The Lodge Care Home

The home is built over four floors, with a range of communal and dining areas on the ground floor.

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

At the last inspection the provider had failed to ensure people’s safety was promoted, did not have effective governance systems and did not submit the required notifications. We identified multiple breaches of regulations.

At this inspection we found required improvements had been made and systems implemented to address the shortfalls were effective. Therefore, the service is no longer in breach of regulations.

People felt safe and said staff were kind and helpful. Relatives said staff were skilled and knowledgeable and they were happy with the care and support people received. People’s safety and welfare was continuously monitored. Incident, events and unexplained injuries were recorded and investigated. Where needed, incidents were reported to external agencies appropriately.

People and staff enjoyed good relationships and staff knew and understood people’s needs well. Care plans had been updated giving staff the information they needed to meet people’s needs safely. The management team reviewed the care and support staff had provided to help ensure people’s needs had been met. People’s medicines were now managed safely, and these were checked routinely as part of the registered manager’s monitoring.

Feedback received from people, their relatives and staff confirmed there was enough staff available to meet people’s needs. The provider’s recruitment process was robust, including all required checks to help ensure staff employed were fit to work in a care setting. Staff had support to carry out their role and said the management team were supportive and approachable. Some staff refresher training has lapsed, the registered manager and provider had already identified this and had developed an action plan to address the issue in a timely manner.

COVID-19 and infection prevention and control had been provided. Staff knew how to reduce the risk of transmission of and worked safely in relation to COVID-19.

The provider’s governance systems were now being used to their full potential supporting the provider and registered manager to identify potential concerns and manage them appropriately. This had been effective in driving improvements in the home.

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 10 June 2021)

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

We carried out an unannounced inspection of this service on 17 February 2021. Breaches of legal requirements were found relating to safe care and treatment, staffing, safeguarding and governance systems at The Lodge Care Home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Lodge Care Home is a residential home registered to provide accommodation and personal care for up to 45 older people, some who may be living with dementia. At the time of our inspection there were 34 people using the service.

The home is built over four floors, with a number of communal and dining areas on the ground floor.

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

Staff used risk assessment tools to assess if people were at risk of pressure ulcers, falls, malnutrition and skin integrity. Care plans were developed to ensure measures were in place to mitigate these risks. Risk assessment tools were not always completed correctly, therefore there was a risk that measures in place were not always as effective as they could have been.

Governance systems, audits and analysis of accidents and incidents had not led to improvements. The information recorded by staff was not always consistent, in enough detail and not always submitted to the registered manager. As a result, some safeguarding incidents were not reported to the local safeguarding authority for investigation.

Medicine administration and management was not always done safely or following best practice guidance. People were not always receiving their medicines as intended by the prescriber.

When things went wrong, lessons were not always learnt and staff practices were not changed to improve the quality and safety of the care provided.

Staff told us they were aware of people’s needs, however there was not enough staff to meet people’s needs safely and effectively. We observed people left waiting for staff, sitting in wheelchairs without pressure relieving cushions in place, although care plans detailed they had to sit on those. This increased the risk of people’s skin breaking down.

People felt safe in the home and told us they liked living there. Relatives were complimentary about staff and management and told us they felt the staff team provided care and support to people in a safe way.

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 good (published 14 December 2018).

Why we inspected

We received concerns in relation to the management of medicines, people’s personal hygiene needs not being met and lack of accurate records kept about people’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding and governance systems at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is built over four floors, with a number of lounges and dining areas.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff with the correct skill mix on duty to support people with their required needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people. 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.

Staff received an induction process and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions and observed practice.

People were able to make choices about the food and drink they had, and staff gave support if and when required to enable people to access a balanced diet.

People were supported to access a variety of health professionals when required, including opticians and doctors to make sure that people received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Further information is in the detailed findings below

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to help keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their families’ access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders were complimentary about the registered manager, deputy manager and how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.

We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

We found that the home was meeting the standards we had inspected.

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

You can see our judgements on the front page of this report.

Is the service caring?

We did not review this aspect of care at this inspection. Pease see inspection report dated 28 August 2014.

Is the service responsive?

We did not review this aspect of care at this inspection. Please see inspection report dated 28 August 2014.

Is the service safe?

We found that the home had systems in place to ensure the safe ordering, storage, administration and recording of medication. We found that medication was administered by staff who were trained to do so.

