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North Lodge Care Home Requires improvement

Reports


Inspection carried out on 13 November 2019

During a routine inspection

About the service

North Lodge Care Home is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 21 people.

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

Risks to people were not always assessed to help ensure they were safely managed. 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. However, the registered manager had not always submitted applications where needed to deprive people of their liberty under the deprivation of liberty safeguards (DoLS). This meant some people’s freedoms were restricted without lawful authority.

Staff received support in their roles through an induction, training and supervision. However, improvement was required to ensure staff received refresher training in areas relevant to people’s needs, in line with the provider’s training requirements. Improvement was also required to ensure the provider’s quality assurance systems were robust in identifying issues and driving service improvements.

We have made a recommendation about using nationally recognised assessment tools when assessing people’s needs.

People told us they felt safe living at the home. They were protected from the risk of abuse because staff knew to follow the provider’s safeguarding and whistle blowing procedures, should the need to do so. There were enough staff working on each shift to meet people’s needs. The provider followed safe recruitment practices. Staff were aware of the action to take to reduce the risk of infection. They knew to report and record the details of any accidents or incidents which occurred at the home. The registered manager reviewed accident and incident information for learning and to reduce the risk of repeat occurrence.

Medicines were safely stored, administered and administration was accurately recorded. People had access to a range of healthcare services when needed and staff worked to ensure people received consistent and effective support when moving between different services. People were supported to maintain a balanced diet. The home had been adapted to meet people’s needs.

Staff treated people with kindness and compassion. People were involved in making decisions about the support they received. Staff treated people with dignity and respected their privacy. People had care plans in place which reflected their individual needs and preferences. They were supported to take part in activities which they enjoyed and to maintain the relationships that were important to them.

People and staff spoke positively about the working culture and management of the service. The registered manager sought people’s views on the service through regular meetings and an annual survey. They sought to make improvements based on people’s feedback. The provider had a complaints procedure in place and people told us they knew how to complain. The expressed confidence that any issues they raised would be addressed to their satisfaction.

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 good (published 13 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the failure to comprehensively assess and manage areas of risk to people and the failure to ensure lawful authorisation had been given to deprive people of their liberty under DoLS, where this was in their best interests.

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.

Inspection carried out on 18 April 2017

During a routine inspection

Care service description

North Lodge Care Home is a residential care home for 21 older people some of whom may be living with dementia. The service is a large, converted domestic property. Accommodation is arranged over two floors and there is a stair lift to assist people to get to the upper floor. The service has 21 single bedrooms. There were 20 people living at the service at the time of our inspection.

Rating at last inspection

At the last inspection, the service was rated Good.

Rating at this inspection

At this inspection we found the service remained Good.

Why the service is rated Good

The registered manager was leading the service and was supported by a deputy manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were kind and caring to people and treated them with dignity and respect at all times. Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. Complaints were investigated and responded to.

People had enough to do during the day, including taking part in activities they had enjoyed before moving into the service. Staff supported people to maintain relationships with their friends and family.

Assessments of people’s needs and any risks had been completed and care had been planned with people and their relatives to meet their needs and preferences and keep them safe.

Changes in people’s health were identified quickly and staff contacted people’s health care professionals for support. People’s medicines were managed safely and people received their medicines in the ways their healthcare professional had prescribed. People were offered a balanced diet and food they liked.

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

There were enough staff to provide the care and support people needed when they wanted it. Staff were recruited safely and Disclosure and Barring Service criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The management team had oversight of the service. Staff felt supported and were motivated by them. Staff shared the manager’s vision of a good quality service and told us they would be happy for their relatives to live at North Lodge Care Home. Records in respect of each person were accurate and complete.

Inspection carried out on 9 November 2014

During a routine inspection

North Lodge Care Home provides accommodation for up to 21 people who need support with their personal care. The service provides support for older people and people living with dementia. The service is a large, converted domestic property. Accommodation is arranged over two floors and there is a stair lift to assist people to get to the upper floor. The service has 21 single bedrooms. There were 20 people living at the service at the time of our inspection.

