Liberty Lodge

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

Regular checks to assess the risks to people of infection from legionella were carried out appropriately. This together with regular checks for hot water temperatures have helped to ensure people’s protection from infection and scalding. Staff and the registered manager received training for legionella.

Appropriate infection control procedures were in place and staff received training with food hygiene.

Quality assurance audits were improved to ensure they identified any issues and problems and made improvements where and when necessary. They took into account people's feedback and how the staff were meeting people's needs in line with their wishes and expectations.

People and their relatives told us they were safe and that staff were kind to them.

Staff had training to do with safeguarding adults that helped them keep up to date with best practice. Staff followed clear safeguarding procedures that helped to protect people from harm.

Risks to people, including those associated with their healthcare needs, were assessed and plans were in place to reduce them.

Whistleblowing procedures were in place and displayed on notice boards. Staff told us they were confident any concerns they reported would be dealt with appropriately.

Staff rotas and staffing levels were appropriate to meet people's needs and safe recruitment practices were in place.

People’s medicines were stored, administered, recorded and audited appropriately. The provider had appropriate policies and procedures in place to support people safely with their medicines as prescribed.

Comprehensive needs assessments were carried out and there was a good level of detail and personalisation in the care plans to ensure the person's needs were met in an individualised way.

Staff refresher training was updated as required to help staff meet people’s needs effectively. Staff received good support and regular supervision.

People were supported to have 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.

Records showed people were supported to have their health needs met, with access to health professionals as required.

People told us their relationships with staff was good. People said their privacy and dignity was respected. They also said they were able to express their views and preferences and staff responded appropriately.

There were systems in place to ensure concerns and complaints were responded to in an appropriate way.

The provider worked collaboratively with other agencies and organisations to meet people’s needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

At the last inspection the service was rated requires improvement (published 27 February 2019). 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 in line with our inspection schedule.

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.

People’s experience of using this service: People told us they felt well supported by kind and caring staff and were empowered to make choices about their daily lives. Staff supported people to be as independent as possible, to access health care when needed and to maintain links with friends, family and the local community. People were treated with dignity and respect.

The environment was clean, tidy and well maintained. Regular checks of the building and equipment were done to keep people safe. However, people were not protected against the risk of Legionella disease as checks on water temperatures were not carried out and there was no recent risk assessment to see if this was needed. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff received appropriate training and support to enable them to carry out their roles safely, including managing medication. There were enough staff to keep people safe. Agency staff were not used as staff from 2 of the provider’s other homes were used to cover sickness or leave, meaning people were always looked after by staff they knew.

People had their needs and choices assessed and appropriate plans of care to meet their needs. People had up-to-date risk assessments and risk management plans.

The registered manager had processes in place to monitor quality and people’s satisfaction with the service, and responded in a timely way to meet people’s needs. However, the provider’s quality monitoring system had not picked up that a Legionella risk assessment was needed but had not been done. The service promoted learning for people and staff.

Rating at last inspection: Good (report published 18th August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will monitor the provider’s action plan to see how they are implementing the required improvements to bring the service back to a rating of at least Good. We will inspect again in future as per our re-inspection programme.

The aim of the inspection was to carry out a full comprehensive review of the service and to follow-up on the compliance action and recommendation made at the previous inspection in July 2015. At this inspection we found the provider had followed their action plan and improvements had been made in the required areas.

Liberty Lodge provides care and accommodation for up to five people who have mental health needs. There were four people using the service at the time of this inspection.

There was a registered manager at the service. 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 registered manager had taken action to review records about people’s care and undertook more robust assessments before people started to use the service. Care plans for people accurately reflected their identified needs and the associated risks to their health and welfare. People’s needs were regularly monitored and reviewed to make sure the care was current and relevant.

We found there were improvements with the ways medicines were managed. Medicines were managed, stored, given to people as prescribed and disposed of safely. There were systems for checking that people received their medicines correctly and that staff administered medicines safely.

People told us they felt safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. Risks to people’s health and safety were being well managed and the service encouraged people to take positive risks.

People were treated with dignity and respect and staff encouraged them to maintain and develop their independence. Individuals spoke positively about their experiences of the home. Staff understood the needs of the people who used the service and how they liked to be supported. We found that staff communicated well with people and with each other.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This is legislation that protects people who are not able to consent to care and support, and ensures people are not unlawfully restricted of their freedom or liberty. People at the service had capacity and the staff sought people's consent about arrangements for their care. Staff were trained in the MCA and DoLS and understood their responsibilities.

People were supported to keep healthy and were encouraged to maintain a healthy lifestyle. Their mental and physical healthcare needs were met and other professionals were involved when people became unwell or required additional services. The registered manager sought and took advice from relevant health professionals when needed.

