South Haven Lodge Care Home

South Haven Lodge Care Home is a care home providing personal and nursing care for up to 46 people, who tend to be older and may be living with dementia. There were 30 people living at South Haven Lodge Care Home at the time of the inspection. It accommodates people in one adapted building with an enclosed garden.

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

People’s care plans and risk assessments identified individual risks which were used to create care plans, for example, where people were at risk of developing pressure area wounds. However, there were inconsistencies between records regarding how often a person needed to be repositioned. Records showed people were not consistently supported to reposition within the correct time frame which meant their skin may be at risk of injury.

People were supported by staff to take their medicines and records were completed. However, the medication records did not match the medicine stocks held in the home. People did not always have protocols in place for medicines prescribed as, ‘when needed’ for severe pain relief or anxiety. Medicines were stored correctly.

There had been improvements regarding the safety of the environment since the last inspection but we identified concerns on the first day of inspection. The registered manager took action to address these.

People’s wishes had not been appropriately sought or complied with regarding the posting of information on social media. The provider had not sought consent or completed best interests decisions regarding the use of sensor mats.

The provider had a system of auditing in place which included the registered manager completing a monthly quality audit. Whilst the governance systems had improved since the last inspection, these were not robust or fully embedded into good practice. There was not a formal system in place to seek and receive feedback from people or their relatives.

Equipment such as hoists were serviced and maintained appropriately. Where people slept on pressure relieving mattresses, the settings were checked and recorded appropriately. Maintenance and safety checks were completed weekly or monthly, as necessary.

The provider had a recruitment procedure in place which included seeking references and checks through the Disclosure and Barring Service before employing new staff. Feedback from relatives and visitors was positive about the staff team.

The provider had policies and procedures in place designed to protect people from the risk of harm and abuse. In the event of accidents or incidents the registered manager completed an investigation and analysis of events. This included analysing incidents to identify trends, actions and learning.

People, their relatives and staff were positive about the home and the impact the registered manager had on improving the service.

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 (published 13 January 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made but the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out a focussed inspection of this service on 4 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safety and governance.

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. We have found evidence the provider needs to make improvements.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for South Haven Lodge Care Home on our website at www.cqc.org.uk.

Enforcement

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

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

South Haven Lodge Care Home is a care home providing personal and nursing care for up to 46 people, who tend to be older and may be living with dementia. There were 32 people living at South Haven Lodge Care Home at the time of the inspection. It accommodates people in one adapted building with an enclosed garden.

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

People were not safe because identified risks had not been mitigated. People’s care plans and risk assessments identified their individual risks but actions to reduce these risks were not clearly defined. Staff had not followed guidance, where it had been provided, this which meant people had been injured or placed at risk of injury.

New staff had not completed moving and handling training which meant they should not support people to move, for example, using a hoist. However, an untrained staff member had assisted other staff in supporting a person to move and the person slipped out of the hoist, which put them at risk of serious injury.

Staff had not always reported concerns such as red skin marks and burns on people’s skin, to enable any required action to be taken.

People had not always received their medicines as prescribed, which put them at risk.

Staff recruitment records did not contain all the relevant checks needed by legislation.

The manager considered how many staff were needed for each shift based on people’s needs. However, the provider relied on agency staff and there was a lack of oversight of their practice. Staff gave us negative feedback about staffing levels as they felt people sometimes waited too long to be supported with their morning personal care routine.

Systems were in place to report any safeguarding concerns to the local authority. Infection control procedures were in place to reduce the risk of people catching infections.

There was not a registered manager at the home. Staff felt the culture of the home was not positive.

Some records were not accurate or complete and some were not kept securely.

Feedback on the provision of care had not been sought from people, their relatives, staff or professionals this year. Monthly audits had not always been completed which meant the quality of care had not been consistently monitored.

We saw staff interacting pleasantly with people and responding to their needs. Staff were respectful of people’s dignity when they were talking to them. One person was supported to put their legs on a stool, which was in their care plan. We saw a nurse supporting someone with their medicines in an unrushed way, whilst sitting at their level.

We received positive feedback about the new manager.

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 (published 6 March 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had not been made and the provider was still in breach of regulations. We also identified further breaches of two regulations.

Why we inspected

We received concerns in relation to risk management and staffing levels. As a result, we undertook a targeted inspection to look at management of risk and staffing. During the first day of our inspection we found concerns and we subsequently received more information of concern. We therefore extended the inspection to a focused one which looked at the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has remained requires improvement. The provider has been responsive to the concerns identified and is committed to improving the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for South Haven Lodge Care Home on our website at www.cqc.org.uk.

Follow up

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

South Haven Lodge Care Home is a residential care home providing personal and nursing care to 36 people at the time of inspection. The service can support up to 46 people. It accommodates people in one adapted building with an enclosed garden.

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

People were placed at risk of harm because the management of medicines was not always effective. Medicines audits had not identified the concerns we found during the inspection. Staff were not clear regarding the emergency evacuation process should there be a fire.

People told us there were enough staff to support them safely. The provider followed a recruitment procedure which ensured pre-employment checks were in place before new staff started work at the home.

