Harrogate Lodge Care Home

Harrogate Lodge Care Home is a care home with nursing and is registered to provide accommodation for up to 50 persons who require nursing or personal care. The home provides intermediate care in the ground floor, which supports hospital discharge through rehabilitation to help people regain previous levels of independence. The first floor accommodates mostly people living with dementia. At the time of our inspection, there were 47 people living at the service.

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

The service was not always managed well. Quality assurance systems were in place and happening regularly, however these had not always been effective in identifying the issues or in driving the necessary improvements identified at this inspection. We found records related to people’s care were not always complete or contemporaneous.

We found risks to people’s care were not always well managed. Some risks to people’s care were assessed and measures put in place to manage these, such as risk of falls. However, we saw examples of other risks not always being well managed such as behaviours considered challenging to others or equipment used to support people’s posture. We found some people did not have an up to date personal emergency evacuation plan.

We received mixed feedback from people and staff in relation to the staffing levels at the service. We observed communal areas were, at times, left unsupervised by staff. Dependency levels were being considered for one area of the home, but not for another. The manager told us they had already identified this was an issue and told us their ongoing work to review staff’s deployment, rotas and recruitment. We recommend the provider reviews their staffing levels taking into consideration dependency levels in both floors.

People and relatives told us the care received at the service had a positive impact on people. We received positive feedback regarding staff being kind and caring. Most staff told us they felt well supported.

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.

We saw evidence of good partnership work with other professionals, to meet the needs of people using the service.

There were plans to continue developing the service, around improvement of care plans and dementia care. There were also plans to renovate the home.

The management team supported this inspection, were receptive to findings and acted timely on the concerns identified.

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 on 14 November 2017).

Why we inspected

This was a planned 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.

Enforcement and Recommendations

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 monitor the service.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

We made a recommendation for the provider to review good practice guidance in relation to safe staffing levels.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had appropriate arrangements to test people and staff for COVID- 19 and was following government guidance on testing. This ensured people and staff were tested for COVID- 19 in a consistent way in line with national guidance.

The home was clean and well ventilated. There was a large enclosed garden which people could access.

The home had appropriate cleaning schedules in place. Hand sanitisers and PPE stations were situated throughout the building.

Appropriate risk assessments were carried out to assess the impact of COVID- 19 on people and staff.

Staff ensured people using the service could maintain links with family members and friends.

We last inspected Harrogate Lodge in December 2016 when the home was rated 'Requires Improvement' overall. The key question 'Safe' was rated Inadequate. We identified two breaches of regulations. We found that medicines administration was not always safe. Medicines were signed for without checks being made to ensure they were taken. Medicines were left with people and stocks of medicines did not always match records. We also found some fire doors were propped open, meaning people were not adequately protected against the risks of fire. People were not fully protected from the risks of unsafe care or treatment because accurate records were not maintained. As a result, we issued two warning notices for regulation 12 (Safe care and treatment) and regulation 17 (Good governance) to the provider telling them they must improve.

Following our December 2016 inspection, the provider sent us an action plan detailing the changes and improvements they intended to make to improve the quality of service provided to people living at the home. We took this into account when planning this inspection to ensure these actions had been completed. At this inspection, we found the provider had made all the required improvements and addressed all our concerns that had been highlighted last time we visited the home.

Harrogate Lodge Care Home is a care home with nursing and is registered to provide accommodation for up to 50 persons who require nursing or personal care. It is situated in the Chapel Allerton area of Leeds, close to local amenities.

There was a manager in post when we inspected. They had been in post since June 2017, and had applied for registration with the Care Quality Commission (CQC). 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.

People using the service told us they felt safe. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

Staff and people we spoke with said staffing levels were sufficient to meet their requirements. We also looked at recruitment processes and found that staff had been recruited safely. All staff received an induction when they started working at the home. Staff received regular supervision and appraisal. Staff also received all the necessary training relevant to their roles.

There was a range of quality audits in place completed by both the manager and provider. These were up to date and completed on a daily, weekly and monthly basis. All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns. Staff told us they enjoyed working at the home and enjoyed their jobs.

All of the people we spoke with during the inspection made positive comments about the care and support provided. People told us they felt staff treated them with dignity and respect and promoted their independence where possible. People felt the home was responsive to their needs. Each person had their own care plan, which was person centred and included their choices and personal preferences.

People were offered a variety of meal options, such as three choices at lunch. They told us they enjoyed their meals and had ample portions. Risk assessments were completed regularly to monitor people against the risks of malnutrition.

The manager ensured staff had training about the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Where people were deprived of their liberty to safeguard them, we found up-to-date records were in place to support decisions made by people. The registered manager and staff ensured good standards in obtaining and recording people's consent to their care.

We observed positive engagement in activities however, space was limited on the first floor and could potentially limit people's participation. We recommend that the service consider the space available to people using the service for the purpose of participating in activities.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. There were no active complaints at the time of the inspection.

Harrogate Lodge Care Home is a care home with nursing and is registered to provide accommodation for up to 50 persons who require nursing or personal care. It is situated in the Chapel Allerton area of Leeds, close to local amenities.

There was a manager in post when we inspected. They had been in post for a fortnight, and had applied for registration with the Care Quality Commission (CQC).

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.

We identified a number of errors of administering and recording of medicines. Some people had not had medicines which had been signed for, medicines were left with people by a nurse who did not stay to witness whether they had taken them, stocks did not always balance with records and we had concerns about the competency of nurses supplied by an agency. Audits of medicines records had not identified errors with stocks. We recommended the provider carry out more robust checks of agency nurse competence to administer medicines before allowing them to work unsupervised in the home.

