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Archived: Colton Lodges Care Home Requires improvement

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Reports


Inspection carried out on 4 April 2016

During a routine inspection

This was an unannounced inspection carried out on 4 April 2016.

Colton Lodges Nursing Home is a purpose built home comprising of four units Newsam, Whitkirk, Elmet and Garforth. It provides care for up to 138 people. At the time of inspection 126 people were living at Colton Lodges Nursing Home.

At the last inspection in March 2015 we found the provider had breached three regulations associated with the Health and Social Care Act 2008.The registered person did not make appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified and skilled and experience staff to meet people’s health and welfare needs. There were not suitable arrangements in place to ensure staff were appropriately supported in relation to their responsibilities to enable them to deliver care safely and to an appropriate standard. The registered person did not take proper steps to ensure that each person was protected against the risks of receiving care or treatment that was inappropriate or unsafe.

The provider told us they would meet the regulations by the end of August 2015. The provider had completed an action plan and on this inspection, we found improvements had been made with regard to these breaches.

At the time of this inspection the home had 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.

Overall, people who used the service and visiting relatives said there were enough staff to meet people’s needs. However, we noted that people who used the service had to wait for periods of time for the support they needed such as assistance with meals.

People told us they felt safe and did not have any concerns about the care they received.

There were systems in place to record accidents and incidents.

The premises and equipment were well maintained to ensure people’s safety. The premises were clean in all four units and decorated to a good standard.

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. However two peoples medication had not been received for two weeks from the local pharmacy.

There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff were trained in the principles of the Mental Capacity Act (2005). However in one unit staff did not fully understand what they must do to comply with the requirements of the Mental Capacity Act.

People were supported by staff who treated them with kindness and respect. Overall, their choices and preferences were respected and they were supported to make their own decisions whenever they could do so. Staff could explain to us what privacy and dignity meant to them and the people they supported.

Most people told us they enjoyed the food and got the support they needed with meals. However, some improvements were needed to ensure people who were underweight and needed support at mealtimes had staff to support and encourage them.

Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff felt supported and had regular supervisions and appraisals.

There were good systems in place to ensure complaints and concerns were fully investigated. People had the opportunity to say what they thought about the service and the feedback gave the provider an opportunity for learning and improvement. People told us they would feel comfortable raising concerns or complaints. People provided positive feedback about the unit managers and registered manager.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service.

Inspection carried out on 10 March 2015

During a routine inspection

This was an unannounced inspection carried out on the 10 March 2015.

Colton Lodges is a purpose built home comprising of four units Newsam, Whitkirk, Elmet and Garforth. It provides care for up to 138 people. Colton Lodges is in a residential area of Leeds, close to local amenities and public transport routes.

At the last inspection in August 2014 we found the provider had breached three regulations associated with the Health and Social Care Act 2008. We found people did not experience care, treatment and support that met their needs and ensured their safety and welfare, we found people did not experience a clean and hygienic environment and the provider did not assess and monitor the quality of the service provision. We told the provider they needed to take action and we received a report on the 10 September 2014 setting out the action they would take to meet the regulations. The provider told us they would have met the regulations by the end of September 2014. At this inspection we found some improvements had been made with regard to these breaches. We did, however, find some concerns with care and welfare, but found these were different issues to the last inspection and we have concluded there was minor impact on people using the service at this inspection. We did, also find other areas of concern.

At the time of this inspection the home did have 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 not always enough staff to keep people safe and staff training and support provided did not equip staff with the knowledge and skills to support people safely. People’s care plans did not always contain sufficient and relevant information to provide consistent, person centred care and support.

Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service and staff completed a comprehensive induction when they started work.

People were happy living at the home and felt well cared for. People enjoyed a range of social activities and had good experiences at mealtimes. People received good support that ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

People told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. There were some very minor issues with infection control practices but generally the home was clean and hygienic. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely. People’s physical health was monitored and appropriate referrals to health professionals were made.

Applications for the Deprivation of Liberty Safeguards had been assessed and carried out. However, further work was required on identifying people’s mental capacity to make decisions.

The service had good management and leadership. People got opportunity to comment on the quality of service and influence service delivery. Effective systems were in place that ensured people received safe quality care. Complaints were investigated and responded to appropriately.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which has since been replaced by Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 12 August 2014

During a routine inspection

This inspection was carried out by three inspectors, an expert by experience and a specialist advisor. Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff, senior managers, our observations and from looking at records. We spoke with over 25 people who used the service, 7 relatives and 18 staff.

