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Inspection carried out on 25 September 2018

During a routine inspection

The inspection took place on 25 September 2018 and was unannounced. This meant that the service did not know we were coming. The last inspection took place on 18 and 19 April 2017, when it was rated as requires improvement in the areas of safe and well led and rated good in effective, caring and responsive. This meant that the overall rating was requires improvement. We identified breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. This was because we had concerns about the management of medicines.

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe and well led to at least good. During this inspection, we found the service was meeting the requirements of the current legislation.

Lostock Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lostock Lodge accommodates up to 32 people in one adapted building. It provides accommodation for persons who require personal care for people living with a dementia and older people. At the time of our inspection 24 people were in receipt of care at the home. All bedrooms were of single occupancy and all but four were located on the ground floor level. Corridors were large and accessible for wheelchair users and level access to the outside gardens was available.

The service had a registered manager in post 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 was run.

People told us they felt safe in the home. Staff we spoke with understood the procedure to take when dealing with any allegations of abuse. Systems were in place to guide staff about acting on abuse allegations.

Improvements were noted in the management of medicines. We saw medicines administered safely during our inspection.

Individual and environmental risk assessments had been completed that provided staff with guidance about how to protect people from risks. Infection control procedures were in place and we observed staff using personal protective equipment during our inspection.

All feedback that we received about the staff was that they had the knowledge and skills to deliver effective care and that relevant training was provided. People had access to health professionals when they required it. Safe recruitment practices were embedded in the home.

Staff understood the principles of the Mental Capacity Act (MCA) and relevant Deprivation of Liberty Safeguards (DoLS) applications had been completed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Details about advocacy services were on display that would support people to make important decisions.

The home had been adapted to ensure it met people’s individual needs. There was an ongoing refurbishment plan. We saw improvements to the environment and décor of the home was taking place.

People were happy with the care they received and staff were seen treating people with dignity and respect. Care people received was delivered in the privacy of their own bedrooms and bathrooms. Care files contained information to guide staff on how to meet people’s individual care needs. Information about how to support people at the end of their life needs was in place.

An activities programme had been developed and we saw people taking part in activities during our inspection.

A complaints procedure was in place and details about how to complain was on display in the public areas of the home. Positive feedback about the home was recorded. The home had completed surveys to obtain the views of people who used the service and the staff team.

Audits were seen that demonstrated the home was monitored and safe for people to live in. We received positive feedback consistently about the leadership and management of the home.

Inspection carried out on 18 April 2017

During a routine inspection

At our inspection on 24 October 2016 we found several breaches of legal requirements. The systems for the management of medicines were not safe and did not protect people using the service and there was a lack of planning and assessment of nutritional and hydration requirements of people.

There were issues with staff training. It was not up to date and the system for the administration of staffing levels was not effective. There were also concerns around cleanliness in the home and staff treating residents with appropriate respect.

In addition, people’s mental capacity had not been assessed in line with the Mental Capacity Act 2005 (MCA) when dealing with applications to restrict people’s liberty and there was a lack of understanding around the implications of this legislation.

We asked the provider to make improvements in all of these areas and they kept CQC informed of the changes that had been made.

At this inspection we found that significant improvements had been made in these areas. We found that people were treated with dignity and respect and the home was clean and tidy. The provider was acting in accordance with the MCA, proper assessments were being made around food and hydration and action had been taken to support people with sufficient numbers of well-trained staff. However, we still had concerns about the management of medicines and this has resulted in a continuing breach of legal requirements. You can see what action we told the provider to take at the back of the full version of the report.

Lostock Lodge is a care home located near Preston in the county of Lancashire. The home is registered to provide accommodation and support for up to 32 people and cares for elderly people including those living with dementia. At the time of our inspection 28 people were using the service.

There was a registered manager in place who had been registered since 14 December 2010. 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.

People using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The manager and provider conducted regular checks to make sure people were receiving appropriate care and support. The provider took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the manager.

Inspection carried out on 24 October 2016

During a routine inspection

We inspected Lostock Lodge on 24 October 2016.

The last full inspection took place on 8 May 2014, when we found the service was meeting the regulations we looked at.

Lostock Lodge is registered to provide personal care and accommodation for up to 32 older people and older people living with dementia. Accommodation is mainly on the ground floor and there is a passenger lift to the first floor accommodation. All the bedrooms are single occupancy with en-suite toilets. There is one lounge, one dining room, one lounge/diner and a conservatory.

