Gibson's Lodge Limited

Gibson’s Lodge is a nursing home providing personal care and support to older people many of whom were living with dementia. There were 29 people living there at the time of the inspection. The service can support up to 53 people.

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

The provider had followed their action plan to monitor and improve the service given the concerns we identified at our last inspection. Systems to ensure the care people received was good enough were sufficient. We did not identify any concerns and people were happy with their care. This meant the registered manager had good oversight of the service. The registered manager understood their role and responsibilities and people and staff told us they were good at their job. At our last inspection we found many of the concerns were impacted by the turnover of managers and this had affected staff morale. At this inspection we found the registered manager had brought much needed stability. Staff felt well supported and enjoyed their jobs.

Risks of avoidable harm were reduced because the provider had improved their assessing and risk management processes. Risks such as entrapment in bed rails were reduced as checks were in place and staff received training. Medicines management had also improved and was now safe. When people required medicines to be hidden in their food this was done safely and in accordance with the law. The provider operated safe and effective recruitment practices to ensure staff working with vulnerable people were suitable. This included carrying out the necessary checks such as identification, criminal record checks, work history, right to work in the UK and health conditions.

The provider followed best practice in relation to infection control and prevention and management of risks relating to COVID-19. The provider carried out health and safety checks of the premises and equipment. Care plans in place were detailed and covered all areas of people’s individual needs and preferences. People were involved in their care planning.

Staff received regular and frequent supervision and appraisal to support them. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the provider’s policies and procedures supported this practice. The provider carried out decision-specific mental capacity assessments relating to areas including the use of bed rails. Staff understood and met people’s needs and preferences relating to eating and drinking. People received a choice of food which was served hot and in sufficient quantities. People’s day to day healthcare needs were met.

Staff supported people in a caring manner and knew the people they were caring for well. People told us they liked the staff and we observed staff were kind and responsive towards people and treated them with dignity and respect. People were encouraged to be involved in their care. Care was personalised to meet people’s needs and preferences. The provider could provide information to people in alternative formats to meet people’s communication needs if required. The provider investigated and responded to any concerns or complaints and people were encouraged to raise concerns.

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 requires improvement (28 May 2021, published 21 September 2021) and there were breaches of regulations relating to relation to people's safety, person-centred care, fit and proper persons employed, need for consent, staffing, and good governance. We served the provider with a warning notice in relation to staffing. We served the provider a notice of our decision to require a monthly action plan in relation to the breaches. At this inspection we found the provider had taken sufficient action and were no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating and breaches.

We also 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.

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

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Gibson’s Lodge is a nursing home providing personal care and support to older people many of whom were living with dementia. There were 27 people living there at the time of the inspection. The service can support up to 53 people.

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

The provider’s systems to ensure the care people received was good enough were inadequate with poor managerial oversight. Although there was a wide range of audits in place these were ineffective as they had not identified or resolved the many concerns we found. The provider had not followed their action plan to improve in relation to the requirements of the Mental Capacity Act (2005) and covert medicines as we identified the same concern again at this inspection. A registered manager was not in post. However, a new manager was in post who was registering with the CQC. The service had experienced a high turnover of managers and a relatively new operations manager was also in post. This had affected staff morale and staff felt unsupported. Staff understood their day to day responsibilities.

People were not always protected from the risk of avoidable harm. Risks were not always appropriately assessed and some risks to people were not assessed at all. We identified several people were at risk of entrapment in their beds as the provider had not identified and resolved these risks. We found continued failings in the use of covert medicines with a lack of checks that crushing certain medicines was safe. In addition, our checks of medicines showed people did not always receive their medicines as prescribed. The provider did not always operate safe and effective recruitment practices to ensure staff working with vulnerable people were suitable. The provider did not always check staff had the right to work in the UK and did not always obtain references in line with their recruitment policy.

The provider followed best practice in relation to infection control and prevention and management of risks relating to COVID-19. However, some people were at risk of infections from bed bumpers which were in poor condition and unable to be cleaned thoroughly. The provider had already ordered new bumpers at the time of our inspection. The provider carried out the expected health and safety checks of the premises, although these checks had not identified staff were not operating a fire door in the kitchen safely. Care plans were not always in place or robust. Some people’s care records lacked accurate, detailed, person-centred information.

Staff did not always receive regular and frequent supervision and appraisal to support them. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The provider had not carried out decision-specific mental capacity assessments relating to areas including the use of bed rails and covert medicines. Staff understood and met people’s needs and preferences relating to eating and drinking. People received a choice of food which was served hot and in sufficient quantities. People’s day to day healthcare needs were met although records were not always in place such as those relating to support people received to turn in bed to reduce the risk of pressure ulcers.

