White lodge Care Home is a residential care home providing personal care and accommodation to up to 25 people, including people living with dementia. At the time of the inspection they were supporting 20 people. Accommodation is arranged over two floors in single bedrooms. There are two communal lounges, a dining room and access to a garden and patio area.
People’s experience of using this service and what we found
Risks to people using the service had not always been assessed. Plans were not always in place to mitigate these risks. There was a lack of guidance and information for staff about some risks which meant people were at risk of receiving inappropriate or unsafe care and treatment.
We received mixed feedback about the staffing levels in the home. The provider did not have a robust or effective system in place to determine the number of staff required to meet people’s needs. Suitably trained and competent staff were not always available on-site to administer people’s medication. Not all the required checks had been completed as required to help ensure people were protected from the employment of unsuitable staff.
External medicines were not always administered as prescribed, the operations manager told us they would investigate this. The effectiveness of a person’s medication with a variable dose was not monitored to mitigate risks to the person from their condition. We have made a recommendation about the management of these medicines.
The system in place to identify, asses and mitigate risks to people from the quality and safety of the service was not always effective. We received mixed feedback from staff about the culture in the service. Staff views had not been formally sought and analysed over the past year.
People’s relatives told us their relatives were safely cared for in the home and they had regular communication about their relative from staff. Restrictions on visiting meant relatives had not been able to have in person contact regularly inside the home over the past year. People we spoke with who were able to tell us about their care told us they felt safe and well-cared for in the home.
Rating at last inspection
The last rating for this service was Good (published 03 March 2020).
Why we inspected
We received concerns in relation to the management of medicines, staffing levels, people’s needs in relations to falls and moving and handling, leadership and culture. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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 have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end 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 coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for White Lodge Care Home on our website at www.cqc.org.uk.
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.
We have identified breaches in relation to safe care and treatment, staffing fit and proper person employed and governance at this inspection. Please see the action we have told the provider to take at the end of this report.
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.