Archived: Red Lodge

Red Lodge is both a residential care home and a domiciliary care service for older people living in sheltered accommodation. At the time of the inspection the service was providing residential care for 30 people and domiciliary care for seven people. The care home can accommodate up to 42 people.

The domiciliary care service is for people living in their own accommodation, adjoining the care home. Not everyone using the service receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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

People were at risk of not receiving the care they needed, because care records had not been consistently reviewed and updated. Risks to people’s safety and wellbeing had not always been effectively assessed and mitigated. Quality assurance systems had not been effective in ensuring issues identified at our last inspection had been addressed. People had not always received their medicines in line with their prescription. The provider was taking action to address this.

People were generally happy with the care they received but had concerns about staffing levels and the quality of food. The provider had recently agreed to increase staffing levels and told us this would be kept under review.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, we made a recommendation about best practice in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were supported by caring staff, who respected their privacy and dignity. There was a good range of activities available to people.

Staff received an induction and training but had not received regular supervision. Staff told us changes over the last year had affected morale, but this was starting to improve. People and staff told us the new management team were approachable. The provider was open and responsive to our feedback.

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

Rating at last inspection

At the last inspection the service was rated requires improvement overall (published 19 June 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a scheduled inspection based on the service’s previous rating.

Enforcement

We have identified continued breaches of legal requirements in relation to safe care and treatment (risk management and medicines) and good governance (quality assurance and record keeping). Please see the action we have told the provider to take at the end of this report. We asked for a plan from the provider about the immediate actions they planned to take to address the areas of highest concern. This was sent to us within the agreed timeframe, with details of action already taken.

Follow up

We will request a further action plan from the provider to understand what they will continue to do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The team inspected the service against three of the five questions we ask about services: is the service safe, is the service responsive and is the service well led. No significant changes were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Red Lodge on our website at www.cqc.org.uk.

Red Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Red Lodge is owned by the Joseph Rowntree Housing Trust (JRHT). The home is situated in New Earswick to the north of York city centre. Each person living at the home has their own flat and access to a range of communal areas, which include a restaurant, communal lounge and quiet areas.

Red Lodge is registered to provide care and support for up to 42 older people, some of whom may have a learning disability or autistic spectrum disorder. At the time of our inspection there were 34 people receiving a residential care service and 10 people living in the sheltered accommodation who received a personal care support service.

At the time of our inspection the registered manager was not at work. An interim manager was in post. 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.

In the main the concerns which were raised anonymously with the CQC were not founded. However, we did identify some other areas of concern. At this inspection we found that there were breaches of two of the fundamental standards of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment and the governance of the service.

Risks to people had not been adequately assessed or mitigated which meant people were at risk of potential harm. One person's bedroom was not as clean as we would expect.

Care planning records did not always accurately reflect people’s changing needs and reviews were not always completed. Quality assurance systems were not consistently effective in identifying and rectifying concerns.

Despite these concerns people told us they received a good standard of care and felt safe. We concluded there were sufficient staff to meet people’s needs and overall medicines were safely managed.

People were provided with good end of life care and staff sought appropriate advice from health care professionals to ensure people were supported comfortably.

Although records related to people’s care were not consistently updated we saw people received a good standard of care from staff who knew them well.

People were confident that concerns they raised would be taken seriously and they were asked about the standard of care they received via a satisfaction survey.

The staff team, interim manager and registered provider were open and transparent throughout the inspection process and were committed to improving the service for people living at Red Lodge.

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

Red Lodge is owned by the Joseph Rowntree Housing Trust (JRHT). The home is situated in New Earswick to the north of York city centre. Each person living at the home has their own flat and access to a range of communal areas, which include a restaurant, communal lounge and quiet areas. The home has its own car park and benefits from outside garden and seating areas.

Red Lodge provides a care home service without nursing care and incorporates a domiciliary care service, which assists people residing in the on-site sheltered accommodation. The home is registered to provide care and support for up to 42 older people, some of whom may have a learning disability or autistic spectrum disorder. At the time of our inspection there were 30 people receiving a residential care service and seven people living in the sheltered accommodation who received a personal care support service.

