Syston Lodge Residential Home

Syston Lodge is a residential care home without nursing providing personal care and accommodation to 22 people at the time of the inspection. The service can support up to 25 people.

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

Quality monitoring and oversight was not fully effective at identifying and addressing shortfalls in areas around care planning, care records and risk assessments.

Improvements were needed to care records as these did not always provide the information and guidance staff needed to ensure people received consistent, effective support and intervention. Information in care records was not consistently recorded to fully demonstrate how people's needs were being met. Most staff had worked at the service for a long time and knew people well, which reduced the risk of immediate harm for people.

People felt safe living at Syston Lodge and staff understood their responsibilities in safeguarding people from the risk of abuse. People's medicines were managed safely and staff followed safe working practices to protect people from the risk of infections. There were sufficient numbers of skilled staff deployed to meet people's needs and keep them safe.

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, relatives and staff were able to share their views and feedback was used to make improvements to the service. Staff had a clear understanding of their roles and responsibilities and felt supported by the registered manager. The registered manager was committed to ensuring people achieved positive outcomes as a result of their care and support.

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 06 July 2018).

Why we inspected

We received concerns in relation to the management of medicines and a serious injury. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Syston Lodge Residential Home on our website at www.cqc.org.uk

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Syston Lodge Residential Home ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the home. This included comprehensive checks for visitors and staff on arrival to the home.

Syston Lodge Residential Home felt well supported by their GP practice who visited the home regularly.

Syston Lodge Residential Home supported people who lived there to remain connected with friends and relatives through visits, video calls, phone calls and letters. They also used an application that allowed friends and relatives to upload messages that could then be forwarded to people living at the home.

Syston Lodge Residential Home used electronic systems to transfer information between groups of staff to reduce the amount of staff present at handovers.

At our last inspection in March 2017, this service was rated overall as requires improvement. At this inspection, improvements had been made and sustained and the service is rated overall good. The inspection took place on the 15 May 2018 and was unannounced.

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.

People received care from staff that knew them and were kind, compassionate and respectful. The staff were friendly, caring and passionate about the care they delivered.

Detailed care plans were in place, which enabled staff to provide consistent care and support in line with people’s personal preferences and choices. End of life wishes were discussed and plans put in place.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

Staff were appropriately recruited and there were sufficient staff to meet people’s needs; staffing levels were kept under review. People were protected from the risk of harm and received their prescribed medicines safely. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

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 home supported this practice. There was a variety of activities available for people to participate in if they wished to and family and friends were welcomed at any time.

Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day-to-day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

Staff had access to the support, supervision and training they required to work effectively in their roles. Development of staff knowledge and skills was encouraged.

The service had a positive ethos and an open culture. The provider was committed to develop the service and looked at ways to improve the service. However, the systems in place to monitor quality and health and safety needed to be strengthened to ensure that shortfalls in the environment were identified and appropriate timely action taken.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.

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 had not had a registered manager working at the service since November 2015. The manager had been overseeing the management of the service since November 2015 and was in the process of applying to become the registered manager of the service.

At our previous comprehensive inspection of the service on 12 January 2016 two breaches of legal requirements were found. After the inspection, the provider sent us an action plan detailing what they would do to meet legal requirements in relation to these breaches. This was to ensure that risks associated with people’s health, safety and welfare were appropriately assessed, premises and equipment were safe and properly maintained and that the provider acted on feedback. These actions had all been completed.

People were protected from the risk of avoidable harm or abuse because staff could identify the potential signs of abuse and knew how to report and escalate any concerns. Risks to people’s safety were assessed and control measures put in place to reduce them. Accidents and incidents were recorded but there was a risk that people’s injuries could deteriorate and staff would fail to notice as the records did not support the ongoing monitoring of them. Medicines were stored appropriately however the recording of medicines did not always evidence best practice.

There were enough staff to keep people safe. Staff felt supported, received an induction, regular supervision and an annual appraisal to support and develop their practice. Staff understood their roles and responsibilities. Staff received training to enable them to meet people's needs. Training was not always renewed to ensure that staff knowledge was up to date with best practice.

People were supported to have 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. People’s day to day health needs were met and people had access to external healthcare professionals when they needed them.

People told us that the staff were kind. Staff members knew people well and were able to tell us about their likes and dislikes. Staff did not always respond to people in a kind and considerate way. Relatives were able to visit their family members without unnecessary restriction. There was information on display at the service in relation to external support groups that were available and about advocacy and people’s rights.

Planned activities took place at times throughout the week. Activities were not always specific to people’s individual preferences and aimed more at group sessions for people to enjoy.

People contributed to an assessment of their needs. People's care records were reviewed but people were not involved in the review process. People who used the service knew how to and felt able to raise any concerns. Relatives did not always feel able to openly to raise their concerns.

Audits throughout the service were carried out and where any concerns were identified they were addressed. Quality assurance surveys were in place. However no action plan was developed from people's feedback to show what actions were going to be taken as a result.

Syston Lodge Residential Home is a purpose built home situated in Syston. It provides accommodation for up to 25 people spread over two floors. There is a passenger lift and stairs to access the upper floor. At the time of our inspection there were 19 people using the service.