There was a registered manager in post. 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.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found, generally, staff were being recruited safely, however, there were no duty rotas in place to show which members of staff were on duty or in what capacity they were working. The registered manager was not using any formalised tool to calculate how many staff were needed, based on the dependencies of people using the service. This meant we could not assure ourselves there were always enough staff on duty to met people’s needs.

People who used the service told us they liked the staff and found them kind and caring. We saw staff were kind and patient with people, however, we saw some practices which showed a lack of respect and overall concluded staff required additional training to ensure they supported people in a person centred way.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS), however, we felt staff required further training in relation to these safeguards and the Mental Capacity Act.

People told us they liked the meals, however, we found risk assessments and care plans did not identify what action needed to be taken in order to mitigate risks to people who were losing weight. People told us the meals were good, however, we felt people were not always aware of the choices on offer and had no control over the portion size of their meals.

People’s healthcare needs were being met, however, we found medicines were not being administered and managed safely.

There were some activities on offer and an annual trip out was organised.

There was a complaints procedure in place and people we spoke with told us if they had any concerns they would tell a member of staff.

We found checks being made on the overall operation and quality of the service were poor and did not identify areas which required improvement. Residents meetings had been held and showed people were being asked for their views, however, it was not always clear what action had been taken in response.

Inspection carried out on 8 May 2014

During a routine inspection

We considered the evidence we had gathered under the outcomes we inspected. We spoke with eight people using the service, one visitor, looked at care records of three people in detail and a selection of other records in relation to other people's care. We also spoke to six staff on duty and the manager who was registered with the Care Quality Commission.

This is a summary of what we found:

Is the service safe?

Before people were admitted to the home arrangements were in place to make sure they would be safe in the environment and there was enough skilled and qualified staff to meet their needs.

We found people had been given a contract of residence outlining the terms and conditions of residency for protecting their legal rights.

People told us they were treated with respect and dignity by the staff. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff had been made aware of who may be at risk of falling, developing pressure ulcers or may not eat enough and they had a plan of care to deal with this.

People using the service could be confident that when their care, treatment and support was to be provided by more than one service, team, individual or agency, the provider worked in co-operation with others for their benefit.

People’s care and treatment was planned and delivered in a way to protect them from any unlawful discrimination within the home and wider community. People irrespective of their physical or mental health needs had opportunities to continue to practice their faith, vote in elections and access community health and social facilities. There were no institutional practices observed.

Care had been taken to employ people who had proven good character records. Staff were trained in emergency procedures such as fire and first aid. Staff had all received training in the safe moving and handling of people. There was sufficient staff on duty at all times and we found people were not left unattended or unsupervised.

The manager and staff had been trained and understood their obligation to apply the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

Systems were in place to make sure the provider and manager continually checked the service was safe. Health and safety checks were carried out at regular intervals and all essential services such as fire, gas electric and water were certified as being safe.

Is the service caring?

People told us they were happy with the care they received and the staff team. Comments included, "The staff are wonderful people. You can sense they care for you. They will always let you know they are there and before they go off duty they say goodnight and God bless.” “Staff help us along the way, and with their support we have a very good life.” “I’ve been here a while now. I wouldn’t want to be anywhere else. I’m happy knowing from now on, I’m not alone tonight. That makes me feel good.” And, “There are some very special people here looking after us. They care with a smile and nothing is too much trouble.”

We observed staff were considerate, respectful of people's wishes, and delivered care and support in a way that maintained people’s dignity and promoted their independence. Staff showed an understanding of what people wanted when they had difficulty in expressing themselves.

Staff worked to care plans that were person centred. They were well written and sufficiently detailed on how best to meet individual needs with reference to dignity, choice, individuality and respect. ‘This is me’ (Alzheimer’s Society Publication) was used for people with dementia to support them receive care tailored to their needs and requirements.

Surveys carried out showed people considered the service they received was very good.

Is the service responsive?

People were given opportunities to say what they wanted with regards to their care and lifestyle. This helped to support people achieve their aims. People’s assessment of needs and care plans were reviewed regularly and professional help and support was sought from health and social care professionals when needed.

Quality assurance was carried out regularly with regard to the operation of the home. This covered the environment, care and welfare of people, and staffing issues. The level of auditing was good and guidance was followed such as health and safety in the work place, fire regulations and control of hazardous substances. Staffing levels had been increased in response to people’s needs.

People using the service and their relatives had completed a satisfaction survey. Meetings were held and people could say what they wanted and they said they felt listened to. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

Is the service effective?

