About the service
St Lawrences Lodge is a residential care home providing personal care to 13 people aged 65 and over at the time of the inspection. The service is registered to support up to 20 people in one adapted building.
People’s experience of using this service and what we found
Health and safety checks were completed, some checks had not been reviewed in the required time frames and action had not always been taken in a timely manner when work needed to be undertaken. The provider's audit process was not sufficiently robust to ensure such checks were completed, therefore safety issues had been left unnoticed. Following our inspection the provider confirmed the required work would be completed.
Systems in place for staff recruitment were not sufficiently robust. Staff files did not all contain the necessary pre-employment checks to ensure fit and proper people were employed. There were sufficient staff to meet peoples’ needs. Staff knew people well, interactions were friendly, caring and unrushed.
People received their medicines as prescribed, but systems were either not in place or robust enough to demonstrate medicines were effectively managed.
Systems in place for the oversight, monitoring and improvement of the service were not sufficiently robust.
Risk management plans were in place to guide staff on the action to take to mitigate risks. Some records were not dated, lacked evidence of review and were not always updated as people’s needs changed. All care records were in the process of being reviewed and updated. We found plans that had been updated gave staff sufficient accurate detail to guide them on the care and support people needed.
Staff were aware of their responsibilities to safeguard people from abuse. Relatives we spoke with were confident their family members were kept safe. They said, “Of course [my relative] is safe. The staff are really kind” and “The staff are just as good with me as they are with [my relative].”
Risks to people who used the service and staff relating to infection prevention and control, and specifically Covid 19, had been assessed and appropriate action taken. The provider was promoting good infection control and hygiene practices. Staff had received additional training, including handwashing and use of personal protective equipment (PPE).
The service is required to have a registered manager in place. 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. The service did not have a registered manager.
Relatives and staff were positive about the home, the way it was run and the new manager. Relatives said, “There’s nothing I’d criticise. It’s a nice, warm, friendly home. It’s got a personal touch” and “Staff are really patient and have a good sense of humour. They are great at getting the residents to laugh. It doesn’t matter if people spill something, the carers tell them not to worry and will make them smile.”
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 26 March 2020).
We also undertook an Infection Prevention and Control inspection in November 2020. We were assured that this service met good infection prevention and control guidance. We did not rate the service at this inspection.
Why we inspected
The inspection was prompted in part due to concerns received about management of the service, medicines, infection control, accidents and incidents, risk management and training. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
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 governance, premises and equipment, medicines and staff recruitment at this inspection. The provider and manager were aware prior to our inspection of most of the concerns we found. They had in place an action plan for rectifying concerns. The provider had also agreed a voluntary suspension on admissions, to allow time to complete improvements required.
Please see the action we have told the provider to take at the end of this report.
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 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.