The home had a manager in place and the provider had submitted an application to the Care Quality Commission (CQC), in respect of the manager's registration. A registered manager is a person who has registered with the 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.

At our last inspection in July 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to ensuring the suitability of workers, staff supervisions and risk management. At this inspection we found that improvement had been made in these areas and the provider was no longer in breach of regulation.

There was a robust recruitment procedure in place to ensure that staff employed were suitable to work in a care setting. Records were retained in relation to agency staff used by the provider, including information about the training they had completed.

Staff received an induction, regular supervision and training appropriate to the role in which they were employed. Checks of staff competency were also completed.

Risks in relation to people’s needs were assessed and generally appropriately managed, although we found gaps in one person’s care file in relation to individual risks. The information was updated during our inspection. Accidents and incidents were recorded and analysed in order to prevent reoccurrence. Checks of the premises and equipment were completed to monitor their safety.

The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff knew how to respond if they had any concerns. People we spoke with told us they felt safe.

There were mixed views about whether there was always sufficient numbers of staff to meet people’s needs promptly. The provider was reviewing the deployment of staffing across the home to enable staff to respond to people in a timelier manner. We will continue to review this at forthcoming inspections.

Systems were in place to ensure people received their medicines safely and the provider was taking action to ensure medicines were stored at the correct temperature.

The provider was meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in decisions about their care and for those people unable to make decisions about their care, these were made in their best interests using an appropriate process.

People were supported to maintain good health and had access to relevant health professionals when needed. People’s nutritional needs were met and information about their dietary requirements was recorded in their care plans.

People and relatives told us that staff were kind and caring. We observed positive and friendly interactions between people and staff. People’s privacy and dignity was maintained.

The provider completed an initial assessment of people’s needs and there were care plans in place to guide staff on how to support each person. We found some inconsistencies in care plans and some gaps in the recording of monitoring information, such as food and fluid intake charts. The manager had issued guidance and reminders to staff in relation to care plans and monitoring documentation, but the files we viewed showed that further improvement was required to ensure consistency.

At the time of our inspection there was a lack of structured activities taking place at the home and some people told us they felt isolated as they spend most of their time in their rooms. The provider had recruited an activities co-ordinator who was due to commence in post shortly after our inspection.

People knew how to complain if they were unhappy about any aspect of the service. We saw that complaints were recorded and investigated, although some relatives felt issues were not always responded to straightaway. Other people and relatives were more confident that issues would be addressed.

People, staff and most relatives we spoke with told us that they felt the manager was approachable. The manager understood their responsibilities and notifications had been appropriately submitted to CQC. There was a quality assurance system in place and people had opportunity to feedback on the quality of care they received.

Red Lodge is owned by the Joseph Rowntree Housing Trust (JRHT). The home is situated in New Earswick to the north of York city centre. Each person living at the home has their own flat, furnished with their own furniture, and access to a range of communal areas, which include a restaurant, communal lounges and quiet areas. The home has its own car parking and benefits from outside garden and seating areas.

Red Lodge provides a care home service without nursing care and incorporates a domiciliary care service, which assists people residing in the on-site sheltered accommodation. The home is registered to provide care and support for up to 42 older people, some of whom have a learning disability or autistic spectrum disorder. At the time of our inspection there were 35 people receiving a service.

The home had a manager in place and the registered provider had submitted an application to the Care Quality Commission (CQC), which was being processed to certify the individual as the registered manager. A registered manager is a person who has registered with the 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 saw people received care and support that was managed by a wide range of risk assessments for the individual, the home and the environment. However, we found that risk assessments were not always appropriate or person centred and where people’s needs had been reviewed, resulting actions had not always been implemented.

We found that environmental risk assessments and reviews had been completed to help protect people and others from the risk of fire and waterborne diseases but at the time of our inspection, resulting actions were outstanding and remedial actions had not been implemented in a timely manner.

The registered provider showed us a health and safety file that contained reference to a policy and procedure for accident and incident reporting but the document was not available. We found that documented outcomes for and evaluations of accidents had not been completed to identify trends and reduce the risk of re-occurrence.

