Eden Lodge Residential Care Home

Eden Lodge Residential Care Home is a care home providing personal care to 19 people, some of whom were living with dementia, at the time of the inspection. The service can support up to 60 people in one adapted building across one floor.

People’s experience of using this service and what we found

People felt safe living at the home and were supported by appropriately trained and competent staff. People were supported to have their medicines safely. People lived in a clean home which implemented infection control procedures in line with current guidance. Risks were being managed to keep people safe.

People’s needs were assessed and documented clearly for staff to be able to meet them. People had choice of what to eat and drink and were supported to do so to maintain their well-being. When people required input from healthcare professionals this was arranged for them by staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by a kind and friendly staff team who cared for them with respect. People were able to choose how to spend their day and their independence was promoted.

People were involved in their care planning and their plans had clear guidance for staff on how to support them in a way they preferred. There was a wide range of activities people could choose to participate in.

The home had a new manager who was really driving improvements and implementing new processes to ensure quality care was being delivered. People and staff felt involved in the running of the home and spoke highly of the new management.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was inadequate (published 15 January 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 6 March 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eden Lodge Residential Care Home is a care home providing personal care to 21 people, some of whom were living with dementia at the time of the inspection. The service can support up to 60 people in one adapted building across one floor.

People’s experience of using this service and what we found

People were not always protected adequately against risk of harm. Risk management had not improved since our last inspection. Risks were not always assessed or reviewed. Incidents were not always recorded or reported appropriately. Staff were not always provided with the information to support people with their medicines in a safe way. There were poor infection control practices. Staffing levels were not matched to people’s needs.

There was very little leadership and oversight of the service was poor. There was insufficient risk management and quality monitoring. Auditing was not robust and there were missed opportunities for learning and improving the quality of care.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. People's needs were not assessed or planned for adequately.

We have made a recommendation to the provider around the documentation of consent and people’s capacity.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 06 March 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 28 and 30 January 2020. Breaches of legal requirements were found around regulation 12 (safe care and treatment) and regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC issued a warning notice for these breaches of regulation. The provider completed an action plan after the last inspection, detailing what action they would take to improve and by what date.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as inadequate. This is based on the findings at this inspection.

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 Eden Lodge Residential Care Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe, care delivery, staffing levels, safeguarding, leadership and oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Eden Lodge Residential Care Home is a care home providing personal care to 32 people, some of whom were living with dementia at the time of the inspection. The service can support up to 60 people in one adapted building across one floor.

People’s experience of using this service and what we found

People were not always being protected adequately against risk of harm. Risk management was poor, with risks not always being assessed or reviewed. Incidents were not always being recorded or reported appropriately. Medicines management was found to be lacking. There were some poor infection control practices. Recruitment practices were not robust.

People spoke positively about the registered manager of the service. However, we found leadership and oversight to be lacking. There was insufficient risk management and quality monitoring. Statutory notifications were not always submitted when required. The registered manager lacked an understanding around their regulatory requirements.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s needs were not always assessed adequately. Although people spoke positively about the staff that supported them, it was found staff were not supported adequately.

People spoke positively about the food in the service, however management of risks around their eating and drinking was lacking. People were supported to access healthcare services but record keeping around this was inconsistent.

Staff sometimes used undignified language about people who lived in the service. People’s information was not always kept private. People said staff were caring and kind however we observed staff not always being respectful and people did not always have a say in how they were being cared for.

People’s care was not always planned in a personalised way. People were not always involved in their care planning. Staff were not always provided with enough information to care for people’s specific needs. People said they were sometimes bored, and we observed very few meaningful activities.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to keeping people safe, care delivery, leadership and oversight of the service at this inspection.

Please see the action we have told the provider to take so far at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan for the provider to understand what they will do to improve the standards of quality and safety.

We will work with the 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Residential Care Home provides accommodation for up to 60 older people. On the day of our inspection 19 people were using the service. This was because the provider is only currently using one section of the service.