A registered manager was 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 and associated Regulations about how the service is run.

People were protected against the risks of abuse. Staff had completed training and knew who to inform if they found signs of possible abuse. The registered manager acted upon concerns raised by staff. The character and skills of new staff were checked to make sure they were suitable to work at the service. Action had been taken to protect people when staff did not perform their role to the required standard.

People received the care they needed, when they needed it, as there were enough staff on duty. Additional staff were deployed every day at busy times. Staff had time to spend with people, and people were not rushed. Staff worked as a team to keep people safe. Staff supported and encouraged people to remain independent and responded quickly when people were at risk.

Accidents and incidents were recorded and investigated. The registered manager looked for patterns and trends and took action to reduce risks to people. Falls at the service had reduced from 29 in May 2014 to 17 in June 2014 and continued to decrease because of the action the registered manager had taken.

People’s medicines were managed safely. Staff had the skills and knowledge they needed. The registered manager checked medicines monthly, to make sure people remained safe.

The service was clean and free from odours and people were protected from the risk of infection. The local district council environmental health department had awarded the service a 5 star rating for food hygiene and safety which means ‘excellent’.

Risks to people from the building and equipment had been identified and action had been taken to remove or reduce risks to keep people safe. Emergency plans and equipment were in place and staff had practiced using them.

Although most people were living with dementia staff made sure they were able to make decisions for themselves. People were offered choices in ways that they understood. People’s ability to make specific decisions had been assessed. When people could not make decisions staff made decisions in their best interests and involved people who knew the person well.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

Staff had learnt all the basic skills they needed to perform their role in the first three months they worked at the service. All staff member had a training plan and had completed basic and further training to meet people’s needs safely. Staff had obtained or were working towards relevant qualifications such as diplomas in Health and Social Care. Staff had the skills and knowledge to meet peoples’ dementia care needs. Staff were supported to undertake their role by the registered manager and deputy manager.

People had enough to eat and drink and were offered a healthy diet. Staff knew what, when and where people liked to eat and offered people a choice at each meal. People who were at risk of losing weight or needed to gain weight were offered high calorie food and drinks. Hot and cold drinks and snacks were available throughout the day and night.

People’s health needs were met. People’s doctors or community nurses were contacted quickly when people’s health changed. People had been referred to the local older person’s community mental health team for support with their dementia care needs. People and their families were involved in discussions about their health care.

People appeared relaxed in each other’s company and the company of staff. Staff showed an interest in what people said and gave them the information they wanted in a way they understood. Staff spoke to people respectfully.

People were helped to remain independent and were not rushed by staff. Staff offered people encouragement and reassurance. People who were anxious or upset were reassured and comforted by staff. People were offered choices in ways that they understood. Staff told people what they were going to do with them before they did it. People and their relatives had been asked about their needs, preferences, and interests. Staff knew people’s likes and dislikes and how they liked their care to be provided.

People were asked for their views about the service and were involved in planning activities and outings. People’s privacy and dignity was maintained and information about them was only shared to help them remain safe and well. People and their relatives were involved in planning the care they would like to receive at the end of their life.

People’s needs had been assessed and care was planned and delivered to meet their needs.

Guidance was provided to staff about how to provide care safely. Risks to people’s health had been identified and care was provided to keep them as healthy as possible. Records were kept of the care people received each day. Care plans were reviewed often and any necessary changes were made.

People were able to continue to take part in activities they enjoyed. An activities coordinator provided a programme of group and 1:1 activities, based upon what people wanted to do.

People and their relatives were able to make complaints about the service. They told us any concerns they had were resolved by the registered manager and they were happy with the action taken.

Staff aimed to provide high quality care to people in a homely environment. The quality of care provided was regularly reviewed and action was taken to correct any shortfalls found.