Colton Lodges comprises of four separate houses. Newsam- Dementia, nursing and residential. Whitkirk- general nursing. Elmet- general nursing and Garforth residential.

At our inspection we gathered evidence to help us 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?

Is the service safe?

Most people told us they were treated with dignity and their rights were respected. People�s comments included:

�I get up when I want nobody tells me I have to get up.�

�They come and talk to me about what I need; quite regularly I think.�

However, we saw on occasions that people were not asked for their consent before any care interventions. For example, we saw on Newsam House that people were not asked for their consent when putting aprons on people during meal times or when being assisted by staff with moving and handling.

Some people on Whikirk House said they did not feel their dignity was respected as they had to wait too long for staff assistance, especially when they wanted to go to the toilet. Staff working on this house said they did not always have enough staff to meet people�s needs fully.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. However, as mentioned below, the practice of locking the rooms of people who used the service to protect them from the unwanted attention of others was not safe.

We found on Newsam unit people were not cared for in a clean, pleasant and hygienic environment. There were systems in place to manage infection control and prevention, however, these were not effective.

We looked at the recruitment of new staff. We saw recruitment practice was safe and all necessary pre-employment checks had been carried out. Staff confirmed their recruitment had been robust and all necessary checks had been completed before they started work.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw applications had been submitted where there was a risk people who used the service were deprived of their liberty. Policies and procedures were in place and under review to ensure people�s rights were protected. However, our inspection visit highlighted the need for further DoLS to be applied for as we found two people on Newsam House had been locked in their rooms to protect them from the unwanted attention of others. This practice was not safe.

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

Is the service effective?

People who used the service or their relatives told us they were asked about their care and able to make decisions about this. One person told us, �When I first got here they sat and talked to me about what I need and what I like, things like that.�

One relative said, �I come every day so I�m involved by default, whether they like it or not.� However, some care records did not show how people who used the service or their relatives were involved in their on-going review.

Care records showed that people had regular contact with health and other professionals. Specialist dietary, mobility and equipment needs had been identified in care plans when required.

People were cared for by staff who were supported to deliver care to an appropriate standard. Training records showed most staff in the home had completed mandatory training and other appropriate training to meet people�s care and support needs. This included dementia care.

Is the service caring?

We observed some very positive interaction between people who used the service and staff. However there were occasions where we saw people being ignored.

Most people told us they felt they were well cared for. People�s comments included:

�It�s like a five star hotel, the food is great.�

�I need help when I have a bath, which was odd at first. They are very nice to me when they�re doing it though; they talk to me and take care of me.�

Overall, people�s family members were complimentary of the staff and care and support their relative received. One said, �My relative (person�s name) has been here a long time, I am very happy with the care they receive. They have got a special chair for my relative so they can get out of bed for some of the day.�

Is the service responsive?

We spoke with people who lived in the home about activities. Most people said they had enough to do and enjoyed the activities on offer. However, a number of people on Whitkirk House said they would like to do more. We did not observe any meaningful activity for people on Newsam House.

We saw people who used the service were, in the main, responded to promptly when they asked for any support or assistance. However, we noted on Newsam house that people had long waits for their lunch time meal and did not always receive a timely response when they pressed their call bell. People who used the service on Whitkirk house also told us they had to wait too long at times for assistance to get to the toilet.

Records we looked at showed people knew how to make a complaint if they were unhappy. We looked at complaints records to see how they were dealt with. We found they had been investigated thoroughly and people were, in the main, responded to in a timely manner.

Is the service well led?

Staff said they felt the service was well managed and the management team were supportive. They said they were kept informed of any issues affecting the service.

Senior managers from the organisation carried out a monthly audit to check standards and the quality of care being provided. We saw there were action plans developed when any shortfalls were identified.

The provider had systems in place to identify and assess risks to the health, safety and welfare of people using the service. However, these were not fully embedded in all areas of the service and did not clearly show how the service was monitored to ensure improvements were made and standards were maintained.

Inspection carried out on 4 July 2013

During a routine inspection

At our inspection we spent time in the communal areas of the home and observed how people were being cared for. We used a different methods to help us understand the experiences of people who, because of their complex needs, were unable to tell us about their experiences themselves. We observed that people were comfortable in the presence of staff and that the atmosphere at the home was friendly and relaxed. We carried out a Short Observational Framework Inspection (SOFI) for sixty minutes during lunchtime. We spoke with nine members of staff and six people who used the service.