When we inspected the service on 6 April 2016 we found there were breaches of regulation and improvements were required in a number of areas in the standard of care provided. This included improvements to how people were protected against the risk of avoidable harm, their nutritional and hydration needs were met and how risks were assessed and safe care provided. This also included improvements with staff’s competency and knowledge, with the premises and equipment and how medicines were managed. There were also improvements needed in relation to the way the registered provider monitored and assessed the service to identify and act on any improvements needed. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan and told us they would make the improvements.

We inspected the service again on 2 August 2016 and reviewed what improvements had been made in relation to how risks were managed and how the provider was monitoring quality and safety. At this inspection we found some improvements had been made but further improvements were still required. The provider sent us a further action plan and told us what additional improvements they would make.

During this comprehensive inspection we looked at whether the provider now met the legal requirements in relation to breaches of regulation we had found in April 2016 and August 2016. We found that the provider had taken action and all the breaches had been met.

People and their relatives told us they felt staff provided safe care and support. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and reviewed to ensure they continued to reflect people’s needs. Risk plans informed staff of the action required to reduce any associated risks to people’s needs. Accidents and incidents were recorded and reported by staff. The registered manager analysed these to ensure appropriate action had been taken to protect people, and to consider if there were any themes or patterns that required further action. Contingency plans were in place to support staff to provide a safe service in the event of an untoward incident affecting the service.

There were sufficient staff to keep people safe and meet their needs. Safe recruitment procedures were in place and followed. Medicines were given to people on time and as prescribed, they were also managed and stored safely following best practice guidance.

People were supported effectively by staff that had received an induction, ongoing training and support.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had received appropriate training and understood the processes in place for ensuring decisions were made in people’s best interests. People and or their relative where appropriate, had given consent to their care and treatment. Some people were living with dementia and experienced periods of anxiety that affected their mood and behaviour. Staff had appropriate information about how to support people during these times.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. Catering staff had received additional training to understand people’s nutritional needs. People were appropriately supported with their eating and drinking needs if required, choices were offered and respected, and independence encouraged as fully as possible.

The service worked well with visiting healthcare professionals to ensure they provided effective care and support. When concerns were identified about people’s healthcare needs, appropriate action was taken to support people’s health and well-being.

Staff were kind and caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt that staff were understanding of their needs and that they had developed positive relationships with them. Information about an independent advocacy service was available for people should this support have been required.

People and or their relatives where appropriate, were involved in the assessment and review of their needs. New care plan documentation had been introduced that informed staff how to support people and were more personalised to people’s needs, routines and preferences. Staff provided social activities and opportunities to support people with any interest’s hobbies and pastimes. People and staff knew how to raise concerns and information about how to make a complaint was available.

People who used the service and relatives or representatives, were given opportunities to share their experience of the service. New and improved quality assurance systems were in place to regularly review the quality and safety of the service provided. Since our last inspection the service had improved in all areas and there was a clear plan in place to continually drive forward improvements and to sustain those already made.

We undertook this focused inspection on 2 August 2016 to confirm that the provider had met the requirements of the warning notices. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eden Lodge Residential Care Home on our website at www.cqc.org.uk.

The inspection was unannounced. Eden Lodge Residential Care Home provides accommodation for up to 60 older people. On the day of our inspection 22 people were using the service. This was because the provider is only currently using one section of the service.

The service had a registered manager in place at the time of our inspection. 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 was a manager in post and they had submitted an application to register with us.

Although people felt safe in the service, people were not always protected from risks in relation to their care and support and medicines were not always managed safely. Information was shared with the local authority safeguarding vulnerable adult’s team when needed and safe recruitment practices had been implemented.

Governance processes had been implemented and although this was identifying issues and leading to improvements, the issues we found had not all been identified. People felt the registered manager was approachable.

You can see what action we told the provider to take at the back of the full version of the report.