Staff were supported by the registered manager and the deputy manager. Staff knew their areas of responsibility and were accountable for their actions.

There was a culture of openness at the service. Regular staff meetings were held. Staff asked for advice and guidance when they needed it. Important events that affected people’s welfare, health and safety had been reported to the Care Quality Commission without delay, so that, were needed, we could take action.

Inspection carried out on 22 October 2013

During a routine inspection

We spoke with two people and one visitor during our visit. All were very complimentary of the service provided. The visitor stated that they wouldn't want their mum to live anywhere else. They said, 'Mum is a vegetarian and the home ensures she gets all she wants and a good variety'. One person said 'The staff always treat me with respect' and 'I get anything I ask for, it's very homely here'.

We spoke with two staff members and the manager who all showed good knowledge of their job role and of the people using the service. We observed staff supporting people as individuals and with patience and care. We observed a group activity being carried out, with good enthusiastic support from the staff. The staff also made sure they supported the people who chose not to participate in the activity. The homes activity co-ordinator worked alongside the care staff to ensure a calm but happy atmosphere.

We reviewed four out of 21 care plans at the home, and found that they all contained individualised risk assessments and corresponding plans of care, which meant that people could be supported in a way that met their needs. The care plans also showed evidence of people being assessed for their mental capacity to make choices showing the staff team were ensuring people's rights were being acknowledged and adhered to.

Inspection carried out on 7 December 2012

During a routine inspection

We spoke with four people and two relatives at the home, and they all said they were happy with the care they received. One person told us "staff look after me", and another person said "I like it here, the staff are very helpful". One relative told us that they had chosen this home after viewing several other homes, as they were so impressed with the care they observed.

We observed care being given to people at the home, and found that staff interacted positively with people, and encouraged them to participate in activities including singing and board games.

We reviewed four out of 21 care plans at the home, and found that they all contained individualised risk assessments and corresponding plans of care, which meant that people could be supported in a way that met their needs.

We spoke with two staff members and the manager, and they were all knowledgeable about their roles and the support needs of each of the people at the home. This meant that the staff and manager were able to provide safe and appropriate care and support for each person.

Inspection carried out on 4 January 2012

During an inspection in response to concerns

We spoke with some people at the home, and we used an observational framework tool to see the care that was given to people. We found that people engaged with staff at the home, and we noticed that some people joked and laughed with their carers in a relaxed manner. We noted that people at the home were comfortable, dressed appropriately and able to move freely about the home.

People told us that they liked the home, and one person told us that he enjoyed gardening and this was encouraged by staff at the home. He also told us that he �wouldn�t live anywhere else�. One other person told us that he enjoyed trips to the local area with staff, and that he thought the home �was a good place to live�.

Inspection carried out on 4 March 2011

During a routine inspection

Some people using the service were able to talk with us about their care. They told us that they were happy living in the home and that the staff treated them well and with respect. People said that they liked the staff that supported them and that they didn�t have to wait long for help when they needed it.

People told us that they enjoyed the activities in the home and said they could have visitors when they wanted. When we visited the home the people we spoke with knew what was for lunch and they told us that they had been given a choice of meals. We heard staff asking a person if they had enjoyed their meal and the person responded �very much, enjoyed dessert even better�.

We spoke with some visitors to the home and the feedback was positive about the care provided. One person commented that �we thought about moving mum nearer to us, but we were so happy with the care we�d rather make the journey�. The visitor also commented that �when I ring the staff always take the phone to her room�. Visitors told us that they were asked their views of the service regularly and were kept up to date about any changes to the service or their relatives� care.

People using the service told us that they had no complaints about their care, but that they were happy to talk to the manager or the staff if they were unhappy with any part of the service. They told us that they felt safe in the home. Visitors we spoke with told us that they were confident that their relative was safe and that the manager would contact them straight away if there were any problems.

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