Brighton & Hove City Council - Ireland Lodge

About the service

Brighton and Hove City Council – Ireland Lodge is a residential care home providing personal care to up to 34 people. The service provides short term and respite support, transitional care and longer term care for people who experience dementia and mental health needs. This includes to prevent hospital admission and to support people after hospital discharge before returning home. At the time of our inspection there were 19 people using the service.

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

We found some governance systems required a more robust approach to ensure training and policies were up to date.

People experienced safe care from kind and respectful staff who understood their needs and preferences. Staff felt valued in their role and valued the people they supported.

Assessments and care plans were created with people and their relatives to ensure support was individualised. People’s risks and needs were reviewed with them to promote improvements and monitor any concerns.

Staff showed genuine care and kindness to people. Relatives and professionals gave consistent feedback that the experience of care was positive and well regarded.

People’s care was coordinated with their relatives and other professionals to ensure their move in and out of the service was as smooth as possible.

There was a positive culture of respect, led by the registered manager, and staff worked together as a team.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (24 April 2020).

At the last inspection we recognised the provider had failed to provide CQC with statutory notifications. This was a breach of regulations and we issued fixed penalty notice. The provider accepted a fixed penalty and paid this in full. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At the last inspection we also found improvements were required for how people’s food and fluid charts were managed. At this inspection we found improvements had been made in this area.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 have found evidence that the provider needs to make improvements to governance systems. Please see the well led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brighton and Hove City Council – Ireland Lodge on our website at www.cqc.org.uk.

Follow up

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

Brighton and Hove City Council – Ireland Lodge is a residential care home providing personal care to 21 people aged 50 and over at the time of inspection. The service can support up to 23 people. Care and support is provided on a short-term basis to people receiving respite or transitional care. This could be following a period of crisis in the community, to prevent a hospital admission or following discharge from hospital. Care and support is provided in one adapted building for people living with dementia or mental health needs. At the time of the inspection, building works were taking place at the service to add additional bedrooms to the service.

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

People’s experience of the care was positive. Relatives also spoke highly of the service and the care and support provided. One relative commented, “I know we can go home, and the people here will do their job and she is safe. That gives us as a family such peace of mind.” However, we found that some areas of the service required improvements.

A quality assurance framework was in place. However, this was not robust in identifying shortfalls. Health and social care providers are required by legislation to notify the Care Quality Commission (CQC) of any serious injuries or Deprivation of Liberty Safeguards (DoLS) authorisations. The Commission had not been notified of any DoLS authorisations in three years. Where required, notifications had not always been submitted to the Commission.

At the last inspection in February 2017, food and fluid charts were in place. However, the recording of fluid charts had not always been fully maintained to ensure there was an accurate record of people's consumption. At this inspection, fluid charts were still not calculated to monitor people’s daily intake and to recognise risk and subsequently to guide hydration risk assessments. This posed a risk that people's hydration needs may not consistently be assessed. This is an area of practice that continues to need improvement.

People told us they felt safe staying at Ireland Lodge. Staff had received safeguarding training and were aware of the signs and indicators of abuse. Incident and accidents were reviewed and, where appropriate, action taken to minimise the risk of future incidents.

The administration of medicines was safe. Staff received training and their competency was regularly assessed. There were enough staff on each shift to support people and robust recruitment checks were carried out before staff started working at the service. Staff received training and supervision to ensure that they had the right skills and abilities to support people.

People spoke highly of the food provided and people’s independence with eating and drinking was promoted. Staff understood the importance of person-centred care and strived to deliver care in line with people’s wishes and preferences. Staff were knowledgeable about behaviours which could challenge and spent time getting to know people and how best to support them during times of anxiety of agitation.

People and relatives said staff treated them and their loved ones kindly. All the interactions we observed were respectful and professional. People's dignity and independence were respected.

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.

People spent time enjoying their own company, the company of staff or other people residing at Ireland Lodge. Staff recognised the importance of activities and a wide range of activities was on offer. On the day of the inspection, people were accessing the garden and enjoying their papers and books in the sunshine.

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 the service was Good (report published 30 March 2017).

Why we inspected:

This was a planned inspection based on the previous rating. We identified one breach of the Care Quality Commission (Registration) Regulations 2009.

Enforcement:

Please see other 'actions we have told the provider to take' section towards the end of the report.

Follow up:

We will request an action plan from the provider to understand what they will do to improve the standards of quality. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People and their relatives told us people felt safe. One person told us, “I have been here five days. It is lovely so far. My daughter says they are doing up my house, but I think I couldn’t be in a safer place. I could stay here forever.” They knew who they could talk with if they had any concerns. They felt it was somewhere where they could raise concerns and they would be listened to. There were systems in place to assess and manage risks and to provide safe and effective care. People were supported by staff who had been through robust recruitment procedures.

Sufficient numbers of suitable staff had been maintained to keep people safe and meet their care and support needs. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, plans were in place to promote good practice and develop the knowledge and skills of staff.

People's individual care and support needs were assessed before they moved into the service. Care and support provided was personalised and based on the identified needs of each individual. People’s care and support plans and risk assessments had been maintained and were detailed and reviewed regularly. People told us they had felt involved and listened to. Where people were unable to make decisions for themselves this had been considered under the Mental Capacity Act 2005, and appropriate actions continued to be followed to arrange meetings to make a decision within their best interests.

The service continued to have a relaxed and homely feel. People were supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. One person told us, “I would recommend this place to anyone.” A member of staff told us, “We build up a rapport and loving and caring relationships and put them in the centre. We look at the personal outlook like their hair and treat them as individuals. For example, one lady loved sprays and crosswords so we bought her some impulse sprays and crosswords in her room. It’s the little things, knowing her interests and what makes them smile and we encourage that.”

People told us the food was good and plentiful. One person told us, “The food is lovely and you can choose what you want to eat. You can even change your mind. The portions are good but you are always asked about everything, before it is served.” Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences. Healthcare professionals, including speech and language therapists and dieticians, had been consulted with as required.

Staff told us that communication throughout the service continued to be good and included comprehensive handovers at the beginning of each shift and staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable. The registered manager told us that senior staff carried out a range of internal audits, and records confirmed this. They operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have. People were asked to complete a satisfaction questionnaire at the end of their stay.

Further information is in the detailed findings below.

This told us people had been asked for their consent for any care or treatment, and that care workers had acted in accordance with their wishes. People or their representatives had been involved in making decisions about their care and treatment. People's care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. One relative commented, 'I think it's wonderful. The staff are lovely and very friendly. I feel more relaxed that my mum is here. From what I see I am very pleased.'

People were provided with a choice of suitable and nutritious food and drink. Comments received included, 'The food is very good. I would have said if I did not get to choose. I get a cup of tea when I want,' and 'The food is quite nice.'

All feedback received confirmed that the service was clean.

There were sufficient numbers of staff with the right skills and qualifications to meet the needs of the people who used the service.

Systems were in place to review and monitor the quality of the care provided.

This told us people had been asked for their consent for any care or treatment, and that care workers had acted in accordance with their wishes. People or their representatives had been involved in making decisions about their care and treatment.

People's care needs had been assessed, planned, reviewed and delivered in line with their individual care plan.

Comments received included 'I can't fault it,' They have been lovely with my mum,' 'It's a well managed place,' 'They have been marvellous. We have been spoilt here,' 'I go home knowing she is happy. It's the staff that make the team.' and 'The staff are very thoughtful, kind and caring.'

Appropriate arrangements were in place for the management of medicines.

There were enough qualified, skilled and experienced staff to meet people's needs.

The records for the management of the home were accurate and complete.