Archived: Godden Lodge Care Home

Following our inspection to the service in January 2016, a Notice of Proposal and subsequent Notice of Decision was issued to the registered provider advising that no further admissions could be made to the service. In addition, the Care Quality Commission met with the registered provider on 18 January 2016 to discuss our on-going concerns. During the meeting the registered provider’s representatives gave an assurance that things would improve. At this inspection we found that significant improvements had been made.

At our previous inspection of 5, 6 and 7 January 2016, we had identified several areas of concern. We completed this inspection on 7, 8 and 9 June 2016 to see if improvements had been made to the service that people received. There were 81 people living at the service when we inspected.

A registered manager was not in post at the time 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. A new manager was appointed following our last inspection to the service in January 2016. At the time of this inspection they were not yet formally registered with the Care Quality Commission however an application to be registered had been submitted.

At this inspection we found that although some areas required further sustained improvement, the majority of improvements had been accomplished.

Further development of the registered provider’s quality assurance arrangements were required to ensure that these were robust. Record keeping in some areas relating to people who used the service also required reviewing and improvement, particularly where matters had been highlighted as part of care plan audit arrangements. Furthermore improvements were required to ensure that suitable control measures were put in place to mitigate risk or potential risk of harm for people using the service. Information relating to people’s capacity to make day-to-day decisions was conflicting and contradictory.

Improvements were required to ensure that effective arrangements were in place for the management of complaints and to ensure that these were addressed in a timely manner and all elements of the complaint dealt with. Improvements were also still required to ensure that people who predominately remained in bed or in their bedroom received opportunities for social stimulation.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety. Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs. Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills to meet people’s needs. Staff felt supported and received appropriate formal supervision. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity. The dining experience for people was positive and people were complimentary about the quality of meals provided.

The inspection was completed on 5 January 2016, 6 January 2016 and 7 January 2016. There were 102 people living at the service when we inspected.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

A registered manager was not in post at the time 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. The service was managed on a day-to-day basis by one of the provider’s Regional Support Managers. In addition they were supported by a Clinical Service Manager and Relief Home Manager.

At our previous inspection on 29 September 2015 improvements had been made and the service was rated ‘requires improvement’ but at this inspection we found that improvements across the service had not been sustained and people were placed at risk.

Arrangements were in place to inform the provider of what was going on in the service, but these were not effective and there was a lack of provider and managerial oversight of the service as a whole. Lessons had not been learned and any improvements had not been sustained in the longer term. There was a reactive rather than proactive approach by the management team which meant that people did not receive a consistent safe and appropriate service.

Checks were not effective to monitor medication practices and ensure that people received their prescribed medication as required. Additionally, systems were not in place to ensure that people always received appropriate care to meet their needs or care that was responsive to their individual needs and preferences. Records were not properly maintained, for example, in relation to staff recruitment, staff induction, staff supervision, food and fluid monitoring and end of life care.

Risks were not appropriately managed or mitigated so as to ensure people’s safety and wellbeing in relation to staffing levels, care planning, management of care and arrangements to respond to emergencies.

Staffing levels were not always appropriate to meet people’s needs and this impacted at times on the level of care and support they received by staff. The deployment of staff, particularly on Cephas House and Victoria House was not always appropriate to meet the needs of people who used the service. Staff did not always have enough time to spend with people to meet their needs or to respond to people’s changing needs.

Staff told us that they did not feel supported by the provider or the management team. Not all staff had received regular formal supervision or an annual appraisal. However, staff told us and records showed that there was a positive approach to staff’s general learning and development needs including induction.

People’s comments were variable about the care and support provided. The majority of interactions by staff were routine and task orientated and we could not be assured that people received appropriate care to meet their needs. Some aspects of care practices required improvements. These related to assisting people to eat and drink, communication with people living at the service and care and support to be less routine and task focused.

The dining experience for people was positive and people were complimentary about the quality of meals provided. Suitable arrangements were in place to ensure that the service was clean, hygienic and free from offensive odours.

Appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected. Peoples privacy and dignity needs were maintained.

You can see what actions we told the provider to take at the back of the full version of the report.

During our inspection we spoke with 15 of the 71 people who used the service and seven relatives. We also spoke with several staff members, the housekeeper supervisor and the manager.

We looked at 10 people's care records. We also looked at the provider's arrangements for obtaining, and acting in accordance with, the consent to care and treatment for people who used the service. In addition we looked at medication practices and procedures, the provider's arrangements for cleanliness and infection control within the home environment, staffing levels and; the provider's arrangements to monitor the quality of the service provided. Records relating to how the service cooperated with other providers were also inspected.

Observation of staff practices throughout the day of our inspection was undertaken to ensure that people who used the service had their care and welfare maintained to an acceptable level.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

Records showed that staff had received Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS] training. Staff spoken with were able to demonstrate a basic understanding and awareness of MCA and DoLS. We found that some people who used the service had not had their capacity to make day-to-day decisions formally assessed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to consent to care and treatment.

We found that people who used the service were protected against the risks associated with the unsafe use and management of medicines.

Effective arrangements were in place to reduce the risk and spread of infection. All areas of the home environment were clean and there were no unpleasant odours.

The provider was able to demonstrate that there were sufficient numbers of staff available for the needs of the people living at Godden Lodge.

Is the service effective?

Our observations and discussions with the manager demonstrated that people who used the service received regular support and access from a variety of health and social care services and professionals as their conditions and circumstances required.

Appropriate arrangements were in place to ensure that people who used the service received regular support and access from a variety of health and social care services and professionals.

Is the service caring?

People told us that they received the care they needed. People living in the service told us that they were happy living there. Our observations showed that care and support was provided in a timely manner.

People who used the service had a care plan in place which detailed their specific care needs and the support to be provided by staff.

Is the service responsive?

People's preferences and diverse needs had been recorded in accordance with people's wishes.

Our observations during the inspection showed that visiting times were flexible.

We found that there were appropriate arrangements in place pertaining to complaints management.

Is the service well-led?

The provider was able to demonstrate that there were systems in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. People's views about the service were noted to be positive.

Our observations suggested that people living at the service were happy, that they felt safe and were well cared for. It was evident that people who used the service had a good relationship and rapport with the staff who supported them.

People's health and personal care needs were assessed and there were care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. Improvements were required so as to ensure that these were robust. Staff spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported. The provider was able to demonstrate that previous issues relating to dignity and respect had been addressed.

Areas for further improvement related to the management of medicines and ensuring that staffing levels were appropriate for the needs of people living at Godden Lodge.

During our first visit in April 2013 we found some of these issues to be true. We carried out a one hour Short Observation Framework for Inspection (SOFI) observation. The SOFI showed us that when staff interacted with people it was good. However we also saw that people had been left in soiled or ill fitting clothing which staff did not address.

We visited a second time in May 2013 as at our previous visit in April 2013 we were unable to visit people in Cephus House due to an outbreak of diarrhoea and sickness. Our visits found some issues of concern but there was a general improvement in staff interaction on all of the houses that we visited.

The care plans were all written in BUPA's new format. They were very clear and included full assessments for all areas of need that included any identified risks and how to manage them.

The staff duty rosters showed that there were sufficient numbers of staff on duty to meet the needs of the people living in the Godden Lodge. Records were well maintained, clear, factual and accurate.