Archived: Preston Lodge

Preston Lodge provides accommodation and personal care for a maximum of six people with dementia. At the time of our inspection, there were five people living in the care home.

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

Some improvements had been made to training and the support provided to staff members. However, more improvements were still required to ensure that staff members had completed mandatory training and received regular supervisions and yearly appraisals.

Improvements had been made to the quality assurance systems. Checks to monitor service delivery were carried out. The service had introduced various audits in respect of the management of the service and these were completed in May and June 2019.

At this focused inspection on 2 July 2019. the service demonstrated that they had taken some action to comply with the warning notices. However, staff training and support and quality assurance still needed further improvements to fully meet the requirements of the Regulations. We therefore found that there was a continuous breach of Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Rating at last inspection: Requires Improvement (Report published 28 June 2019)

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 2 May 2019 and found breaches of legal regulations. For two of those breaches we issued the service with a warning notice. One breach was in relation to staff training, supervision and appraisals. We were not confident that staff members had received appropriate and relevant training to assist them in carrying out the duties they were employed to perform. Another breach was in relation to the service not having effective systems and processes in place to assess and monitor the quality and safety of the services provided, to mitigate risks to the health, safety and welfare of people using the service, and to ensure that records relating to service users were accurate and complete.

We undertook a focused inspection on the 2 July 2019 to check whether the service had met the warning notice and to confirm that they now met legal requirements. We inspected the effective and well-led domain only at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Preston Lodge' on our website at www.cqc.org.uk'.

Follow up:

We will continue to monitor the service and we will revisit it in the future to check if improvement have been made. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Preston Lodge provides accommodation and personal care to a maximum of six people with dementia. At the time of our inspection, there were five people living in the care home.

People’s experience of using this service:

People spoke positively about the care they received in the home. They told us they felt safe and care workers were kind and caring and they raised no concerns. People’s relatives said they were satisfied with the level of care and said staff treated people with respect and dignity.

There were aspects of the care provided that were not safe. The arrangements for ensuring that people living in the home and staff were kept safe in event of a fire were not adequate. There were deficiencies with fire arrangements and we found a breach of regulation in respect of this.

We looked at the arrangements for medicines in the home. There were systems in place for obtaining and disposing of medicines and the home had a suitable medicines storage facility in place. Medicines were administered as prescribed.

Individual risk assessments were completed for people. However, the service had failed to identify areas of potential risks to people. This could result in people receiving unsafe care and we found a breach of regulation in respect of this.

On the day of the inspection, we observed that care workers did not appear rushed and were able to complete their tasks. They told us there were sufficient staff numbers and raised no concerns.

Care workers spoke positively about their experiences working at the home. They said they felt supported by the registered manager and said they worked well as a team. However, we found there was a lack of evidence to confirm staff had received training and this was confirmed by care workers we spoke with. The lack of training meant that staff may not have had the skills and competencies to enable them to support people safely. We found a breach of regulation in respect of this.

People were supported to live a healthy life. Staff supported people to have a healthy and nutritious diet that was in line with their individual dietary needs and preferences. People had access to healthcare professionals when needed.

People's care support plans were comprehensive and personalised. They included details about people’s individual needs and preferences and guidance for staff to follow so people received personalised care and support that met their individual needs and preferences.

Staff knew people well and had a caring approach to their work. They understood the importance of treating people with dignity, protecting people's privacy and respecting their differences and human rights. During the inspection, we observed staff treated people with respect, kindness and compassion. Positive caring relationships had developed between people who used the service and staff and people appeared at ease in the presence of care support workers and the registered manager.

Care support plans included detailed information about people's capacity and their mental state. Staff we spoke with had a basic knowledge of the MCA, but there was no evidence to confirm they had received MCA training.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. Two people in the home were subject to DoLS and we noted that one had expired and queried this with the registered manager. They explained that they had submitted the application to the local authority and were waiting for an assessment.

There was an activities timetable in place which included board games, daily exercises, reading the newspaper together and discussing current affairs, going to the local library and out in the community.

