Jennifer's Lodge

Jennifer's Lodge is a residential care home providing personal care to seven people in a large, adapted house. It supports older people, including those living with dementia and adults with disabilities. The accommodation was spread over three floors. There was a communal lounge, dining area, kitchen and a large rear garden.

We found the following examples of good practice:

The provider created a mandatory Personal Protective Equipment (PPE) procedure to inform staff of the appropriate equipment for visitors and staff and when it should be worn.

The provider followed best practice guidance to ensure visitors to the home did not introduce and spread COVID-19. Information and instructions for visitors were displayed and explained in person by the receptionist. Staff were adhering to PPE and social distancing guidance.

The provider had ensured all staff had a COVID-19 risk assessment in place, which took account of people in a vulnerable group. If it was not safe for staff to be at work, they had a furlough scheme to protect staff and people.

The provider had a comprehensive infection prevention and control policy that outlined the requirement for outbreaks of infectious diseases and provided handwashing instructions and uniform care during COVID-19.

Jennifer’s Lodge is a residential care home providing personal care to six people in a large, adapted house. It supports older people, including those living with dementia and adults with disabilities. The accommodation was spread over three floors. There was a communal lounge, dining area, kitchen and a large rear garden. The service can support six people.

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

We received universally positive feedback about the home from people who lived there, their relatives and staff. The home had a homely, family atmosphere and people told us they loved living there.

People told us they felt safe. They were protected by well-trained staff who knew them well and understood their needs. People’s medicines were safely managed and stored. Fire safety checks and drills were regularly completed, however several critical fire doors were routinely propped open.

People had detailed care plans they helped develop. Care plans and risk assessments were holistic and well-recorded.

People accessed the community, took part in meaningful activities and had fun with staff and each other. People were treated with kindness and respect.

The home was very clean and tidy. People told us they enjoyed the food and we could see it was fresh and plentiful.

The home had a caring and dedicated staff. The registered manager also lived at the home and people, relatives and staff all told us that she was an excellent manager. Improvements had been made to procedures and record-keeping since the last inspection.

There were regular, documented safety checks and external assessments of safety and equipment. The registered manager regularly audited and reviewed the home's records, policies and procedures.

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.

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 10 July 2018).

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 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.

At the last inspection on 15 February 2017 the service was rated Requires Improvement. Following the last inspection, we asked the provider to send us an action plan to show what they would do to improve the key questions Safe, Responsive and Well-led.

Jennifer’s Lodge is a residential care home for older people with mental health needs and dementia. 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. The care home accommodates six people in one adapted building. At the time of the inspection there were six people living at the home.

The premises is laid out over three floors. Communal areas included a lounge, dining room, kitchen and a separate laundry area. There are shared communal bathrooms that are suitably adapted. At the rear of the home is a large garden that is accessible through patio doors.

The service had a registered manager who was available on both days of the inspection. 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.

Although the systems were in place to safeguard people from abuse and the correct action taken, the Care Quality Commission (CQC) had not been notified of an allegation of abuse when this had occurred. Sufficient guidance was in place about the actions staff needed to take to make sure risks were safely managed.

A routine fire safety inspection had been carried out in the service and the provider agreed to send us a plan of action. Health and safety checks had been carried out on the premises.

People received their medicines when this was needed and staff had received training on the safe management of medicines.

There were enough staff deployed to work in the service who had been suitably recruited. Training was available for staff to ensure they had the skills and knowledge to provide effective care for people. Staff had received regular supervision and appraisals.

People gave us positive feedback about the quality of the food. They were provided with sufficient food and drink; however, menus were not displayed during mealtimes so people could choose what foods they would like to eat. Information was not available in an easy read format so they could better understand the services they received.

Routine visits were carried out by health practitioners to offer advice and treatment for people to meet their medical needs.

People and their relatives told us staff were kind and caring and their privacy was respected. Advocacy services were accessible to ensure people had their views heard.

Systems were in place to monitor complaints and informal complaints that were raised had been resolved. The provider had discussions with people about end of life care and documented their advanced decisions in line with their wishes.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Although the service was meeting these requirements, they had not notified the CQC where a person's liberty was restricted in their best interests.

