Archived: Seaforth Lodge

At this inspection we found improvements had been made in some areas of concern, the issues raised in the warning notices had been partly addressed. However, the service was still in breach of five legal requirements.

This inspection took place on 19 July 2017 and was unannounced. Seaforth Lodge is registered to provide accommodation with personal care for up to 21 people; at the time of this inspection there were 14 people living there. Seaforth Lodge is a converted house in a residential area of North London; it has a garden and is close to local amenities.

As a condition of its registration the provider is required to have a registered manager in place. There was a registered manager in post at the time of our inspection. There was also another registered manager who was not working as a registered manager but had yet to de-register despite our advice to do so. 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.

Supervision was taking place regularly and training courses had been booked to boost staff knowledge on meeting people’s needs. Staffing levels had increased and there were extra staff in the morning at the busiest point in the day. People were having their needs better met because of the increase in staff; this meant there was no longer a breach in legal requirements in the area of staffing.

Improvements in the consistency of recording consent meant the service was now meeting legal requirements in the area of consent and in following the principles of the Mental Capacity Act 2005.

We found that efforts had been made to capture more person-centred information in care files and involve relatives more. Where people were not having their preferences met for showering and bathing at our previous inspection, some improvements had been made in this area. This meant that although there was still some improvement to be made, the service was no longer in breach of legal requirements around person-centred care.

However, safe care and treatment was not being provided and a continuing breach of legal requirements was found in this area. Many times throughout the day people were put at risk of being given food that was not suitable for them, which placed them at risk of worsening health. People were also put at risk of pressure ulcers developing through not being repositioned regularly, and at risk of falling when mobility equipment was not used.

We also found a continuing breach of legal requirement in the area of premises and equipment. New wheelchairs and shower equipment had been ordered and equipment was cleaner. Despite this, the premises was not secure, with one ground floor window wide open throughout the day. This window and another on the first floor did not have a fully functional window restrictor fitted. This placed people at risk of an intruder climbing in through the window and someone falling or climbing out of the first floor window.

At our last inspection we found a breach in legal requirements around nutrition and hydration. At this inspection we saw professional advice had been followed in regards to fortification of food with cream and milk and butter where needed.

Staff told us they felt more supported since the last inspection. During the inspection there was insufficient oversight of the care being provided resulting in errors that affected people and put them at risk. There were no audits of people’s daily care records and gaps not being identified. This resulted in a negative impact on people’s safety. There was no quality assurance support from the provider for the registered manager. We found a repeated breach of legal requirements in the area of governance.

There were overall four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 arising at this inspection. You can see what action we told the provider to take at the back of the full version of the report. 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.

The overall rating for this service is 'Inadequate' and the service therefore remains 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. 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.

Seaforth Lodge is registered to provide accommodation for up to 24 people who require nursing or personal care. The people living in the home are predominantly older people with needs around dementia. At the time of inspection there were 18 people living there.

Seaforth Lodge requires a registered manager to be in post as part of its registration requirements from the Care Quality Commission. There was a registered manager in post at the time of the inspection and they had been registered since July 2016. 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.

Relatives and people told us staff were caring but at times there were not enough staff. People’s privacy and dignity was not always maintained and there were not always enough staff to provide person centred care to people.

Staff we spoke with understood what abuse was and how to report it if they had any concerns, although they had not attended safeguarding training. We saw that safeguarding concerns were not always reported to the local authority to be investigated.

Staff recruitment procedures were in place and the provider had a policy to ensure they were employing appropriate people.

We found the recording and administration of medicines was carried out by staff that had their competency checked regularly and there were no gaps in the daily administration of medicines. On the day of inspection medicines were administered two hours late which went against the advised time they should have been taken.

Nutritional needs were not being met and we had to intervene to point this out. There were no fresh fruit or vegetables available and the food was not nutritionally balanced. We saw that advice from dieticians was not being followed for people who were at risk of losing weight and malnutrition.

There was a complaints procedure in place and available to people and visitors. People felt comfortable complaining and said they could talk to staff and the registered manager.

The principles of the Mental Capacity Act 20015 were not being adhered to in care and consent documents. There was a lack of understanding in the service around consent and best interests decisions.

Care documents and care were not person centred. People were not always involved in the planning of their care.

There was a lack of oversight from the provider and quality checks did not pick up on gaps in risk assessments, consent documents and where needs were not being met.

We found risk assessments were inconsistent in places and were not clear on how risks could be minimised. People were being put at risk due to the disrepair of the building and equipment.

We found overall that people were at risk of receiving unsafe, ineffective care. We found breaches of nine of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider and will report further on this when it is completed.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

People expressed satisfaction with the meals provided. Their comments included, 'the food's nice' and 'it's good, there's enough.' We found there was appropriate choice and support with nutrition and hydration, which protected people from foreseeable risks.

People told us they were happy with the communal environment and their rooms. We saw investment in the maintenance of the premises, and found that people were protected against the risks of unsafe or unsuitable premises.

There were systems to assess and monitor quality and risk at the service. These included through asking and responding to people's views. One person said, 'if I don't like something, I ask them and they change things.'

However, we found that training arrangements were not suitable to ensure that staff were appropriately supported to deliver care to people safely and to an appropriate standard. Several staff had not received formal training on infection control, food hygiene and dementia care.

At this visit, we found that our concerns had been addressed. Care plans had been updated to reflect people's current needs. Care planning processes included consideration of people's capacity to make decisions. Staff interacted respectfully and warmly with people who use the service. New staff had adequate recruitment checks in place before they started working with people.

We spoke with three people who use the service and a health professional. People were positive about the service and the care provided. Comments included, 'I'd not want to be anywhere else' and 'the staff are lovely.'

Our observations showed staff noticed when people needed support with personal care and were responsive to requests. A greater range of activities was provided, and we saw that this had a positive effect on some people's well-being.

There has been no registered manager working at the service since May 2012. This is a breach of the provider's registration condition. We are writing separately to the provider about addressing this.