Residential Care Home provides accommodation for up to 60 older people. On the day of our inspection 24 people were using the service. This was because the provider is only currently using one section of the service.

When inspected the service on 14 July 2015 we found there were breaches of regulation and improvements were required to ensure incidents of a safeguarding nature were handled appropriately, people received care and support from adequate numbers of experienced staff and that staff recruitment practices were safe. There were also improvements needed in relation to the way the registered provider monitored and assessed the service to identify and act on any improvements needed. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan and told us they would make the improvements.

During this comprehensive inspection we looked at whether the provider now met the legal requirements in relation to breaches of regulation we had found. We found that although some improvements had been made there were further improvements needed. We also found the service had deteriorated in other areas.

The service did not have a registered manager in place at the time of our inspection. 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 was a manager in post and they had submitted an application to register with us.

Although people felt safe in the service, people were not always protected from unauthorised restraint and information of concern was not always being acted on or shared with the local authority. Risks in relation to people’s care were not always planned for appropriately to ensure people received safe care and support. Safe recruitment practices were not always followed and medicines were not managed safely. People were supported by enough staff to ensure they received care and support when they needed it.

People were not supported to eat and drink enough. People were supported to make decisions but there was a lack of understanding of supporting people who lacked the capacity to make certain decisions. People were supported by staff who had received training and supervision. Staff were responding to people’s daily health needs.

There was a lack of consistency in people’s needs being recognised and responded to by staff and in how privacy and dignity was respected. People were supported to make choices about how they spent their day.

People did not have their care and support planned for appropriately and this led to people receiving inconsistent care which was not always safe. People knew how to raise concerns and complaints were responded to appropriately. People were involved in giving their views on how the service was run and felt the management team were approachable.

There was a lack of appropriate governance and risk management framework and this resulted in us finding multiple breaches in regulation and negative outcomes for some people who used the service. You can see what action we told the provider to take at the back of the full version of the report.

A relative told us, 'Staff ask my relative for consent; they don't just do things or tell my relative to do things.'

One person who used the service told us, 'I'm very happy here. My family and I made the right choice.'

We saw that people's care plans contained detailed information about themselves and their preferences. We saw that care plans and risk assessments had been reviewed on a regular basis and information had been updated following reviews.

An external health care professional told us, 'I've seen a steady improvement.'

One person who used the service told us, 'I feel safe here; I've got no worries.'

All of the staff we spoke with were able to tell us the procedures in place to make a safeguarding referral. They told us they would report concerns to the manager and felt their concerns would be dealt with appropriately.

One relative told us, 'If I had a complaint I'd raise it with the manager but I've not had to yet. I haven't attended any relatives meetings yet but the manager is always available.'

We noted that meetings had been held regularly with staff and people who used the service. We looked at minutes for meetings and saw that action had been taken to address issues raised at meetings.

We looked at surveys completed by people who used the service, their relatives and health care professionals. The responses were mostly positive.

We saw that audits and risk assessments had been completed appropriately on a monthly basis and actions identified for completion.

We looked at the service's contract of residency, the service user guide and statement of purpose. The documents provided relevant and appropriate information.

We found that care plans were not detailed for each person's individual likes and dislikes which meant staff may not have sufficient information to provide care to people using information from their care plans.

Staff offered a choice of meals to people and asked them what drinks they preferred with their meals. Staff were busy throughout the lunch period. Staff members mostly responded to people's requests in a timely manner.

One person, who uses the service, told us, 'The home is clean.' One staff member said, 'The home is generally clean but I don't think the cleaners are on duty long enough.'

One staff member said, 'I feel rushed to get jobs done,' and the second staff member said, 'I have more time to be with people in the afternoons.'

We saw that the acting manager was completing audits on a variety of areas. We saw that visual inspections of the home were regularly carried out.

Two relatives of people using the service were both aware of the complaints system.

We looked at care plan records for people using the service. We saw inconsistent records in all the care plans relating to people's choices in their care and treatment and the information they were provided about the services they used.