There is a registered manager at the service, however at the time of our inspection they were not at work. 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 provider had arranged for a manager from their other service to oversee the day to day management of Syston Lodge Residential Home in the registered managers absence.

People at the service felt safe. They were supported by staff that understood their responsibilities to identify and report any signs of abuse using the provider’s safeguarding procedures. People’s safety was supported by the provider’s recruitment practices. Relevant checks had been carried out on staff before they started work.

Staff were aware of risks associated with people’s care and support, although these had not always been updated in people's plans of care. Accidents and incidents were recorded but on one occasion we found that there had been a delay in a person seeking further medical attention following a fall.

People were supported by staff with the right training and support to meet their needs. However staff did not have a consistent understanding of people's dietary needs. The provider could not assure themselves that people that required a fortified diet were always being provided with one. People were provided with a choice of meals. People were offered regular drinks and snacks throughout the day.

Staff obtained people's consent prior to assisting them with any care and support. The management team were aware of their roles and responsibilities under the Mental Capacity Act 2005.

Staff treated people with dignity and respect. People were able to spend their time the way they wanted and their choices were respected. People were able to spend private time alone or with other people in communal areas of the service. Staff were caring and attentive to people's needs.

People contributed to an assessment of their needs, Care plans contained information about people’s likes, dislikes and preferences and things that were important to them such as their religion.

People were supported to pursue their interests and hobbies. Arrangements had been made so that people could continue to observe their faith.

People did not feel confident about raising their concerns about the service. The provider had a complaints policy available to people.

Staff at the service shared the same vision and values which was consistent with the services statement of purpose. Staff felt well supported and enjoyed their work.

Premises and equipment were not adequately maintained to ensure people’s health, wellbeing and safety was protected.

The provider had quality assurance and governance systems in place but these were not effectively monitoring the quality and safety of the service. The concerns relating to the general environment had not been identified by audits that were in place. Areas relating to the building and premises continued to present a risk to people that used the service.

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

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and were treated with respect and dignity by the staff. There were sufficient staff to meet people's needs. Staff had regular supervision and annual appraisals were being completed. Staff had received mandatory training. This meant that staff had the right knowledge to meet people's individual needs.

No person in the home was subject to Deprivation of Liberty Safeguards (2007). We saw no restrictions on people's liberty. Specific training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been provided for staff. The Mental Capacity Act and Deprivation of Liberty Safeguards is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive.

Improvements were needed in ensuring people were protected against the risks associated with waste disposal and in the maintenance of some bathroom areas.

Is the service effective?

All people we spoke to told us the care and support provided was good and they got on well with staff. They said staff were helpful and listened to them. One person told us, 'They are really good ' you can't fault it'. Another said, 'They all do their best for us'.

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person's care. This helped staff provide care and support according to the person's needs and choices.

Is the service caring?

All the people we spoke with understood the care choices available to them and told us staff supported them in making their choices. They were all positive about the staff and how their care was provided. One person told us, 'We can choose what we want to do'. This meant that people were encouraged to make their own decisions about their daily life.

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this. This helped to make sure people felt listened to and their needs were met.

Is the service responsive?

People had regular opportunities to do things they enjoyed. A range of activities was provided for people who used the service. People told us they enjoyed these activities.

Information on how to make a complaint was available in the home and in the information pack given to people who used the service and their representatives. There had been no recent complaints.

Is the service well-led?

The service had a quality assurance system in place. We found that a range of internal audits were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service was identified and followed up.

People who used the service were asked for their views about the quality of care and support being provided. This meant that the care and service provided was informed by the comments made by people who used the service.

We also spoke with a relative that was visiting, they said 'I think the home is wonderful, the staff are nice and very helpful.'

People felt their food and meals were good, and they had a good choice.

We looked at the medication system and found that this was operated efficiently and medicines were stored appropriately.

We found care plans and risk assessments were reviewed regularly. Other information included in the files covered people's nutritional needs and information that could be used in an emergency.

We noted that a repair to a broken window and some information on control of substances hazardous to health (COSHH) were needed to ensure people's safety in the home.

We also noted that further guidance could be given to staff about the temperature storage for medicines.

Our inspection of 4 September 2012 found that there was poor medication administration, which meant that the arrangements were not sufficiently robust to keep people safe. We also found that there were poor arrangements around locks on doors to promote privacy and dignity; there were also some bedrooms which did not have appropriate door closers.

We received a comprehensive action plan on 3 January 2013 and further more detailed information the following day. We reviewed the action plan and additional evidence, which explained how the staff are going are going to improve areas we highlighted to ensure compliance.

We looked at the quality assurance questionnaires that were put out in January 2012. People were asked to comment if they were satisfied with the services provided in the home and could add comments or return these anonymously if they wished. We looked at the feedback compiled from the 16 returned forms. We noted comments such as 'too much sausages'; 'waiting too long at tables'; and 'in the summer we could have a coach trip'. We saw other types of quality assurance that was used in to ensure peoples safety in the home.

We saw that staff were receiving training on a regular basis, and that they used a number of documents to ensure people's care was appropriate and safe.

We looked at the medication system and noted errors in two records where staff had given people less medication than they were prescribed.

We looked around the home and noticed some issues with door locks and asked the fire authority to follow these issues up.