Is the service effective?

We did not review this aspect of the service at this inspection. Please see inspection report dated 28 August 2014.

Is the service well led?

We did not review this aspect of the service at this inspection. Please see inspection report dated 28 August 2014.

Below is a summary of our findings.

Is the service safe?

At the last inspection carried out on the 11 July 2014 we were told by some of the people who lived at the Lodge Care Home that they did not always feel safe. By safe, we mean that people were protected from abuse and avoidable harm. At this inspection we spoke to some of the same people and we were told that they now felt safe and protected. We found that the manager had acted on the feedback we had given them and had investigated and taken appropriate action to ensure that the people felt safe.

We found that the staff were kind and caring and were aware of their duty of care to the people using the service. Discussions with the staff and a review of records showed that they had training in how to recognise signs of abuse. All the staff we spoke with told us that they would report any incidents and would ensure they were dealt with.

The people told us that the manger was easy to talk to and therefore they could tell her anything. 'The new manager is lovely and very easy to talk to and that nothing is too much bother for her.' We were told that call bells were answered in a timely manner.

However we noted that mental capacity assessments had not been carried out on those people who had memory loss and a Deprivation of Liberty order had not been applied for, for all the people who had their freedom of movement curtailed. We were told that this was underway but had not yet been completed.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes and promoted a good quality of life which was evidence-based where possible.

We reviewed the care and support plans for six people who lived at The Lodge Care Home and we found that the care plans had been reviewed and now contained appropriate person centred information to inform care staff how to support people in an individualised way. All of the care plans we looked at had 'This is me' the form provided by the Alzheimer's Society to ensure personal knowledge of the person.

Is the service caring?

By caring, we mean that staff involved the person in how they wanted their care delivered and that they treated people with compassion, kindness.

We observed the staff on duty to be caring and compassionate throughout the two days of the inspection. Staff had quality time to spend with the people and we saw that people were not left unattended. We noted that some staff knew the person as an individual, their background and personal details including their identified needs. However, not all agency staff were aware of the personal needs of the people.

Is the service responsive?

By responsive, we mean that services were organised so that they recognised and met people's needs in a timely manner. We found that the staff were well managed and that staff had been given designated duties. This meant that staff knew who they were attending to and did so in a timely manner. The home was managed in the best interests of the people who lived there. Lunch was well managed and those people who needed the most assistance were attended to by an appropriate number of staff.

Care plans had been reviewed and were written in a person centred manner. The home was aware of when it was no longer able to meet the needs of the people and referrals were made to the appropriate health and social care professionals.

The serving of lunch was staggered and this meant that the kitchen staff served food to the people in a manner that ensured the food was hot and appetising. Snack and drinks were freely available to the people and those who were not able to help themselves were assisted by staff.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation assured the delivery of high-quality person-centred care. We found that the home had made significant improvements since the last inspection. The manager was supported in achieving this improvement by managers from other services.

We noted the home was running in a more organised manner with close attention given to those who were most at risk.

We saw that there were new systems in place to audit the quality of care. We saw the positive impact of these audits, however errors were still being made in medication and had not been picked up by the auditing system.

Staff and the people who used the service had a forum where they could easily give their opinions on the services offered by the home. Staff's morale was better and we were told that this had a positive effect on the people who lived there.

There were systems in place to ensure there was sufficient numbers of staff on duty to meet the needs of people and respect their wishes.

At the time of our inspection there was no registered manager in post. The person who had been managing the service had recently resigned. The position had been filled by an acting manager. In this report the names of two registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register. This was because they had failed to inform us they were no longer managing the service.

We had sight of all the people who lived in the home and we spoke to eight of the 38 people who lived there.

As the home is medium size, the inspection team was made up of one inspector. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

We found that the home was not meeting all the standards we had inspected.

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

You can see our judgements on the front page of this report.

Is the service caring?

We observed staff and saw that some members of staff were caring and ensured the cared for the person in a manner that promoted their dignity and independence. We saw that other staff did not treat people with dignity and respect. We saw one member of staff put a bib on a person who clearly said that they did not want it.

We saw a person offered lunch, this was handed to them in a chair, no table or cutlery was offered to them. We saw that a visitors to the home cared for the person and endeavoured to meet their needs by getting them a small table and offering them a spoon.

Is the service responsive?