The provider’s recruitment and employment processes were robust and protected people from unsafe care. People received support from staff who knew them well, and had the skills to provide the care they required. Staff received the necessary training to fulfil their role and had ongoing support and supervision from the registered manager.

People knew how to raise any concerns. Staff listened and acted on what people said and there were opportunities for people to contribute to how the service was organised. The views of people, relatives, health and social care professionals and staff were sought as part of the quality assurance process.

There was an open and inclusive atmosphere in the service and the registered manager showed effective leadership. Staff felt well supported and had confidence in the registered manager.

There were systems in place for checking and auditing the safety and quality of the service. Where improvements were needed, action was taken.

We met with the manager for the service, interviewed one member of staff and looked at records held by the provider for staff recruitment. We found that the processes for recruiting staff had been strengthened so that people using the service were not put at risk of receiving care from unsuitable staff.

At our last inspection in February 2014 we identified areas where the provider was not meeting the essential standards of quality and safety. They sent us an action plan to tell us how the service would become compliant with the regulations. We carried out an inspection to review these improvements.

As part of this inspection we spoke with the one person using the service, the registered manager, one member of care staff and the new manager who joined in February 2014. We also toured the premises and reviewed records relating to the person using the service and the management of the home.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

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

Is the service safe?

The person using the service told us they felt safe living at Liberty Lodge. We found that staff had been trained to recognise and respond to abuse and they followed appropriate procedures.

People who use the service, staff and visitors were not protected against the risks associated with unsafe or unsuitable premises. There were some environmental hazards that had not been identified and could pose a risk to people using the service. A compliance action has been set for this and the provider must tell us how they plan to improve.

Staff personnel records did not contain all the information required by the Health and Social Care Act 2008. This meant the provider could not demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. At our last inspection we were concerned that the required staff recruitment checks were not being carried out. We are therefore taking further action to protect the safety and welfare of people who use services.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The manager had been trained to understand when an application should be made, and how to submit one. We saw that there were plans for other care staff to attend refresher training.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Is the service effective?

Since our last inspection, an appropriate care and support plan had been developed with the person using the service. The plan was based on their assessed needs and outlined their agreed care arrangements. The person had only moved to the home recently but their needs had been regularly reviewed to make sure they got the right care and support.

The service had made timely referrals for health and social care support when they identified concerns in the person's wellbeing. Records showed that staff had followed the advice and guidance provided by health and social care professionals.

Our observations showed that staff were kind and considerate although they had not received regular training and supervision to keep their knowledge and practical skills up to date. We were not assured that staff had the skills and expertise to support the needs of the people using the service. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service caring?

The person using the service had recently moved to the home. They told us they were pleased with the service so far. They felt that staff listened to them and were approachable. They told us, 'The staff are ok, they know what I want.'

We found that staff respected the person's independence and saw they were kind and attentive when supporting the person. Staff we spoke with knew the importance of treating people as individuals and maintaining their dignity when giving personal care.

Is the service responsive?

Since our last inspection, the manager had improved care records and information held about people using the service. One person was using the service and records confirmed that their needs had been fully assessed before they moved to Liberty Lodge. We found that the person's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

Is the service well-led?

The provider did not have adequate quality assurance systems in place to check that the quality of the service being delivered was meeting people's needs. We saw that the new manager had commenced a number of audits but that they were not yet fully established or used to effectively to identify and monitor the health and safety risks posed to people using the service. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Health and social care professionals from outside the service were involved in people's care so that the person's needs were monitored and met. The service worked well with other agencies to make sure the person using the service received care in a joined up way.

We carried out this inspection to check that the provider had taken appropriate steps to comply with the warning notice. We found there had been improvements.

We found the service had ceased 'double dispensing' of medicines. This is when medicines are removed from their original packaging and placed in pill boxes. The service had introduced a new monitored dosage system. Our checks of the medical records of the one person using the service showed they were receiving all the medicines that had been prescribed to them by their healthcare professional.

We also found all medicines at the home were stored safely. Staff documented and recorded their checks of medicines in the home to give them assurance that people received their medicines as prescribed.

However, although people were generally satisfied with the care and support they received we identified a number of concerns during our inspection.

We found there were no care and support plans in place for people using the service. This meant staff had no written guidance or instructions about how to look after the people they cared for. Risks to people's safety and welfare were not routinely identified in a timely manner so that people's safety was not being ensured when staff carried out any care or support.

We identified serious concerns with the way medicines were managed in the home. We found people were put at serious risk of harm as they did not receive all the medicines prescribed to them to manage their medical conditions. Medicines were not handled or stored appropriately. There were no appropriate records to show when medicines were ordered and received at the home.

People's records were not accurate or fit for purpose. They did not contain the most up to date information about them which put them at risk of receiving unsafe or inappropriate care. Poor record keeping by staff was also identified, particularly in relation to people's medical information.