Systems were in place which ensured safety checks and maintenance was completed for equipment such as hoists, gas and electric installations.

People had risk assessments in place which identified potential risks to their safety. Staff had received training to ensure they supported people safely.

The provider had policies and procedures in place designed to protect people from the risk of harm and abuse.

Infection and control procedures were followed to minimise the risk of the spread of infection.

The manager ensured when things went wrong, issues were investigated and lessons were learnt.

There was a system of audits in the home, which were used to monitor the quality of the service. The new manager had identified areas where improvement was necessary to improve the culture of the home and they worked in partnership with other professionals.

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 3 April 2020).

Why we inspected

We received concerns in relation to the safety of people when staff supported them to move with a hoist and issues with infection control. We had also received several statutory notifications about errors made when administering medicines. As a result, we undertook a focussed inspection to review the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

South Haven Lodge Care Home is a residential care home providing personal care to 38 people at the time of the inspection. The service is registered to support up to 46 older people who may be living with dementia or have other mental health needs. It accommodates people in one adapted building. There was an enclosed garden with an outhouse and areas for sitting out.

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

People received care and support that was safe, effective, caring, responsive and well led. People were protected from avoidable harm, abuse and other risks to their health and welfare, including the risk of the spread of infectious diseases. There were enough numbers of staff deployed to support people safely and promptly. People had their medicines in line with their prescriptions and preferences.

People’s care and support was effective and based on detailed assessments and care plans which reflected their physical, mental and social needs. 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.

There were caring relationships between people and staff. Staff had got to know people, their interests and families. Staff respected and promoted people’s privacy and dignity, and encouraged people to be as independent as possible.

People’s care and support met their needs and reflected their preferences. The provider was aware of and followed best practice guidance. People could take part in activities inside and outside the home which reflected their interests and prevented social isolation.

The service was well led. There was focus on meeting people’s individual needs and preferences. There were effective management and quality processes in place.

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

Rating at last inspection

The last rating for this service was good (report published 16 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager at the home. 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.

Risks to individuals were assessed and monitored. Where risks were present, the service put measures in place to reduce the risk of harm to people. Where people’s health needs changed, the service involved external professionals to ensure people received assessment and care which was appropriate to meet their needs. People had access to healthcare services as required, which helped to maintain their health and wellbeing.

People’s care plans detailed people’s preferences around their personal care routines and documented areas in which they remained independent. Care plans were regularly reviewed and people were involved in making choices about how they were cared for. Where people lacked the capacity to make specific decisions, the service had followed the principles of the Mental Capacity Act (2005) to ensure that decisions made were in their best interest and were as least restrictive as possible. Staff understood the need to gain consent before providing care and treated people with dignity and respect.

There were sufficient staff available to meet people’s needs. The service had robust recruitment processes, which helped ensure that staff were of appropriate character and experience to provide effective care for people. Staff received appropriate training, induction and supervision to carry out their role and told us they were happy with the support they received from the registered manager. Staff had received training in safeguarding and understood their responsibilities in reporting concerns through the appropriate channels, which helped to keep people safe from abuse. People and their relatives told us that staff were caring, compassionate and understood their needs well. Staff cared for people calmly, this helped to create a homely atmosphere within the service where visitors were welcomed and people felt safe and relaxed.

There were systems in place in safely mange people’s medicines to ensure they received them as prescribed. Where some people took medicines for anxiety, staff worked with people and doctors to ensure that people were only administered these medicines when necessary to keep people safe.

People’s nutritional needs were assessed to help ensure people received appropriate support. Where people required additional help to eat and drink, staff provided the assistance they required and monitored their food or fluid intake to ensure they were receiving enough to eat and drink.

The registered manager's quality assurance systems ensured that they had an insight into the daily running of the service. They monitored key areas of staff performance and the wellbeing of people to help ensure that issues or concerns were identified and addressed quickly. The registered manager had a ‘home improvement plan’, which detailed and tracked improvements identified through auditing and feedback. Formal feedback was used to make improvements to the service. Responses from questionnaires and consultation with people had led to changes, which improved the quality of the environment and the care provided. There was a complaints policy in place and people were aware how and to whom to address their concerns.

There was a clear management structure in place at the service. Staff understood their roles well and told us that the registered manager was supportive and approachable. People and their relatives told us the service was well run and provided good quality care.

We spoke with four members of staff, the manager and the operations manager. One member of staff said "The staff work well together and it's great to be a part of the team." Another member of staff said "You are really well supported to do your job". One member of staff said "It's great to see people make progress and regain skills."

We saw people were involved in making decisions in their daily lives and could see they were being listened to by staff. Their needs were identified in a care plan which staff followed when delivering care. People's health needs were identified and responded to if they changed.

Staff were aware of safeguarding and helped people to remain safe. Concerns were reported and the management responded appropriately. We saw concerns were referred to the local safeguarding authority who worked with the provider to address the issues identified.

The service managed the administration of medicines safely and ensured people received their medicines appropriately. Staff received appropriate support and training.