The registered provider undertook pre-employment checks for care workers they employed. These included checks with the Disclosure and Barring Service (DBS), details of pre-employment references, application forms and right to work in the UK documents. The provider undertook some additional checks when recruiting agency staff. However, these checks were inconsistent and failed to provide information to demonstrate care workers who worked in the service from employment agencies were always suitably trained and of appropriate character to work with vulnerable people.

People and care workers we spoke with voiced their concerns around the number of care workers available during the night shift. We were informed that staffing was reviewed and was adjusted dependent on the number of number of residents, their needs and any planned activities. People had access to a call system and care workers responded to people on an individual basis. We recommended the registered provider undertook a review of the effectiveness of night staffing.

People we spoke with told us they felt safe. Care workers we spoke with had received training in and understood how to recognise signs of abuse and discussed appropriate action they would take if they had concerns. We saw a safeguarding policy and procedure, however, the whistleblowing policy was in the process of being updated and a copy was not available in the file at the time of our inspection. Safeguarding concerns were managed appropriately with guidance sought from the relevant safeguarding authorities.

Safe systems and processes for the management of medicines were in place. Medicines were administered safely by care workers who had received appropriate up to date training. However, the policy statement for the management of medications required updating.

We found that the registered provider was implementing an induction programme for all new employees that reflected the care certificate. Despite a process in place to provide supervisions, one to ones and annual appraisals, these had not always been completed.

Training for employees was managed electronically ensuring care workers received appropriate training at the right time and included adaptions to meet people’s individual care and support needs.

Staff had received training and understood the requirements of The Mental Capacity Act 2005. We looked at people's care plans and saw people or their representatives were involved in their care planning and where people had capacity, consent had been sought that confirmed they agreed with the care and support provided. There was evidence that for those people unable to make decisions about their care, decisions were made in their best interests using an appropriate process.

People were supported to maintain good health. Care plans contained detailed information to ensure people had access to relevant health professionals to support them with a holistic approach and enable them to remain healthy.

People’s dietary requirements were noted in their care plans and the chef ensured that food provided met with people’s individual requirements.

People and their families told us and we saw that care workers provided compassionate and person centred care that was centred on the individual. The manager told us people were assigned a key worker as their main point of contact. However, people were not always clear who this was.

People were treated respectfully and their dignity was maintained at all times. Care workers understood the importance of this and told us how they recognised and maintained people’s confidentiality.

People had received an initial assessment of their needs as part of their application process to the home to receive either residential or community care in their own rooms. This enabled the registered provider to ensure they were able to meet the person’s needs and to ensure the service was right for the individual.

We observed a number of activities took place at the home. People were supported to follow their interests and take part in social activities and were protected from social isolation.

People knew how to complain if they were unhappy about any aspect of the service. We saw that information from complaints and compliments was collated and fully investigated with a view to future learning and improvement.

People, staff and relatives we spoke with told us that they felt the manager was approachable and was working hard to improve the standards of care at the home. There was a clear management structure in place and staff had an understanding of their roles and responsibilities.

We found three breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the staffing, supervisions and risk management. You can see what action we told the provider to take at the back of the full version of this report.

The inspectors visited the service and the information they collected helped answer one of our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Is the service safe?

Medicines were not always managed safely for people and medication records had not been completed correctly. This increased the risk of people not receiving their medications safely and as prescribed.

Care plans overall were not well completed. Some records were inaccurate or incomplete. This increased the risk of people living at the service receiving unsafe, inappropriate care. The lack of robust risk assessments also increased the risk of people's care needs not being well managed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to managing medication and maintaining accurate records.

Is the service effective?

Not applicable.

Is the service caring?

Not applicable

Is the service responsive?

Not applicable.

Is the service well-led?

Not applicable.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We saw overall that people were receiving their medications as prescribed. People told us that staff supported them in a kind and sensitive way. Those people we spoke with told us they received their medication at the times they wanted them and they could not recall an occasion when the service had ever run out of their medicines.