We found some fire doors had been propped open, an action which would have prevented them operating to preserve the safety of people if there had been a fire.

There were no concerns related to infection control identified during the inspection, however we noted that some paintwork was worn down to bare wood, which would have reduced the effectiveness of cleaning activities.

We found risks associated with people’s care and support was well documented across all relevant areas.

Recruitment of staff was carried out safely with appropriate background checks being made. Staff understood the principles of safeguarding and whistle-blowing, and knew when and how to report any concerns. There were sufficient staff on duty to meet people’s care and support needs.

Staff told us they received a thorough induction and ongoing support including training and supervision, which meant they were able to provide effective care and support to people.

We found the provider had a good approach to assessing people’s capacity to make specific decisions and providing appropriate support to people who lacked capacity. Staff had good knowledge of how to support people who may lack capacity, and the provider managed Deprivation of Liberty Safeguards appropriately.

We saw people were usually asked for consent before any care interventions took place, and found the provider supported people to access other healthcare professionals when this was needed.

People told us they enjoyed the food served, and we saw mealtimes were unrushed. Alternatives were made available when people did not want meals from the menu.

Staff had good relationships with people who used the service, and we found care was planned and delivered in a person-centred way. This was achieved by including people in the writing of their care plans.

Complaints were well managed, and we saw the provider received a range of compliments from relatives of people who used the service.

There was a programme of audit in place, however we found this was not always effective in relation to checks on medicines. Staff said they felt supported by the manager and enjoyed working in the service. They had opportunity to attend regular staff meetings to discuss the running of the service.

People and their relatives had opportunities to attend meetings with the management team, and we received feedback that the provider took action when issues were raised. In addition the provider sent out regular surveys to measure satisfaction with the service.

During this inspection we identified two breaches of the 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.

The inspection was carried out by an individual inspector. We looked at five specific questions; Was the service safe? Was the service effective? Was the service caring? Was the service responsive? Was the service well led?

Was the service safe?

We spoke with six people who used the service. They all told us they were happy with the care and support they received. One person told us 'It's nice and comfortable here'. Another told us 'I am happy enough here, people are very caring'.

We saw evidence staff received regular training in safeguarding vulnerable adults and the service had an up to date safeguarding policy. This meant they were able to protect people from the risk of harm.

Staff had regular training on a variety of subjects and the staff we spoke with told us they felt the training was important as it helped them keep their skills and knowledge up to date. They told us they would like to have further training in specific areas such as wound management and tissue viability. The deputy manager told us training in tissue viability had been scheduled for staff.

Was the service effective?

People had an assessment of their care needs prior to admission into the home. Once they had settled into the home, a further assessment of need was carried out and care records were developed. The resulting care records were then reviewed at regular intervals. This ensured people were having their needs assessed on a regular basis.

The service used advocacy services if people needed it; this meant that, when required, people could access additional support.

The manager set the staff rota and ensured there were the right mix of skills on each shift. This meant people were being cared for by staff that were qualified and experienced. The staff we spoke with told us they had concerns regarding the level of staff sickness at weekends. The deputy manager told us this had been addressed by the manager. The service provider did not routinely use agency staff to cover vacancies amongst care staff. They only used agency staff to cover vacancies amongst qualified staff.

Was the service caring?

We saw interaction between staff and people who used the service was warm and respectful. The staff we spoke with told us they had known a lot of the people for a very long time and had developed a good relationship with people. This meant they had a good understanding of people's care needs.

People were supported by staff who were kind and attentive. We saw care staff showed patience and gave encouragement when supporting people. Some people commented 'Staff are very kind and caring'. However other people told us some care staff were better than others and they felt the care was not always consistent.

We saw people's preferences, interests and diverse needs had been recorded in their care plan. There was evidence people's religious and cultural beliefs were being met.

Was the service responsive?

People took part in a range of activities organised by the activities co-ordinator. Visiting relatives told us the activity co-ordinator had made a big difference within the home.

People told us they knew what to do if they weren't happy with the service. We looked at how complaints had been dealt with within the home. We saw complaints had been responded to in a timely fashion.

Was the service well led?

The service was going through a period of refurbishment which was coming to an end. The staff we spoke with felt the refurbishment had made a difference to the environment. A new manager and deputy manager was in post. There was a voluntary embargo on new referrals and the local health authority had stopped placing people in the home. The service had a difficult relationship with some local General Practitioners and other external agencies. These issues were being addressed by the management team.

The relatives we spoke with told us they had seen a positive change in the way the home was managed. They felt the new manager was approachable and appreciated the time they spent with people who used the service.

Staff were clear about their roles and responsibilities and felt able to talk to the manager if they had any concerns. The manager took an active part in managing the home and the team felt they were as much a part of the team as the care staff.

The people we spoke with told us they could talk to the manager if they had any concerns. We spoke with some visitors to the home and they felt that the home was well managed. They too felt able to talk to the manager if they had any concerns.

People told us they were happy with the care provided. Comments included, 'Staff are very good and put residents first', 'Staff are brilliant, they value the residents, and are very friendly and genuine.'" A visitor said, 'Everyone at home is very happy with Mums care.'

People were satisfied with staffing levels. One person said, 'If I pull the bell they come straight away.' Another person said, 'The staff are in and out of (relative's) bedroom all the time.'

We found the provider requested feedback from people who used the service, relatives and staff, and took action to address any concerns.

We found records were up to date and securely held.