A formal complaints procedure was in place which was available to people. People and relatives told us they had not had any complaints and they felt listened to by staff and the registered manager.

The home had a system in place to check care plans, medicines, infection control, fire safety and maintenance in the home. However, it was not effective as the service had failed to identify their failings in respect of fire safety in the home, medicines storage and staff training. We saw no evidence of any checks and audits being carried out after September 2018 and there was a lack of evidence to confirm the service was continuously monitoring the level of care they provided. The service was unable to demonstrate that they were ensuring that people were protected against the risk of unsafe or inappropriate care and we found a breach of regulation in respect of this.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of risk assessments and fire arrangements in the home; a lack of staff training, supervision and appraisals; and a lack of evidence to confirm the service was continuously monitoring the level of care they provided. Please see the action we have told the provider to take at the end of this report.

Rating at last inspection: The service was inspected on 21 and 22 November 2016 and was rated as Good.

Why we inspected: This was a scheduled planned comprehensive inspection.

Follow up: We will continue to monitor the service through the information we receive.

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

Our last inspection on 13 January 2016 found five breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches in respect of medicines management, appliances, deprivation of liberties safeguards (DoLS) authorisations, staffing and good governance.

There was a registered manager in post at the time of our 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

People who used the service told us they were satisfied with the care and services provided in the home. During the inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff.

Safeguarding policies and procedures were in place to help protect people and minimise the risks of abuse to people. Care support staff were able to describe the process for identifying and reporting concerns and were able to give examples of types of abuse that may occur. They told us that if they saw something of concern they would report it appropriately.

The inspection in January 2016 found a breach of regulation as controlled drugs were not stored in accordance with legislation. The inspection in November 2016 found that the provider had addressed this and the appropriate medicines storage cabinet was in place. We also found that appropriate arrangements were in place in relation to the recording and administration of medicines.

The inspection in January 2016 found that there was an unpleasant odour in one person’s bedroom and a large stain on the carpet. The inspection in November 2016 found there was no unpleasant odour in any bedrooms or in communal areas. Also the large stain on the carpet had been removed. We also found that some areas of the home which were 'tired' looking at the previous inspection had been redecorated.

The inspection in January 2016 found that the safety inspections for portable appliances was overdue and we found a breach in respect of this. During the inspection in November 2016 we saw evidence that since the last inspection this safety test had been carried out.

On both days of the inspection we observed that care support staff did not appear rushed and were able to complete their tasks. Care support staff we spoke with told us there were enough staff and they were able to complete their tasks. The registered manager confirmed that they did not use agency staff and that the home focused on ensuring there was consistency of care support staff so that people who lived in the home were familiar and comfortable around care support staff.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were also

noted.

During the inspection in January 2016 we did not see sufficient evidence to confirm that care support staff were supported in respect of training and supervisions and we found a breach of regulation in respect of this. The inspection in November 2016 found that the provider had taken appropriate action to improve the service. Care support staff had completed appropriate training and received regular supervision sessions where they had an opportunity to review their personal development and progress.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The inspection in January 2016 found that people’s capacity to make specific decisions was not always recorded in people’s care plans and we found a breach of regulations in respect of this. During the inspection in November 2016 we saw evidence that care plans included information about people’s mental health which included details about people’s mental state and cognition. We also found care support staff had received training in the MCA.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The provider confirmed that since the last inspection, they had made the necessary DoLs application and the assessments had been carried out but they were waiting for the necessary documentation..

People spoke positively about the food in the home and told us that there was a variety of food available. Staff were aware of special diets people required either as a result of a clinical need or a cultural preference. We also noted that the food prepared on the day of the inspection was freshly prepared and looked appetising.

During the inspection in January 2016 it was not evident how the provider was monitoring its service in order to demonstrate how they were ensuring that people were protected against the risk of unsafe or inappropriate care and we found a breach of regulations in respect of this. The inspection in November 2016 found the provider had introduced various audits and checks in order to monitor the quality of care provided in the home. The inspection in November 2016 found that there were effective systems and processes in place to assess, monitor and improve the quality of the services provided.

