Archived: Wyvern Lodge

Updated 28 September 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 over three days on the 3, 7 and 23 July 2015 and was unannounced.

The inspection team consisted of one lead inspector, one pharmacist inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of experience was older people’s care.

We reviewed information held about the service and notification we had received. A notification is information about important events which the service is required to send us by law.

During this inspection we spoke with eight people who were living at Wyvern Lodge, two relatives, five members of the care staff, the manager and their wife who were also the providers. We also spoke with three health professionals who had been involved with the service. In addition we observed staff supporting people throughout the home. We observed the lunchtime meal and staff administering medicines. We also looked at a range of management records. These included four care plans, five staff files, medication records, training records, staff duty rotas, meeting minutes and the service’s policies and procedures.

Updated 28 September 2015

The inspection took place on the 3, 7 and 23 July 2015 and was unannounced.

Wyvern Lodge provides accommodation for up to 16 older people who require personal and/or nursing care.

At the time of our visit there were 14 people living in the home. Wyvern Lodge is set over three floors. The ground floor has five bedrooms, two toilets and a bathroom, along with two communal lounges, a laundry room, a dining area, kitchen and access to the outside garden and patio area and the manager’s office. The first floor has four rooms, the medication cupboard, airing cupboard and toilet and the second floor has five bedrooms. Not all bedrooms have en- suite shower rooms.

There was no registered manager in post at the time of our inspection. We have received a application for a registered manager; this is currently going through the registration process. There has not been a registered manager since April 2013. 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 Wyvern Lodge the manager is also the owner/provider of the service. We are currently monitoring the registered manager’s application.

People experienced poor standards of cleanliness and inappropriate infection control measures throughout Wyvern Lodge. Staff did not follow guidelines relating to soiled and contaminated laundry or ensured personal protective equipment was used appropriately. Staff did not follow safe administration of medicines and medicines training was out of date.

People were not protected from the risk of harm. There was lack of risk assessments that identified risks to people and how these risks were being managed. Personal evacuation plans were out of date and had not been updated when people moved rooms.

People’s rights were not protected due to the provider failing to ensure mental capacity assessments and best interest decisions were in place for people who were unable to make decisions about their care and treatment. Regular meetings were held to enable people to make suggestions regarding any changes.

People told us they felt safe in the home. Recruitment procedures did not always ensure staff had received appropriate checks before they started employment to ensure they were of good character or fit to work with vulnerable people. Staffing levels were variable and affected the cleaning throughout the home, as care staff were expected to pick up this additional role when the cleaner was off. People were supported by staff who did not receive adequate supervision and appraisals. There was a lack of mandatory training so staff did not have adequate skills.

People had choice and flexibility with the meals provided. There were opportunities for people to access their local community and enjoy activities. People were supported by staff who demonstrated a kind and caring approach. Care was provided by staff who knew people well. People told us they were treated with dignity and respect.

There were no audits and monitoring processes in place to ensure the service recognised and took action when improvements were required. People felt comfortable raising concerns or complaints with the provider, however not all comments and issues had been logged as a complaint and no actions had been taken as a result. People were at risk because not all incidents and accidents were recorded and appropriate actions were not taken as a result.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.