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Princess Lodge Limited Requires improvement

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Inspection report

Date of Inspection: 30 June and 8 July 2014
Date of Publication: 27 August 2014
Inspection Report published 27 August 2014 PDF

Overview

Inspection carried out on 30 June and 8 July 2014

During a routine inspection

The names Mr Frank Brown and Mrs Jayne Elizabeth Whitehouse appear in this report. However, those people were not in post and were not managing the regulatory activities at this location at the time of our inspection. Their names appear because they were still identified as registered managers on our database at the time of our inspection.

Our inspection of October 2013 and our pharmacy inspection of January 2014 highlighted some serious non-compliance. As a result we issued two warning notices to the provider and also set compliance actions for improvements to be made. After we issued the second warning notice we determined some improvement but identified that further improvement was needed in relation to care and welfare. During this, our most recent inspection, we again found non-compliance relating to the same areas we had previously.

Our inspection was carried out over two days. An inspector conducted the first inspection day and our pharmacy inspector inspected the medicine management systems on a second day. No-one knew we would be going to the home on either day as our inspection days were unannounced.

During our inspection days 25 people lived at the home. During our inspection days we spoke with eight people who lived there, three relatives, seven members of staff and the manager. Several people who lived there were unable to tell us about their care and support experiences so we spent time observing how staff interacted with people and looked at the daily routines.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Systems to protect vulnerable people from the risk of abuse were not followed so had not ensured people�s wellbeing and safety.

Staff we spoke with had a basic knowledge of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. However, we found that an application or advice that should have been sought for one person was not.

Recent recruitment practice did not comply with the law. It was not safe or effective and placed the vulnerable people who lived there at risk of harm from potentially unsuitable staff being in contact with them.

People were not protected against the risks associated with medicines because staff were not following arrangements in place to manage medicines safely.

Is the service effective?

People we spoke with gave us mixed views about the standard of care and support they received. One person said, �They look after me well, I do not know about the other people�. Another person said, �It could be a lot better here. I do not think it is that good�.

We found that staffing numbers were in need of a review as they did not demonstrate that they could effectively meet people's needs and preferences. A number of people and staff we spoke with highlighted that additional staff were needed. People told us that at times, they had to wait for support and assistance.

The provider had taken note of previous concerns raised by us, the Care Quality Commission, the local authority and Clinical Commissioning Group (CCG) at the end of 2013 and had made some improvements. However, insufficient action had been taken to ensure that those improvements were sustained. This inspection identified similar issues to those we had identified in 2013. This did not give assurance that the service provided was effective.

Is the service caring?

Overall, we found that care and support was provided with kindness and compassion. People told us that they could make some choices about how they wanted to be supported. All people we spoke with were complimentary the staff and described them as, �Kind� and �Caring�. One person told us, �Staff are kind and friendly�. A relative told us, �The staff themselves are caring�.

We spent some time observing interactions between staff and the people who used the service. We saw that most staff showed patience when supporting people. However, we observed durations when there was no engagement or interaction from staff. People were asleep in their chairs, or looked unhappy. We saw that their faces had a blank expression and some people were restless.

Is the service responsive?

We found that basic systems were in place to give people and their relatives the opportunity to raise any issues. However, the issues about the lack of staff and activity provision had not been adequately addressed. This showed that the provider had systems in place listen to the views of the people who lived there but did not always take action to address them adequately.

We found that for one person nursing staff had not assessed a person�s sore arm when the care alerted them to this. This meant that the person was at risk of continuing unnecessary discomfort.

Is the service well led?

At the time of our inspection, although a manager was in post, they had not formally registered with us as is required by law. The registered provider gave us assurance that they would ensure that the manager applied for registration as a matter of priority.

We found that the manager was responsible for this and another home. Evidence presented to us by documents and verbally from staff indicated that there was not adequate manager input. Inadequate manager input and the findings from our inspection did not give confidence that the home was well led.

We identified from observations and care plans that some staff did not follow instructions. During our inspection we identified some issues that should have been reported to social services as people were not being safeguarded as they should have been. This had a negative impact on people's health and wellbeing and did not demonstrate a well led service.

Staffing was not always organised to ensure people�s needs were met and support was not always available for activities. A number of people told us that they had to wait for staff assistance.