Staff supported people in a caring manner and knew the people they were caring for well. People told us they liked the staff and we observed staff were kind and responsive towards people and treated them with dignity and respect. People were encouraged to be involved in their care. Care was personalised to meet people’s needs and preferences, although the provider had not ensured staff had reliable records to refer to. The provider could provide information to people in alternative formats to meet people’s communication needs if required. The provider investigated and responded to any concerns or complaints and people were encouraged to complain.

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 requires improvement (2 July 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection there had not been enough sustained improvement and the provider was still in breach of this regulation and others.

Why we inspected

This was a planned inspection based on the previous ratings and recent incident of behaviour which challenges between people using the service.

We also 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.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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.

The overall rating for the service is requires improvement. We have identified breaches in relation to people's safety, person-centred care, fit and proper persons employed, need for consent, staffing, and good governance. We have served the provider with a warning notice in relation to staffing. We also served the provider a notice of our decision to require a monthly action plan. This action plan must set out how they will improve in relation to the breaches of safety, fit and proper person's employed, need for consent and good governance.

Follow up

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.

Gibson's Lodge is a care home which provides personal and nursing care. Gibson's Lodge accommodates up to 53 adults some of whom were living with dementia. At the time of the inspection, there were 36 people living at Gibson's Lodge which is located on a residential road in Streatham.

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

People received their medicines when they were due. However, the service did not follow the correct procedures when people might lack capacity to make decisions about taking medicines and when they may need to be given without their knowledge or consent.

People's needs were assessed and they received care which met their needs. People were satisfied with the quality of care they received. However, people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

People felt safe and were protected from avoidable harm as staff had been trained to recognise signs of abuse and knew who to report this to if they had concerns.

There were enough staff to support people safely and meet their needs. People were supported by staff who were well trained and received regular performance reviews. Staff were caring and treated people with respect.

People received effective support to maintain their health and had access to external healthcare professionals. People had personalised risk assessments and staff understood the actions required to help minimise these risks. This included close monitoring of food and fluid intake for people at risk of malnutrition and dehydration

People had a choice of healthy meals and enough to eat and drink. People had the opportunity to take part in organised activities.

People were protected from the risk and spread of infection. All areas of Gibson's Lodge were clean, well-furnished and well-maintained. The home was fully accessible and people moved freely around the home regardless of any mobility difficulties.

People, relatives and staff were kept informed about the plans for the service and had the opportunity to give their feedback. People knew how to make a complaint. There were appropriate systems in place to assess and monitor the quality of care people received.

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 inadequate (the last inspection report was published in January 2019). We found multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 11 January 2019. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We inspected Gibson's Lodge on 2 July 2019. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We found evidence that the provider had made significant improvements but further improvements need to be made. Please see the Safe, Effective and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Following the inspection, the provider sent us evidence that new procedures have been put in place in relation to capacity assessments, best interest meetings and people receiving their medicines covertly.

Follow up:

We will request an action plan for the provider to understand what they will do to improve and maintain 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.

Gibson’s Lodge is located in a quiet residential road in Streatham close to transport links and shops. The service is registered to accommodate up to 53 elderly people. At the time of this inspection 41 people were living at Gibson's Lodge. The majority of the people at Gibson's Lodge were living with dementia.

At our previous inspection of the service in March 2017 the service was rated good. During this inspection we found breaches of the regulations relating to safe care and treatment, staffing, the lack of effective recruitment procedures, the suitability of the premises and the provider's failure to protect people from abuse and improper treatment. We also found breaches in relation to the lack of person-centred care; failure to respect people’s privacy and dignity, the provider's failure to support staff, the provider's failure to submit statutory notifications and the lack of good governance.

The inspection was prompted by information shared with CQC about incidents which indicated a cause for concern regarding the management of risk relating to people using the service. This inspection examined those risks.

The home had 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.

The provider had safeguarding policies and procedures in place but the registered manager and some staff did not have a clear understanding of these procedures. This meant that incidents which should have been reported to local authority safeguarding teams and the CQC were not always reported.

Management plans were in place to support people where risks associated with their health and care needs had been identified. The provider recorded accidents and incidents but did not always take action to prevent recurrence. The equipment people required to be kept safe was not always available.

People’s medicines were not always stored safely. People received their medicines when they were due and in the correct dosage. People had a sufficient amount to eat and drink and were satisfied with the variety and quality of their meals.

People were not adequately protected from the risk and spread of infection because staff were not following the provider’s infection control procedures. Many areas of the home were not hygienically clean. This included equipment and soft furnishings. There were ongoing building works which posed a risk to people’s safety. Building materials and tools were left in an unlocked room to which people had access on both days of our inspection despite this being pointed out to the registered and area managers on the first day of the inspection.