There was a management structure in place with a team of care support staff, administrator and the registered manager. All care support staff spoke positively about working at the home and told us that the morale within the home was good. The home had an open and transparent culture. Staff were encouraged to have their say and were supported to improve their practice.

At the time of this inspection there were six older people living in the home. During the inspection we spoke with all of the six people who used the service. Some people due to their dementia needs provided one word answers, gestured, nodded or shook their head in response to the questions that we asked. We spent time observing and we spoke with a relative of a person who used the service, two care workers, the administrator and the registered manager/provider. Following the inspection we spoke with a relative, an advocate and a care manager of people who used the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People who used the service told us that they felt safe, staff were friendly and treated them well. Comments from people included 'I feel safe,' 'They are good here,' and 'I can speak with staff. They listen.' We saw staff interacted with people who used the service in a respectful manner. A relative, an advocate and a care manager told us that they were confident that people living in the home were safe.

Staff understood their role in safeguarding the people whom they supported.

Staff were clear about their roles and responsibilities. Staff received appropriate support and advice from the registered manager. Arrangements were in place to keep staffing levels under review. Staffing numbers and skill mix met people's needs.

The home had systems in place to identify, assess and manage risks relating to the health, welfare and safety of people who used the service.

Arrangements were in place for managing medicines safely.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS authorisations for some people may be required.

Incidents were responded to appropriately. Arrangements were in place to ensure that the home was clean.

Is the service effective?

People told us that they were happy living in the home and received the care and support that they wanted and needed. Comments from people about the staff included 'Things are very good,' 'The food is good, I like it,' and 'They help me when I need it.'

Staff told us that there was good communication amongst staff about the service and people's needs, which enabled them to provide the care and support people needed.

People's care needs had been assessed and care and treatment were planned and delivered in a way that promoted people's safety and welfare. People's care plans had been regularly reviewed. However, it was not evident that people participated in the monthly review of their care plans.

Is the service caring?

We saw that people were supported by kind, attentive staff who approached people in a friendly manner. Staff spoke with people who used the service in a respectful way. People living in the home told us staff were kind and listened to them. A relative and an advocate of a person who used the service told us that people were well cared for and were treated with respect by staff. A care manager told us 'They are providing a good service.'

Staff were knowledgeable regarding the specific care needs of people and respected the choices that they made. Staff had an understanding of people's cultural and religious needs and arrangements had been made to meet these needs. People's privacy and dignity were respected. People took part in a variety of activities of their choice.

Is the service responsive?

People received individualised care that was responsive to their interests and preferences. People told us that they participated in decisions about their care. A person who used the service told us that they 'felt involved' in their care. People's care and health were monitored closely. Written notes about people's health and care were completed by staff.

People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of healthcare and social care professionals.

People who used the service told us that if they had any concerns or complaints, they would feel comfortable raising them with staff and/or those important to them.

Is the service well-led?

The registered manager had owned and managed the home for many years. She was knowledgeable regarding her role and responsibilities. The registered manager was accessible for advice and support and worked in the home most days during the week. Staff meetings took place regularly so staff views about the service could be taken into account.

The service worked well with other agencies and services to make sure people received their care and support in a joined up way.

Peoples' relatives, an advocate and a care manager told us that they frequently discussed people's progress with care staff and the registered manager.

Regular checks had been carried out in areas such as fire safety and the cleanliness of the premises.

People were supported to make choices. These included decisions about what they wanted to do and when they wanted to go to bed. Staff interacted with people who used the service in a respectful and very sensitive manner. Comments from people who used the service and relatives of people included, 'It's fine here,' 'the owner and her team are fantastic,' and 'the staff are very friendly and very good.'

Each person who used the service had a plan of care that included up to date information about the individual support and care they needed. People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. People knew how to make a complaint. Staff had the skills to meet people's needs and they received appropriate support and advice from the manager.