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Princess Lodge Limited Requires improvement

All reports

Inspection report

Date of Inspection: 16 December 2013
Date of Publication: 24 January 2014
Inspection Report published 24 January 2014 PDF

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Not met this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 16 December 2013, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff and reviewed information given to us by the provider.

Our judgement

The provider had no effective system to regularly assess and monitor the quality of service that people receive.

The provider had no effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Reasons for our judgement

We looked for evidence to see if the provider had met all of the requirements of the waning notice we served on 13 November 2013. We saw that provider had made some improvements to monitor the quality of the service provided. This included a ‘Complete server’ audit which covered a range of areas such as health and safety, food and nutrition and quality assurance. This meant that the quality of the service provided was being monitored. When we asked people and their relatives about their views of the service provided their responses included comments such as, "The staff are very helpful" and, "I am happy". One relative said, “Staff are very good”. This showed that people and their relatives were overall happy with the staff working at the home.

At our last inspection in October 2013, no surveys were offered to people or their relatives. During this inspection we saw that recent surveys were provided to people and their relatives to allow them to give feedback on the service. We saw there were only four completed and returned surveys, three were from friends/relatives and one was from a person who lived at the home. The general manager told us once further surveys were returned the feedback would be analysed. This demonstrated that there was a system in place to seek the views of people and their relatives in order to improve the service.

At our last inspection we found that the provider had not forwarded a statutory notification for harm to a person or allegation of abuse. We also saw that there was no overall system to record and track safeguarding referrals. During this inspection, the deputy manager told us that there had been no safeguarding incidents at the home to warrant a statutory notification to us, the Care Quality Commission (CQC). The general manager told us that if a safeguarding incident occurred, they would then put a system in place and they were seeking support from the local safeguarding team to develop a system. As this was a requirement of the warning notice, this meant that that the provider had not fully complied with the warning notice. We also confirmed with the general manager that since our last inspection in October 2013, there had been three incidents that would have required the provider to send CQC statutory notifications however, no notifications were sent. This showed that some staff again had not taken the action to inform CQC of accidents or incidents that required statutory notifications to us. This meant that that the provider had not fully complied with the requirements of the warning notice.

At our last inspection we saw no evidence that meetings took place for people who lived at the home or their relatives. During this inspection all of the people we spoke with and their relatives told us that meetings did not happen. This was also confirmed by the general manager. One person told us, “There is not much to do other than watch television”. A relative told us, “There is not much activities”. This showed that people and their relatives had feedback to give. Some of the staff spoken with told us that they did not always have time to do meaningful activities, we saw no activities taking place on the day of our inspection. The general manager told us of plans to increase activities at the home and that a meeting for people who lived at the home was scheduled for 14 January 2014, this was because their newly appointed manager would be in post. However, the absence of any meetings meant that there was no formal system in place for people and their relatives to have the opportunity to regularly comment on their experiences of the service and how they would like the service to be delivered. This meant that that the provider had not fully complied with the requirements of the warning notice.

At our last inspection in October 2013, we identified that the provider had a complaints policy however, there was no complaints information available in an accessible format for people. The provider was al