We found some written records to help staff provide the right care and support were not in sufficient detail to enable staff to provide this support safely and appropriately. There were no care records relating to 'as required' medication nor the administration of creams and ointments. The lack of records for staff to refer to increases the risk of the individual receiving inconsistent, inappropriate or unsafe care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining accurate and up to date records.

Is the service effective?

Not applicable

Is the service caring?

Not applicable

Is the service responsive?

Not applicable

Is the service well-led?

Not applicable

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

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

Is the service safe?

People living at Red lodge felt safe because their rights and dignity were respected and they were supported to make decisions about how they spent their time.

People's care needs were assessed before they moved to the home so that the provider was satisfied that staff had the skills and knowledge to support the individual safely and appropriately.

People were protected from the risks of harm because the service assessed that risk and where necessary introduced measures to minimise that risk. We noted though that some improvements in record-keeping would better evidence this.

People were not always protected against the risks of unsafe medication management. We have told the provider to take action to improve this area of care and we will re-visit the service to check these improvements have been made.

Is the service effective?

People were encouraged to express their views about their care and their care records included some information about their preferences and choices. This helped to ensure these views were taken into account when care was planned.

People were involved in decisions and choices about their nutrition and hydration needs, although the records evidencing these discussions could be improved.

People who chose to look after their own medications were assessed and regularly monitored to check they were still willing and able to have this responsibility. This promoted people's independence and wellbeing.

Staff were supported to undertake training and refresher training so they had the up to date skills and knowledge to support people safely and appropriately.

Is the service caring?

People were supported by kind, friendly and attentive staff. They told us 'The staff are wonderful. They let you do things for yourself but are there to help if you need them.' One visitor commented the home was 'fine' and 'super'. They added 'We're pleased our relative has ended up here. Our family has experienced other care services and this is the best.'

We noted that care staff were polite and respectful towards people living there. None of the visitors could recall an occasion when they had observed or seen any staff behaviours or attitudes that caused them concern.

The manager was a visible presence in the home. People told us he regularly talked with them and checked on their welfare. This helped them feel listened to and meant they had the opportunities to speak about how they were feeling, and how the home was being run.

Is the service responsive?

The provider actively sought people's views about how the service was operating. The provider acted on those views and fed back to people where possible, so people knew they had been listened to.

There were a range of activities and these were provided following discussion with the people living there. This meant they were tailored to the group's needs, not what the provider thought they would like.

People were regularly reminded about the need to inform the manager or staff if they had a concern or worry, so that these could be properly looked into and addressed.

Is the service well-led?

The provider had a quality assurance system to monitor the quality of the service delivery. This needed to be built on to ensure audits were conducted in a robust and consistent way.

The provider had a clear senior and local management team and staff were aware of their roles and responsibilities and felt valued and listened to. This helped to promote a supportive team that worked together to provide quality care.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. A person we spoke with said "I'm so glad I am here, it's a nice place.' We saw that people were supported to maintain their independence and observed a warm and friendly rapport between those living and working within this service.

There were policies and procedures in place which helped to protect people from abuse. Issues raised were referred appropriately to the local authority's safeguarding of vulnerable adult's team for further investigation or advice. This helped to protect and safeguard

people.

We saw that there were sufficient staff on duty and staff received training to ensure that they had the skills they needed to be able to look after people safely. A member of staff said "It is a very good organisation to work for; we are kept up to date with our training."

There were quality monitoring systems in place to gain the views and opinions of people regarding the way in which the service was ran. One person told us "We often have meetings where we are asked for our views and opinions."

All of the people we spoke with said that they were well cared for by staff. They told us that there was a restaurant on site which many people used and people said that the food was good. Other comments included "Staff are very good, they are really helpful' and "I get lots of help, the staff visit every day, I couldn't be better looked after.'

People said they felt safe and there were systems in place which helped to protect people. Comments included "I feel safer here than I did in my own bungalow" and "I know if I press my alarm, staff will come and check on me."

Staff were recruited safely with relevant checks being completed to ensure that they were suitable to care for people. People told us "They are often short staffed which means sometimes you can wait' and 'They are all very nice girls but they are often really busy.'

People said they felt confident in raising any concerns and said that they felt these were appropriately addressed.