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White Lodge Care Home Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 January 2019

This inspection took place on 21 November 2018 and was unannounced.

White Lodge is a ‘care home without nursing’. People in care homes receive accommodation and 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.

White Lodge accommodates up to 25 people living with dementia and physical frailty. There were 21 people at the home when we inspected.

At the last inspection in April 2018, the service was rated Inadequate and nine breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were found. Following the inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least ‘Good’. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

This inspection found that whilst improvements had been made and number of regulatory breaches had been met. There were areas still to improve and embed in to everyday practice. The service has been taken out of special measures.

There had been no registered manager in place since August 2018. A manager had been appointed and they had begun the process of being registered with CQC. They will be referred to as the manager in the report. 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.

There had been improvements to the management of medicines, although further improvements were needed. Actions had been taken to address medicine errors made by staff, and supervisions and daily audits had been implemented to improve the management of people’s medicines in the home. However, there were still concerns about some medicines management. For example, maintaining accurate records regarding the safe administration of medicines.

A quality assurance framework was in place. However, this was not consistently effective and shortfalls in the provision of care were not always identified.

There had been an improvement in the assessment and mitigation of risks associated with falls. Most of the risk assessment and management plans to minimise risks to people from falls were completed in sufficient detail and risk management plans were followed by staff.

Staff were knowledgeable about the risks associated with people’s care. The information available to new and unfamiliar staff, such as handover notes and care plans was consistent to guide staff on how to support people safely. However, work was still needed for care records to be more person centred.

There was robust recruitment procedures in place and staff had been safely recruited. Sufficient staff were available to meet people’s needs. The provider told us there had been changes to the number of permanent staff on duty and the more effective shift management and allocation of staff. However, people and their relatives told us they did not think there were always enough staff available.

The provider told us about the recent staffing changes they had made and were confident these would achieve improvements for people. This included recruitment to an operations manager post. Further time was required to embed these changes into practice and ensure sufficient staff were available to meet people’s needs and keep them safe at all times.

People told us they felt safe living at the home. Staff understood their responsibilities to protect people from abuse and referrals had been made to the local authority when incidents or allegations occurred.

Staff protected people from the risk of infection and followed procedures to prevent

Inspection areas

Safe

Requires improvement

Updated 17 January 2019

The service was not consistently safe. Whilst meeting the legal requirements that were previously in breach there were areas that required further development and embedding into everyday care delivery.

Records relating to the safe management of medicines were not consistently kept or maintained.

The provider operated an appropriate recruitment and selection procedure for new staff.

Risks to people's safety and welfare had been assessed and information about how to support people to manage risks was recorded in their support plan.

People told us they felt safe and staff were aware of safeguarding adults' procedures.

All areas of the home seen had a satisfactory level of cleanliness and there were arrangements in place for ongoing routine maintenance and repairs.

Effective

Requires improvement

Updated 17 January 2019

White Lodge Care Home was not consistently effective. Whilst meeting the legal requirements that were previously in breach there were areas that required further development and embedding into everyday care delivery.

Staff received the induction, training and support they required for their roles.

The service met the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People's nutritional needs were met. People had access to

healthcare professionals.

Caring

Requires improvement

Updated 17 January 2019

White Lodge Care Home was not consistently caring. Whilst meeting the legal requirements that were previously in breach there were areas that required further development and embedding into everyday care delivery.

People were supported by caring and attentive staff. People's privacy and dignity was respected by staff. Staff encouraged people's independence where possible.

Staff made suitable adjustments to meet the diverse needs of people who used the service.

Responsive

Requires improvement

Updated 17 January 2019

White Lodge Care Home was not consistently responsive.

Whilst meeting the legal requirements that were previously in breach there were areas that required further development and embedding into everyday care delivery.

There were activities on offer to meet people's needs and interests.

Complaints and concerns procedures were in place to managed issues promptly and efficiently.

Staff were familiar with people and their needs which enabled them to provide support.

Well-led

Requires improvement

Updated 17 January 2019

The service was not always well-led

There was no registered manager.

A quality assurance system was in place and information from audits was used to inform a central action plan to drive continuous improvements. However, it was not always effective and failed to consistently identify shortfalls. They did not evidence that actions taken were to drive continuous improvement.

There was a new management team in place and feedback from staff and people was mostly positive about the leadership of the home. Some time was needed for the team to develop and embed the changes and improvements they had begun.

Quality assurance surveys and meeting records showed people, their relatives and staff were engaged through meetings to give their views on the service which were responded to by the provider.