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Inspection carried out on 25 February 2019

During a routine inspection

About the service:

Lapal House and Lodge is registered to provide accommodation for up to 41 older people who require personal care. The home is located in the Halesowen area of Birmingham, West Midlands.

Rating at last inspection:

Our last inspection of Lapal House and Lodge was in September 2015. The overall rating at that inspection was ‘Good’, with no regulatory breaches identified.

People’s experience of using this service at this inspection:

We carried out this comprehensive inspection on 25 February 2019. At the time of the inspection there were 37 people living at the home. We found the service had retained its overall ‘Good’ rating. Due to this, the report is written in a shorter format because we found people had continued to receive a good level of care and support since our last comprehensive inspection.

People said they felt safe living at the service, with staff demonstrating a good understanding about how to protect people from the risk of harm.

Staff were recruited safely, with appropriate checks carried out to ensure there were no risks presented to people using the service.

There were enough staff to care for people safely and we saw people’s needs being responded to promptly.

Accidents and incidents were closely monitored, with regular trends analysis carried out to ensure any re-occurring themes could be identified in a timely way.

People’s mental capacity was kept under review and deprivation of liberty safeguards (DoLS) applications were submitted to the local authority as required, although some of these were still awaiting further assessment from the council.

Staff received the necessary training and support to help them in their roles. Staff supervisions and appraisals were carried out and gave staff the opportunity to discuss their work.

People told us they liked the food available and we saw staff supporting people at meal times, if this was something they needed help with. Where people needed modified diets, due to having swallowing difficulties, these were provided.

People living at the home and visiting relatives made positive comments about the care provided at the home. The feedback we received from people we spoke with was that staff were kind and caring towards people.

People said they felt treated with dignity and respect and that staff promoted their independence as required.

Complaints were handled appropriately. Compliments were also maintained about the quality of service provided.

There were a range of activities available for people to participate in, both in and out of the service. Trips out often took place for people to participate in if they wished.

We received positive feedback from everybody we spoke with about management and leadership within the home. Staff said they felt supported and could approach the home manager with any concerns they had about their work.

More information is in detailed findings below.

Why we inspected:

This inspection was carried out to check people who lived at Lapal House and Lodge were still receiving a ‘Good’ level of care and support and to check that regulatory requirements were still being met.

Follow up:

We will continue to monitor information and intelligence we receive about the home to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for ‘Good’ rated services. However, if any further information of concern is received, we may inspect sooner.

Inspection carried out on 17 September 2015

During a routine inspection

This inspection took place on 17 September 2015 and was unannounced. The provider provides personal care in a residential setting for up to 41people who may have dementia and or physical disabilities. At our last inspection in November 2013 the provider was compliant with the regulations we assessed. On the day of our inspection there were 36 people living at the home.

There was a registered manager in post and she was present during 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 and associated Regulations about how the service is run.

People felt safe using the service and risks to their safety had been identified. People and their relatives had no concerns about their family member’s day to day safety. Staff knew how to support people safely and had training in how to recognise and report abuse.

Staff were recruited in a safe way. We found there were enough staff to support people and meet their needs in a personalised manner.

We found that staff did not follow the procedures for the safe administration of people’s medicines. Staff had signed records before people had taken their medicine and there were gaps in the medicine records. We also saw medicines were not dispensed for one person at a time to reduce the risk of mistakes being made.

People were involved in identifying their needs and preferences. Staff had support and training to ensure they had the skills to meet people’s needs.

Staff were aware of how to support people’s rights, seek their consent and respect their choices.

People told us they enjoyed the meals and we saw that risks to their dietary intake were known and staff supported them to eat and drink enough. People’s health was supported by access to appropriate external healthcare professionals.

People and their relatives were positive about the care provided. Our observations confirmed that staff were attentive and caring towards people. Staff knew people well and how best to support them. Staff respected people’s dignity, privacy and independence.

People knew how to make a complaint and were confident this would be listened to and acted upon.

People described the management of the home as friendly and approachable. Staff felt supported by the provider. The provider had carried out audits to identify and address issues with the quality of the service and had made improvements to ensure the safety of people.