People told us they discussed their care. They had their own preferred routines, likes and dislikes staff knew about. People commented, “I couldn’t handle anything that was institutional. We are our own person here and do what we want.” “I don’t have to worry about anything here at all. The staff are very pleasant. If you ring for them they come. I think they treat us very well.” “I’ve been here a while now. I wouldn’t want to be anywhere else. I ’m happy knowing from now on, I’m not alone tonight. That makes me feel good.”

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. The service had good links with other health care professionals that helped towards people receiving prompt, co-ordinated and effective care.

People told us they were consulted with and listened to. Staff worked to a key worker system to oversee people’s care. Staff had been trained in dealing with health conditions people presented linked to diabetes, end of life care and dementia. There were no institutional practices imposed on people and staff were flexible in their work to accommodate individual needs and preferences.

Is the service well led?

The service had a registered manager responsible for the day to day management of the home. Staff were clear about their responsibilities and duty of care and were able to raise their views and concerns. Meetings were held and these showed people were kept up to date with all aspects of the running of the home including best practice issues and quality monitoring.

People told us the management of the service was very good. They said, “The manager always talks to us and asks us how we are. I tell her all the time I’ve no complaints. I admire her from her toes to the top of her head. We get everything we need provided and I mean provided with a smile. Nothing is too much trouble for anyone”.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. We saw evidence the service knew when to consult with health and social care professionals when required. This meant any decision to be made about people’s care and support was made by the appropriate staff at the appropriate level.

The service had Investors In People (IIP). This is an external accredited award for providers who strive for excellence, recognises achievement and values people.

Inspection carried out on 16 May 2013

During a routine inspection

People told us they were very happy and cared for very well by the staff. “I would recommend this place 100%. We get well looked after”. “God is good. I’ve come here to be helped and everyone is so very nice”.

People who lacked capacity to make the best choices, or access the right care had their interests protected by a named person, for example a family member.

People had care plans that promoted a person centred approach to their care. Some people could not express their needs easily. Staff appeared to understand what people wanted. They were attentive to peoples request for assistance.

Staff knew how to care for people at risk of falling, developing pressure ulcers or may not eat enough.

People told us they were satisfied with the catering arrangements. “I’m not too fussy. I like everything really. We get good puddings. I like rice pudding that’s one of my favourites”. “No complaints”. “

Equipment people used was kept in good working order.

People who use the service benefit from staff that were well trained and had been subject to the necessary character checks to ensure they were fit, trustworthy, qualified and physically and mentally fit to do their job.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

Inspection carried out on 23 November 2012

During an inspection to make sure that the improvements required had been made

We found compliance was achieved in ensuring people were respected and involved in determining the service they wanted and needed.

People received the level and quality of person-centred support they required to meet their individual needs. Their physical, social and health care was promoted.

We found that staff spoke to people respectfully, communicated well and appropriately. We also found improvements had been made with particular attention to the management of known risk. People who may be at risk of pressure ulcers, falls, or may not eat enough were identified properly and their health and well being was protected.

We found medication was managed in a safe way.

People lived in a pleasant well maintained environment that was found to be very clean and hygienic. We found the use of communal rooms had changed to make a more pleasant and congenial atmosphere in the home.

We found there was evidence of a continuous improvement strategy in place. A new manager had been appointed and there were significant improvements in all essential standards of quality and safety in relation to the running of the home, the environment, staffing, service users’ welfare, and management. As a result the provider was compliant in all outcomes we reviewed.

Inspection carried out on 10 May 2012

During an inspection to make sure that the improvements required had been made

One person told us they were staying at the home until they were well enough to make proper arrangements for their future. They said, “I’m not sure about the future plans. I have to get well enough first, but hope to move on from here.” They told us they had discussed the type of support they needed when they were admitted. They could not stand up and needed carers to help them attend to their personal care. They said, “It’s been all right. The male carers are very good and will chat to me. Sometimes the night staff will bring me a taste of their supper, one night I had some pizza and another night I had a plate of chips. It was good.”

People who could express themselves told us that staff attended to their needs. They said, “I’m very well cared for, I love it here, the staff are very good”. “It’s really good. I tend to chat a lot and have lived here for years. I wouldn’t move, I do most things myself”. And “I need two carers so I tend to get left a bit. I do have breakfast in bed though when staff haven’t the time to get me up straight away. Overall the staff are quite good”.

People told us they had activities they could join in. One person told us she liked to go out. Another person told us staff did not always have the time to help them join in, but had enjoyed the singing.