The care records contained information about people�s care needs and staff arranged the health care people needed. Most of the care practice we saw was safe and considerate. We saw that staff were respectful and kind when they spoke with people. During lunchtime staff did not speak with the people who used the service. We informed the manager during the inspection that we had observed this. They told us they would speak with the staff concerned.

The provider had systems in place to assess and monitor the standards at the home and action plans showed they address items that came to their attention. People expressed their views about the service. The staff listened to people and took account of their comments. We spoke with six people who used the service about their experience of living in the home. They told us �Staff looked after them well� and �A carer took them out to the local shops�.

Inspection carried out on 13 November 2012

During a routine inspection

During our inspection we saw that people smiled and appeared relaxed and comfortable with staff and others living in the home. We saw that people received good care and that staff treated them with respect. The provider had systems in place to assess and monitor the standards at the home. Meetings had been held with the people who lived at the home and their relatives and they were asked for their opinion on the services they received.

People we spoke with said they enjoyed living at the home and were very satisfied with the care and support they received. Comments included: �The staff are kind and lovely�, �I like living here� and �It is really nice here.� Relatives we spoke with said they were involved in making decisions about their relative�s care, their comments included: �Staff are excellent� and �Staff tell you what is happening and they involve us in the care.�

Some people who lived at Colton Lodges had a diagnosis of dementia; as such their ability to recall their experiences and express their views was limited. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. This allows us to spend time observing what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they had positive experiences.

Inspection carried out on 24 October 2011

During an inspection to make sure that the improvements required had been made

We received positive comments from people who live at Colton Lodges about the care and support they receive.

We spoke to relatives who told us they had been involved in reviewing their relatives care plan.

One person summed up the care of others by saying, �all very nice staff, they know their job�.

Inspection carried out on 5 July 2011

During an inspection in response to concerns

At our last review of the service, in March 2011 these are some of the comments people made to us �

�One person told us that she sees the care records regularly and enjoys reading about how they look after her husband.

People told us that if people are unwell the staff do not hesitate to ask the general practitioner to visit.

People said that they were happy with care and that they were looked after in the way they wanted.

�I like all the staff �they are all good girls�

�get on like a house on fire�

�Every confidence in the nurses�

�The nurses are very nice�

(The staff) �dress him well�

�has improved from before��

At this review we found that many of the people whose care we looked at in detail could not tell us directly about their care due to a variety of complex needs.

On our arrival to the house we looked at several people were sat in the lounge listening to a keyboard player who was visiting the home. People were enjoying the music with some tapping their feet to the beat.

Local clergy arrived to carry out a service with communion later on during the morning.

A number of people remained in bed. These people looked comfortable and were being nursed appropriately in specialist beds specifically designed for those who have been identified at risk of skin damage due to their conditions.

We observed the care being provided and saw that people looked comfortable in their surroundings. Staff approached people in a patient and respectful manner. Staff knew the people they were caring for.

When in one case the staff member was not sure about how to carry out a particular action, we saw her referring to the care plan. She told us that after being away from work for a while she always found the care plans useful in helping her know how to care for people properly.

We saw that in some cases records of specific care of particularly vulnerable people were not accurate.

Inspection carried out on 31 January 2011

During a routine inspection

We spoke with people who use the service and a number of relatives and all told us that they have access to care records and are involved in planning and reviewing care.

Relatives of people who were unable to make a decision told us that they were able to look at care plans whenever they wanted to and were able to contribute to the care plan.

All the people we spoke to were aware of the relatives and residents meetings and said that they felt able to speak up.

People said that they were happy with care and that they were looked after in the way they wanted. These are some of the things people said to us:

�I like all the staff �they are all good girls�

�get on like a house on fire�

�Every confidence in the nurses�

�The nurses are very nice�

(The staff) �dress him well�

�has improved from before�

A relative of someone who uses the service said that they had �Every confidence in the nurses�.

Another relative said that they were confident that staff knew how to care for her husband properly.

Those who were unable to speak for themselves appeared comfortable and confident with staff and us during the visit.

People told us that they enjoyed the food. One person told us that she knew her husband always ate a cooked breakfast which he enjoyed and this was why he did not eat a lot at the lunchtime meal.

People we spoke with told us that the service did not hesitate to contact the general practitioner (GP) if they became unwell.

Relatives told us that they were always kept informed about any changes or illnesses.

Reports under our old system of regulation (including those from before CQC was created)