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We are carrying out checks at White Lodge Care Home. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Inadequate

Updated 12 July 2018

The inspection took place on 23 and 24 April 2018 and was unannounced on day one and announced on day two.

White Lodge is a ‘care home’ situated in Emsworth near Portsmouth. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home sits within its own grounds and provides accommodation and support for up to 25 older people. Nursing care is not provided. Accommodation is sited over two floors. On the day of the inspection there were 23 people using the service.

The service requires a registered manager. 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. At the time of the inspection there was no registered manager, although the manager had made an application to CQC to be registered. They will be referred to as “the manager” throughout this report. The previous registered manager had also been at the service on the first day of the inspection and where applicable they will be referred to as “the previous manager”.

At the last inspection in January 2017 the service was rated Requires Improvement and there were three breaches of the Health and Social Care Act 2008. Regulation 11, Need for consent; Regulation 12, Safe care and treatment; and Regulation 12, Good governance. At this inspection we found continued breaches in Safe and Well Led, together with other concerns.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Responsive, Effective and Well led to at least a rating of Good. We had to contact the previous manager to request an action plan, as one had not been sent.

At this inspection, although people and relatives gave mainly positive feedback about the service, we continued to have concerns about the safety and well-being of people. Emerging risks were seen in areas where there had been no previous concerns and breaches and continued breaches of Regulation were found.

Risks including those associated with medicines, people’s care, the spread of infection and fire drills had not been properly assessed or minimised in order to keep people safe.

People were at risk because staff did not administer or manage medicines safely. For example, there were no assessments of risk associated with blood thinning medicines. This was a repeated breach, and we saw deterioration since our last inspection in January 2017.

Accidents and incidents were not competently managed. We found the approach to reviewing and investigating causes to be insufficient. There was little evidence of learning from these occurrences.

The provider did not always make referrals for appropriate care and treatment at the right time. In some examples, we found that recommendations for care and treatment by other professionals were not always carried out as directed.

People's care needs were not regularly reviewed. We found care plans did not sufficiently inform staff of people's current care, treatment and support needs, which left people exposed to the risk of receiving inappropriate care or treatment.

Staff had not received training for them to be able to undertake their role and meet people’s needs.

There was minimal evidence to show the service was monitored to ensure its’ safety and there was no evidence that lessons had been learned and improvements made when things went wrong.

People's healthcare had not been effectively monitored and concerns escalated in a timely way. Care plans did not always reflect people’s needs which left people exposed to the risk of receiving inappropriate care or treatment.

The principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards had not been properly understood or applied in the service.

Whilst we saw that staff asked for people's permission before carrying out care, people's care records did not always reflect how decisions had been reached in their best interests. We also found some staff were unclear about the requirements relating to consent.

We received mostly positive feedback from people, relatives and visitors who were able to speak with us. We observed that generally people were treated with dignity, respect and kindness during all interactions with staff. However, we noted that some staff did not always respond to the needs of people in a timely way.

The service was not well-led. Issues raised at our last inspection remained unaddressed in some cases and new problems emerged in other areas. Auditing had been ineffective in identifying shortfalls. There was little evidence of people's involvement in their care or decisions about it.

People had routine appointments with GPs, health and social care specialists, opticians, dentists,

chiropodists and podiatrists. People enjoyed their meals and were supported to eat if necessary.

Most people, relatives and staff felt the new manager was approachable and responsive.

We found seven breaches and continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review. If we have not taken immediate action to propose to cancel the provider's registration of the service, they will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe and a rating of inadequate remains for any key question or overall, we will take action in line with our enforcement procedures. This could be to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

You can see what action we told the provider to take at the back of the full version of the report. We are currently considering what action to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Inspection areas

Safe

Inadequate

Updated 12 July 2018

The service was not safe.

Risks to people had not always been identified and managed appropriately. Where risks had been assessed there were no comprehensive plans in place to instruct staff on how to safely manage those risks.

Medicines were not managed safely.

There were insufficient checks to make sure people lived in a safe environment.

There was a lack of learning from incidents.

Staff had been recruited safely.

Effective

Inadequate

Updated 12 July 2018

The service was not effective.

People's healthcare needs had not been consistently recognised or escalated. Fluid intake and output was not always managed effectively.

People were not always supported to maintain their health and wellbeing.

Staff training was not effective in supporting them to carry out their roles.

The service was not meeting the requirements of the Deprivation of Liberty Safeguards and Mental Capacity Act 2005.

People enjoyed their meals and received support to eat them.

Caring

Requires improvement

Updated 12 July 2018

The service was not consistently caring.

Whilst people and relatives told us staff were kind and caring, the provider had failed to address matters which had been raised at previous inspections. People had continued to be at risk.

People's dignity had not always been considered.

There was limited information in care files about people's involvement in care decisions.

Staff treated people with kindness and gentleness.

People's independence was encouraged and promoted.

Responsive

Requires improvement

Updated 12 July 2018

The service was not always responsive.

Care planning was not person centred and inaccuracies or anomalies between sources of information had not been corrected.

End of life care planning was scant and did not place emphasis on people's preferences and wishes.

Complaints were properly logged and recorded but actions arising from them were not always effective.

People enjoyed activities on some days, but there was little or nothing to do on others.

Well-led

Inadequate

Updated 12 July 2018

The service was not well led.

The leadership and management of the service was inadequate and placed people at risk of harm.

Issues raised at our last inspection had not been resolved and new problems had emerged.

Progress against the provider's action plan was slow and had not prioritised the high risk areas identified at our last inspection.

The provider did not effectively assess, monitor and improve the quality and safety of the service provided.