One person told us, whilst staff are in general good, they didn’t like it “when they (staff) spend time texting on their mobile when they are supposed to be helping you”. Most people said staff generally were polite, caring and friendly. One person named individual staff they described as “kind, polite, and gentle” and one carer in particular was “excellent very gentle”, and when they are on duty they are “happy”. We were also told that some staff are “grumpy” and attributed this to being “tired”.

People in general said their accommodation was all right. One person told us she liked the home, it was not far from the town centre. She could get out and about. Another person told us “It is not as clean as it should be, and there seems to be a shortage of sheets. They can’t always make my bed till later in the day”.

One person we had spoken to during the visit told us, “Peter, (Nominated Individual of Lostock Lodge Ltd) is on the ball checking things. He wants to know I’m all right. I wouldn’t tell him everything, I suppose I should though. I don’t want anyone getting into trouble”.

Inspection carried out on 13 February 2012

During an inspection to make sure that the improvements required had been made

People generally thought the staff were all right. One person told us, It’s all right, you know you have to stay, so you do what you have to”. Another person told us some of the staff are all right, but some are not. The male carers were very good; they were, “Thoughtful”, and “respectful”.

We spoke to two people who had been out to a day centre. They told us they had a good time. The staff in the home were very good.

People living in the home thought most of the staff treated them well. They were not expected to follow strict regimes. They liked their bedrooms and their home.

Inspection carried out on 4 August 2011

During an inspection to make sure that the improvements required had been made

Generally people were involved in their admission to the home. They had discussed the care they needed and were given an assurance they would be cared for as they required. One person told us his daughter had chosen the home for him as it was near her house and it was easier for her to visit. He said he had discussed his care. He said the staff are very friendly and will visit him in his room.

Relatives of people accommodated in the dementia unit told us although they were not formally involved in planning their relations care; most considered staff were very good at telling them if there are any changes they needed to know.

People living in the home considered staff to be generally very good. They commented “The staff are very good. They always ask if I have everything I need”. Relatives generally thought that some of their relations needs were met and found the staff to be very friendly and helpful when they visited. They said for example, “She is cared for very well and is quite happy. She would say herself if there were any issues. She has an en suite room and one morning I visited, she was having breakfast on the patio.” And, “I spent about an hour and a half there and had a cup of tea. People appeared to be happy, quiet and content.”

Some thought their relatives privacy and dignity was not as it should be and considered attention to personal hygiene could be improved. They also thought more attention to looking after their relatives’ clothes was needed as people were not always dressed appropriately and sometimes wore other peoples’ clothes.

Relatives also thought that more staff was required in the dementia unit as their relations care was not always satisfactory and their safety and welfare compromised. Comments were made, such as “There never seems enough staff. The last time I visited there was no staff around to supervise people for a while. Anything could have happened. People can fall or slip.” And, “They can’t go out, and she likes to get out and walk, but they can’t do that with every one. It’s not the staffs fault; they are very pleasant with her.”

We found peoples' ability to open their doors independently in the dementia unit was not assessed and measures put in place to support them. This meant people who lacked capacity to make an informed choice regarding keeping their rooms locked, had their right to privacy, autonomy and safety compromised. People were not always provided with clean bedding when they required it or had their rooms cleaned adequately to maintain their dignity.

Inspection carried out on 10 December 2010 and 9 January 2011

During a routine inspection

We spoke to some people living at Lostock Lodge and a relative visiting. They told us their experience of coming to stay in the home and why they had chosen to live there. People could not remember if they had discussed in detail arrangements for their care, but considered staff knew what they liked.

Several people said staff were very good and helpful and said they came when asked to help them at all times. When asked about staff attending to their needs at night, one person said “I just press my alarm and they come straight away”. People reported that if they were unwell their doctor would visit. The manager would arrange this if they asked.

People were generally happy with the food. Although they were not always aware of the day’s menu, or had a choice at lunch commented, “They seem to know what I don’t like. They always give me something else”. And “we never go hungry” and “I enjoy my meals”. A relative commented on staff giving his wife the supervision she needed.

The home was considered to be very clean. People said they had regular cleaners who cleaned their rooms and care staff did their laundry. They were satisfied with their accommodation and said the en-suite facilities gave them a degree of privacy.

People described staff as “helpful”, “nice girls” and “can’t fault them”. One person thought some were better than others, but had confidence in staff who had worked in the home for a long time.

A relative visiting said staff kept him up to date with any changes in his wife’s needs. He said he had no complaints about the service. He said he was not aware of the procedure but would raise any issue with the manager if it was necessary. People we spoke to were unsure of the procedure, but said they had no complaints.

Reports under our old system of regulation (including those from before CQC was created)