People told us that there was no point in ringing their call bells at night as no one answered them. There was no order in how lunch was served. People who had the highest needs were left to fend for themselves while all but one of the staff attended to those people who were able to ask for their needs to be met. We saw that people were left to wait for assistance with their lunch and that their food was served at least 15 minutes before assistance was offered. We saw that the temperature of the food had not been checked prior to serving to people.

Is the service safe?

Three of the people we spoke with told us that there were staff members who they were frightened of. They carried this fear and were not able to be open about who they were frightened of. The manager undertook to address this issue. We saw that the majority of people were left on their own during lunch which meant that people could have put people at risk. Currently, the home was under the Local Authorities serious concerns process.

Is the service effective?

We saw that people were left unattended by staff for long periods of time. We saw that staff did not know how to engage with the people in a meaningful manner. The day of our visit was a hot day and there were signs displayed to remind people to have plenty of drinks. But we saw that there were no drinks available for them to help themselves to. We noted that most of the people we observed were not able to assist themselves to drinks.

Is the service well led?

The home has a new manager who was appointed three weeks prior to the inspection., Therefore, it was too soon to comment on their approach to management. During the inspection we found them to be open and helpful in what was a difficult day. We found that staff were not recognising and meeting people's needs.

responsive, safe, effective and well led?

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people are protected from abuse and avoidable harm. We found that overall staff were able to demonstrate they knew how to keep people safe, and minimise risk.

We found that actions from medication audits had not been followed up and this may have put people at risk of repeated errors. We found that in some cases records had not been kept up to date, and or followed up, such as following up on episodes of challenging behaviour, and this may have put people at risk. We saw from records that staff had been trained in the protection of vulnerable adults. Staff we spoke with demonstrated their awareness of types of abuse, and explained the process they followed to raise any concerns.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes,

and promoted a good quality of life which is evidence-based where possible. We reviewed

the care records for five people who lived at The Lodge care home and we found that

they contained person centred information, which enabled staff to care for people

effectively. However, staff were not always provided with information on how to deal with aggressive situations, which meant that people may not have always received the care they needed We noted that people's cultural preferences were not always recorded.

Is the service caring?

By caring, we mean that staff involved and treated people with compassion, kindness,

dignity and respect. We observed that overall the staff were kind and caring. We saw that the staff were approachable and showed patience and understanding with people who used the service. People who used the service and their relatives told us the staff were very 'caring'.

Is the service responsive?

By responsive, we mean that services are organised so that they meet people's needs. We

observed the staff to be responsive when interacting with people. Staff were aware of

people's needs and responded appropriately when people requested help.

However the provider had not taken appropriate action when medication errors had been identified. An action plan was not in place, and similar errors had been repeated during recent checks.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation

assured the delivery of high-quality person-centred care, which supports learning and

innovation, and promoted an open and fair culture.

We found that improvements were required in the overall management and day to day running of the home. There was no registered manager at the location. We spoke with the area operations director about this and recruitment plans were in progress at the time of our inspection.

We also discussed some of the day to day shortcomings with the deputy manager. The deputy manager acknowledged the shortcomings and said the inspection had been useful in identifying some of the day to day difficulties, which would be addressed without delay.

You can see our judgements on the front page of this report.

One person told us that "The home is quite good" and "My room is very nice". Another person said "The staff usually come quickly when I ring the call bell". A third person said "Lunch was very nice. I thoroughly enjoyed it." and another person told us "I am very happy here".

A visitor told us "People are very well looked after. The staff are polite and friendly and I have no worries or concerns".

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We observed that generally staff interacted positively with people in the home but we saw occasions where people were not supported appropriately when standing and walking, placing people at risk. We also saw that people's care plans were not fully reflective of needs and were not reviewed regularly meaning staff did not have clear guidance to provide care for people.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were effective systems in place to reduce the risk and spread of infection.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.

We found that people and their relatives had been involved in the decisions about the care and support provided. People's privacy and dignity had been respected and promoted. We noted that the care plans and the risk assessments had been reviewed regularly so that current and up to date information was available to staff. We also noted that each person had an assessment of their needs carried out before admission, so that the staff at the care home would be able to make a decision whether they would be able to meet their needs.

There were appropriate systems for the management and administration of medicines so that people received their medicines regularly and on time. Staff had received appropriate training and support for the work they did. There were effective systems in place to assess and monitor the quality of service.