and had informal discussions with one other. We spoke with the deputy manager and three staff and spent time observing life within the home. We observed staff interacting with people, giving appropriate support and explanations. We saw staff engaging in a positive way with people, they were kind, sensitive and respectful. We observed people being offered a range of choices, such as options to remain in their own rooms and to have their meals in their rooms

People spoken with were confident that their nursing and care needs had been met. They said, "I was a bit apprehensive about coming here but I think it is brilliant, can't say anything other." Another person said, "It has been wonderful here, it has done me the world of good, there has been excellent care and attention and I have improved a lot since being here."

People had their nursing and care needs assessed, however we found that of the care plans looked at, not all were up to date.

From the records we looked at, we saw that there were good systems in place for ensuring effective recruitment of staff and that the environment was safe.