Carmel Lodge Care Home

Carmel Lodge Care Home is a residential care home providing personal care to 32 people aged 65 and over at the time of the inspection. The service can support up to 36 people across two separate floors, each of which has separate adapted facilities. A number of people who received care lived with dementia.

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

Governance systems to monitor the quality of care being delivered to people required improvement. Existing systems failed to identify shortfalls in care recording which placed people at risk of receiving poor care.

Staff were recruited safely. Appropriate checks were undertaken for all temporary staff (agency workers). We inspected Carmel Lodge at a difficult period as the home was experiencing an outbreak of COVID-19. This had impacted on regular staffing levels, staff morale and the ability to maintain effective communication with families. The registered manager was actively recruiting new staff and putting measures in place to improve communication and relationships with families and staff.

Although we found some improvements were needed, we did observe positive and caring interactions between staff and people living at Carmel Lodge. Staff sought consent before providing care and demonstrated an understanding of people’s preferences.

The communication needs of people were clearly documented, and people had access to appropriate healthcare services. Although activities were limited at the time of the inspection, people were supported appropriately to reduce the risk of social isolation and to keep in touch with family and friends.

Checks were in place to ensure people lived in a safe environment and this was maintained to a high standard. Ongoing refurbishment and redecoration of the home was planned.

We were assured the provider had effective measures in place to reduce the risks of infection and manage the impact of the COVID-19 pandemic.

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 13 March 2018).

Why we inspected

We received concerns in relation to staffing levels and poor management of pressure care during an outbreak of COVID-19 in the home. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 COVID-19 and other infection outbreaks effectively.

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.

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

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

The registered manager responded during our inspection to the issues we found. Measures were put in place to improve the monitoring of peoples care needs. The provider had recently strengthened their whistleblowing procedures to encourage staff to speak up when they had concerns.

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

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 a breach of regulation in relation to accurate record keeping and effectiveness of the management oversight of care records at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 located on the outskirts of Poynton, near Macclesfield, in Cheshire. The home has accommodation for up to 36 people. All bedrooms have ensuite toilets. There are also two lounges, two dining rooms and a conservatory leading into an enclosed garden available for residents and visitors. The home is situated within a short walking distance of the shops and local amenities. It provides residential and respite services for people with dementia.

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.

At this inspection we found the service remained Good. The service met all the relevant fundamental standards.

People and their relatives we spoke with were all positive about the care they received and approach of the staff within the home.

There were systems and processes in place to ensure that people who lived in the home were safeguarded from abuse and staff were aware of how to report any concerns. Risks to people were effectively recorded and subject to regular reviews and there were clear instructions for staff to try to minimise risks to people without unnecessary restrictions. Staff were safely recruited and deployed in sufficient numbers to meet the needs of the people living in the home. Medicines were managed and administered safely.

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 were trained and supported to give them the skills and knowledge to meet the needs of the people and assist them to maintain good standards of health and nutrition. People had access to other health professionals and staff maintained good relationships with other health professionals.

We observed that staff knew people well and respected their dignity. Staff promoted independence as far as possible and everyone spoke positively about the staff and manager.

People’s care plans were person centred and contained details about the person, their history, preferences and how they wanted to be supported. These were regularly reviewed and contained any necessary advice from other professionals. There was a complaints procedure in place and people were clear who to speak to if they wanted to raise any issues.

People, their relatives and staff spoke positively about the management of the home and the approachability and responsiveness of the manager. The service had a clear vision to provide person centred care. Quality assurance systems were robust and considered a wide range of service provision. We saw where issues were identified they were subject to an action plan and issues were resolved in a timely manner.

Further information is in the detailed findings below.

We looked around the home and the gardens and spent time sitting with people in their lounges. We visited some people in their bedrooms. We also looked at care and other records.

We found that staff understood people's right to make choices about the care that they received and that they treated people with respect and dignity. Staff related positively to people and provided personalised care wherever possible. We found that the provider operated effective recruitment procedures to ensure that staff were suitable to work in the home and that there was a complaints system in place.

During our inspection we found that staff had a good understanding of safeguarding and whistleblowing arrangements which are procedures which help to keep people safe. We were told that some of the people living in Carmel Lodge no longer had the capacity to make decisions for themselves but when we could not find evidence that the appropriate assessments had been undertaken to protect these people.