Inspection carried out on 25 November 2013

During a routine inspection

When we visited Lapal House and Lodge we found that 37 people used the service and we met and spoke with eight of those people. We spoke with one relative, the registered manager, the deputy manager and four members of staff who delivered care. We looked at seven people's care records and six care staff records.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, "The staff are very good and caring, I like it here."

We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

We found that systems were in place to deal with complaints. The provider monitored the quality of the service and had made improvements where needed. One person told us, "It's really nice here, I see my relatives regularly and get to do what I want."

Inspection carried out on 17 September 2012

During a themed inspection looking at Dignity and Nutrition

We carried out a visit on 17 September 2012. People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an expert by experience that is a person who has experience of using services and who can provide that perspective.

There were 40 people living in the home when we visited and we talked with 10 of them about their experience of living there. We spoke with three visitors, six staff, the cook and the manager.

Some of the people that use the service had dementia and therefore not everyone was able to tell us about their care. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed and heard from people that staff respected their privacy and dignity. We saw staff knocked doors before entering. Systems were in place to ensure people had the choice of a key to their room, and that they had been asked how they wished their personal mail to be managed.

We found that staff offered people choices of which meal they would like and asked people where they would like to have their meal. We saw staff provided assistance and support with meals to people who needed it, although at times this was interrupted.

We saw people were encouraged to be as independent as possible by having utensils and cutlery to eat their meals with dignity.

People who lived in the home and their visitors told us the they were happy with the choice and quantity of the meals provided. People had the choice to entertain or celebrate with family or friends, in a private facility. A relative we spoke with told us ‘it’s excellent, we have regularly booked the table and had a full three course meal, in private’. This ensured people had the option of a ‘dining out’ experience.

We found staff understood people's needs, and had taken appropriate action to protect people who might be at risk of harm due to their age or health. People at risk of harm due to weight loss or dehydration had the assistance to eat and drink adequate amounts. We found that safeguarding concerns had been reported properly to protect people from the risk of abuse.

Staffing levels were appropriate to support people with their nutritional needs, although the deployment of staff could improve to provide better consistency for people during their meal.

We found people’s care records were detailed, accurate and up to date, providing staff with the information they needed to ensure they ate and drank sufficiently. However some personal information displayed on wardrobe doors, meant people's confidentiality was not always being fully considered and respected.

Inspection carried out on 16 May and 7 June 2011

During a routine inspection

We saw that people were asked about whether or not they wanted care and treatment. Staff respected their views, so helping to ensure their well being.

“I like it here, the people are nice.”

“I am happy here, we go on day trips about every three weeks. The staff are very good, it’s the best place I could be, staff would come if I needed to use call bell but I haven’t needed to.”

“It’s the best place there is, there couldn’t be any better, staff are very good.”

“The staff are very good. I get up in time for breakfast to be served. I don’t go to bed that early and stop up if watching something on TV. They look after us well, I can’t grumble at all. “

People were able to choose what they did each day, what time they get up and go to bed and what they eat and drink.

People can take part in a range of activities if they want to.

One person said, “I like it here, we go out in the minibus. The food is nice, we have a choice the day before, I don’t like chips but prefer mash, so I have this.”

Relatives told us, “We are very pleased with the home, our relative is well looked after.”

“Since my relative has been here they have been better. If they don’t like the food, staff find something else for them, can have three courses at lunchtime if they want. I think this is one of the nicest homes, it’s more like a hotel, it never smells.”

Most staff have received the training they need to keep people safe. We saw that some staff needed this and others needed to be updated in their knowledge so they could ensure that any incidents are reported appropriately.

The equipment that people need is safe and comfortable for people to use.

The staff that work there know how to support the people living there to meet their needs.

People told us: “Staff are marvellous, doesn’t matter what I ask them, they do it for me.”

“Staff are very good, all Florence Nightingales, I have a call bell which staff answer when I ring. I have my own phone so I can keep in touch with my friends.”

People know how to make a complaint and told us that their views are listened to.

Regular checks and monitoring is done to make sure that people are getting the support they need and where needed improvements are made.