People were supported to maintain positive relationships with their relatives and friends. They were provided with opportunities to participate in a programme of activities. People’s cultural and spiritual needs were met and their care plans were personalised to meet their assessed needs.

People’s feedback was sought about the quality of care. Checks were carried out and audits undertaken to monitor how care was being delivered but some audits were not always consistently recorded. People spoke favourably about the management of the service. The provider worked with external stakeholders to deliver effective care for people to ensure their medicines outcomes were met.

We undertook an unannounced inspection of this service on 15 February 2017. At our previous inspection on 26 March 2015 the service was rated Good. At this inspection, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that relates to safe care and treatment, fit and proper persons employed and good governance. You can see what action we have told the provider to take at the back of the full version of this report.

The service has 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.

There were no effective systems to assess and monitor the quality of service provided as concerns about the service had not been identified and resolved. We also found that records were not always maintained, updated and clear. Records relating to day to day care provided to people were not completed for the three weeks period before our inspection.

Risk assessments were not comprehensive to ensure risk associated with the care of people and their well-being were identified and action plan put in place to reduce such risks. Health and safety checks such as the weekly fire alarm and emergency lights test were not conducted to ensure they were functioning properly to keep people safe. There was a fire risk assessment in place. People had personal emergency evacuation plan in place for staff to follow in the event of an emergency.

The system for managing people’s finances was not robust at protect them from the risk of financial abuse. Records of financial transactions for people were not clearly documented to clearly show money received, money spent and balance. There was also no system to check and audit the account regularly so as to identify discrepancies in the account.

Recruitment checks were not fully completed for some staff. We found that references were not always obtained from volunteers. There was also no personnel file set-up for them to show who worked at the service, their experience, professional trainings and qualifications.

People were supported to had their individual needs and preferences met. Staff were aware of people’s support needs and what they were able to do independently. Staff communicated with people using the methods they understood. People were encouraged and supported to access the community and participate in activities of their choice.

Staff were knowledgeable about safeguarding adult procedures. Staff knew how to report concerns and how to escalate any concerns if not addressed by their manager.

Medicines were handled and administered safely. Staff understood the organisation’s medicines procedure and followed it to ensure people received their medicines safely and in line with good practice. People were supported to eat and drink to meet their dietary and nutritional requirements.

There were sufficient numbers of staff on duty to meet people’s needs safely. Staff understood their responsibilities within the Mental Capacity Act 2005. Staff were supported through effective induction, supervision, appraisal and training to provide an effective service to people.

The service worked with social care and health care professionals. People were supported to arrange appointments to ensure their health needs were met. Staff followed the instructions and recommendations given to them by professionals to ensure people’s needs were met.

People, their relatives and staff were encouraged to provide feedback and to raise concerns. The registered manager investigated and responded to complaints and concerns appropriately to improve the service.

People told us staff treated them with kindness, compassion and respect. Staff provided support to people in the way they wanted to be cared for. People and their representatives were involved in their care planning and these were reviewed and updated regularly to reflect people’s changing needs.

We found people who used the service had their care needs assessed and reviewed and professional guidance was sort when required. This ensured peoples care and treatment was delivered in a way they wished and ensured their safety and welfare.

We saw from speaking to staff and checking staff records, they were given the opportunity to develop their professional skills and to obtain further relevant qualifications. The manager said they encouraged staff to develop further skills as this helped them provide good care to people who used the service.

We checked a variety of records relating maintenance of the home. All the records we saw including those relating to people who used the service were clear and well-kept and relevant.

We observed that people gave their verbal consent to receive care and support, and members of staff took time to explain and discuss their care and support needs.

Medicines were appropriately managed and the premises were suitably maintained. The provider met legal requirements relating health and safety and insurance. However some improvements were needed in the fire safety arrangements.

Staff with appropriate qualifications, skills and experience were employed and their background was checked to safeguard people from unsuitable workers.

People confirmed they knew how to make complaints. However, we found that the comments and complaints book, which was located in a communal area, held information that identified individuals concerned, so did not ensure their privacy was protected.