The inspection took place on 7 and 9 March 2016 and was unannounced. This meant the provider or staff did not know about our inspection visit.
We previously inspected St Aidan Lodge Residential Care Home on 30 April 2014, at which time the service was compliant with all regulatory standards.
St Aidan Lodge Residential Care Home is a residential home in Durham providing accommodation and personal care for up to 62 older people. There were 49 people using the service at the time of our inspection.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were well maintained. All areas of the building including people’s rooms, bathrooms and communal areas were clean and odour-free. Infection control risks were well managed throughout.
The storage, administration and disposal of medicines was found to be safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). Medicines practices we observed were patient, safe and in line with the registered provider’s policy.
Risks to people were managed through risk assessments and associated care plans. These risks were reviewed regularly and we saw when relevant information was provided by healthcare professionals this was incorporated into care planning and risk assessment.
Staff displayed a good knowledge of safeguarding principles and what to look out for in terms of indicators of potential abuse. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.
There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks.
Visiting professionals were complimentary about the knowledge and skills of staff, citing a range of examples where they ensured people’s healthcare needs were met. There was regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.
Training was relevant to people’s needs, with staff completing a range of training the registered provider considered mandatory, as well as training specific to people’s needs, for example Gold Standard Framework end of life training. Other training included: dementia awareness, infection control, moving and handling, first aid, person-centred care, safeguarding and medicines administration. Staff displayed a good knowledge of the subjects they had received training in.
Staff were well supported through formal supervision and appraisal processes as well as ad hoc support when required. Staff had a good knowledge of people’s likes, dislikes and life histories and had built a rapport with the people they cared for.
We saw people had choices at each meal as well as being offered alternatives. People spoke positively about the food they had and confirmed they could choose whether to eat with other people or in their room. We observed calm and unhurried interactions between staff and people they supported during lunchtime.
The premises were well designed for people who used the service, with aspects of dementia-friendly design in place, spacious corridors, lifting and bathing equipment tailored to people’s physical needs, and a spacious salon for hairdressing and other uses, such as visits by opticians.
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 take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).
We checked whether the service was working within the principles of the MCA. The registered manager displayed a good understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.
The atmosphere at the home was welcoming. People who used the service, relatives and external stakeholders agreed that staff were caring and compassionate.
Person-centred care plans were in place and daily notes were accurate and contemporaneous. We saw regular reviews took place, ensuring people who used the service, relatives and healthcare professionals were involved.
The service had built and maintained good community links, although there was scope to build better links with a local community centre.
Staff, people who used the service, relatives and external professionals we spoke with were positive about the registered manager in terms of their accountability and approachability.