Archived: Skell Lodge

We found the following examples of good practice.

Effective systems were in place to ensure staff and visitors to the service followed government guidelines for wearing Personal Protective Equipment (PPE). Facilities were available for visitors to sanitise their hands and put on PPE. Screening questions and a temperature check were standard requirements for all visitors.

Infection prevention and control (IPC) procedures were clear and followed by staff. All staff were trained in safe IPC practices.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. There had been a good uptake of residents receiving the COVID-19 vaccine.

Skell Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Skell Lodge is a large, detached house situated in a quiet residential area, within walking distance of Ripon city centre. The service is registered to accommodate a maximum number of 23 older people. At the time of the inspection there were 18 people who used the service.

Although the overall rating for the service was good we found there were insufficient staff on duty at times to meet the needs of people who used the service and this had placed people at potential risk of harm. We informed the registered manager about our concerns with staffing levels who told us they would speak with senior management. After the inspection the registered manager spoke with the regional director and changes were made to increase staffing numbers. However, although staffing levels were increased following our inspection, the provider had not done this previously of their own accord.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring.

Medicines were managed safely with an effective system in place. Staff competencies around administering medicines were regularly checked.

The home was clean and tidy and communal areas were well maintained. Appropriate personal protective equipment and hand washing facilities were available. Checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. People were supported by a team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place.

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 supported people to maintain a healthy and nutritional diet. People were supported by staff to maintain their health and attend routine health care appointments.

Staff were kind and caring. A health professional told us end of life care was exceptional and people were treated with dignity and compassion. Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People had access to a range of activities. The service had a clear process for handling complaints.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the registered manager, senior staff and the provider, to monitor and improve the quality of the service. Feedback was sought from people who used the service through meetings and surveys. This information was analysed and action plans produced when needed.

Skell Lodge is a large, detached house situated in a quiet area, within walking distance of Ripon city centre. The registered provider is Maria Mallaband Care Group Ltd and is registered to provide accommodation and personal care for up to twenty-three older people. On the day of the inspection there were eighteen (18) people living at the service.

This service was registered by Care Quality Commission (CQC) on 12 October 2015 and this was the first comprehensive inspection for this location.

The registered provider is required to have a registered manager in post and on the day of this inspection there was a registered manager registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

People spoke positively about the service and those we spoke with said they felt safe. Staff recruitment processes included carrying out appropriate checks to reduce the risk of employing unsuitable people. Staff had received training with regard to safeguarding adults and were able to demonstrate they knew what to do in the event of suspected abuse. Risks to people had been assessed and plans put in place to keep risks to a minimum.

There were enough staff on duty to make sure people's needs were met. Staff recruitment processes included carrying out appropriate checks to reduce the risk of employing unsuitable people. Staff had received relevant training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

People received their medicines at the times they needed them. The systems in place meant medicines were administered and recorded properly and this was audited regularly by the service and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was re-assessed regularly.

People had their nutritional needs met. There was a variety of choices available on the menus, snacks were freely available throughout the home and people were supported to have sufficient food and drinks to meet their dietary needs.

People knew how to make a complaint if they were unhappy and all the people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

People told us that they were well cared for and happy with the support they received. People were treated with kindness and compassion. We saw staff had a good rapport with people whilst treating them with dignity and respect. Staff had a knowledge and understanding of people's needs and worked together well as a team. The service had a relaxed and comfortable atmosphere.

People were involved in decisions about their care and their care plans provided information about how to assist and support them in meeting their needs. People's needs were regularly reviewed and, where necessary, appropriate changes were made to the support people received. People were supported to maintain their health and had access to health services if needed.

The provider actively sought the views of people using and visiting the service. People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the provider to address any shortfalls and improve the service.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the registered manager was supportive and promoted positive team working.

The registered provider completed a range of audits in order to monitor and improve service delivery. Where improvements were needed or lessons learnt, action was taken.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people's relatives and the staff supporting them and from looking at records.

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

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The provider knew how to request an assessment if this was required. Staff received safeguarding and Mental Capacity Act training. This meant people would be safeguarded as required.

There were sufficient care staff to respond to people's health and welfare needs.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care, wherever possible. People told us they were included in making decisions about how their care and support was provided. From speaking with staff they were able to demonstrate a good understanding of people's care and support needs.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. This ensured that the outcomes for people would continue to improve.

There was a resident's forum at the home, which met regularly and where people had the opportunity to discuss things that affected the running of the home.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. The home had a relaxed and comfortable atmosphere. We saw that there was some good humoured banter between several people living at the home and staff. One person said 'They (staff) are all wonderful. The lasses (staff) look after us all very well. What I like about these lasses here, they all have a sense of humour.'

People looked well cared for and we observed good care practices taking place. We observed the lunchtime experience and saw that staff were calm and unhurried and they spent time with people.

Relatives we spoke with described the home as being 'homely' and staff as being 'friendly' one relative told us 'This home is absolutely fantastic from the day we walked in they(staff) were friendly.' Another said 'X is very well treated here as X constantly tells me this.'

Is the service responsive?

People's needs were assessed and records we looked at showed they received specialist equipment or aids that they needed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People we spoke with knew how to make a complaint if they were unhappy.

When we visited we saw a staff team that acted professionally and responded appropriately to people's care needs. People were being assisted promptly and we saw that the staff had time to spend socialising and engaging with people.

The service carried out an annual satisfaction survey. Results were collated and analysed and action plans in response were agreed and actioned.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff we spoke with were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

Effective management systems were in place to promote and safeguard people's safety and welfare. Such as health and safety records and peoples care records were up to date and had been reviewed regularly.

Relatives we spoke with told us they thought that overall the service ran well. One relative said 'The staff here are lovely and everyone is treated with the same respect.'

There were robust recruitment and selection processes in place. People were supported by suitably qualified, skilled and experienced staff. Staff were described as 'very kind and helpful.' People told us they felt that they were well looked after by the staff and that the manager at the home was "Very caring and easy to talk to". People who used the service and visitors we spoke with gave us the impression that their experiences of the service provided was very good and that they received a good standard of care and support.

Audits and quality checks were undertaken to ensure that people experienced a safe and effective care service.

There was an effective complaints system available. At the time of our visit there were no outstanding complaints.

People told us they felt safe living at the home and that they had confidence and trust in the staff and management team to provide good care and support.

We saw that regular audits took place in the home to make sure that the home was clean, warm, safe and well maintained. We saw that systems were in place to make sure that staff were aware of any changes to company policy, procedures and audits. This helped to ensure that learning from incidents, investigations or audit findings took place and appropriate changes were implemented across all over the provider group to improve the service provided to people