The provider's recruitment process was not sufficiently robust to ensure the staff employed had the competence, skills and experience to perform the role for which they were employed. Additionally, once recruited staff did not receive appropriate support from the provider through an induction or regular supervision. Staff training was inconsistent with some staff not receiving the training they needed to meet people’s needs. The provider did not always deploy a sufficient number of staff to meet people's needs and this impacted the care people received.

People’s needs were assessed with their or where appropriate their relatives input. Care plans comprehensively covered people’s health needs but contained little information in relation their social needs, dislikes and preferences. Consequently, the care people received was not person-centred.

People had access to external health care professionals and were supported well by staff to maintain their physical health. However, care was not provided in a way which respected people’s privacy and dignity. People were dissatisfied with the quality of care they received and did not feel the staff were caring.

There were limited arrangements in place for monitoring the quality and safety of the care people received. The provider did not have effective systems in place to seek people’s views on the care they received. The provider did not always respond in a timely manner to feedback and recommendations made by external agencies to improve the home and the quality of care people received.

Staff said they enjoyed working at the home and felt supported by the registered manager. However, they felt that the provider did not listen to their views on what was required to improve the quality of care people received.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Information about the CQC regulatory response to the concerns found during this inspection can be found at the back of this report.

The home had 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 carried out an unannounced comprehensive inspection of this service in May2016. Although people received the medicines they were prescribed the arrangements for the management of medicines were unsatisfactory and a breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what actions they would take to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. We found improvements had been made and the home had sustained this improvement in the management of medicine. and we have revised our rating to good for the Safe section.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Gibson's Lodge

This inspection took place on 29 April and 3 May 2016, the first inspection day was unannounced.

Gibson's Lodge Limited is a residential nursing home that provides accommodation and personal support for up to 53 older people some of whom were living with dementia. There were 46 people using the service at the time of our inspection.

We inspected the service in February 2015, at the time we found the service required improvements in three areas. We returned in September 2015 and completed a focused inspection; the home had made the necessary improvements. At that inspection we found the service was meeting all the regulations that we assessed.

There was 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 is run.

Although people received medicines prescribed there were aspects of the medicine practices that were unsafe. This constituted a breach of the regulation 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.

People told us they felt safe, and relatives felt reassured their family members were well cared for. Staff were trained and knowledgeable in safeguarding adults and followed the policies and procedures in place. They responded appropriately to allegations or suspicions of abuse. The service ensured that people’s human rights were respected and took action to identify and minimise risks to people.

Staffing levels promoted safety during the day and at night; these were based on the numbers and needs of the people who lived at the service and on the layout of the premises. People were cared for by motivated and well-trained staff that had completed essential training and responded to their individual training needs and the needs of the service. The learning opportunities were good and enabled staff to carry out their roles and responsibilities.

New staff completed an induction training programme and there was a training and development programme for staff. The support network in the home was good, staff felt supported, they had their practice appraised.

There was sufficient information in people’s care records to guide staff on the care and support needs. Care was arranged and delivered in a way that promoted equality and diversity.

Risks associated with people’s health and well-being were identified and appropriate management plans were developed to help minimise these risks.

Staff had a good understanding of people’s individual needs and the support they required. Care was delivered consistently by a team of workers who knew how to support people. New staff worked alongside experienced trained staff to get to know people and their individual ways.

We saw that arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People told us they were happy with the service and found staff kind and compassionate. Staff interacted with people in a patient and sensitive manner.

People were provided with a range of activities in the service but these were not well developed and did not fully consider the needs of people with cognitive impairment.

People felt assured by staff and were informed promptly of any changes to their relative’s conditions. People were encouraged to continue to see friends and relatives and access the community with staff or relatives.

The service had systems in place to monitor the quality of the service provided and drive improvement. Some of the benefits of these were seen in a better developed workforce. The service benefited from good leadership, staff found the registered manager to be open and fair. She led by example and inspired staff to develop their skills through learning. Staff enjoyed the opportunities they got for learning and developing new skills.

Any complaints, incidents and accidents were managed well and measures were put in place so that they were less likely to reoccur. Management were vigilant in monitoring the quality of the service, they supported staff and completed out of hours checks on the welfare of people and on staff practice.

One of the relatives we spoke to on the day said 'We looked at other care homes, but this one stood out for us. I was impressed with the way care was provided.'

We found the care plans to be comprehensive. When we spoke to the relative of another person who used the service they told us they were kept informed by the staff about their care and treatment plans.

We observed positive interactions between the staff and the people who lived in the home and also between staff and relatives visiting.

We looked at people's records and saw where appropriate, the service had worked proactively with other external healthcare professionals to improve the overall health and wellbeing of people using the service.

We saw improvements had been made around administering medication since our last visit. Appropriate arrangements were in place to ensure medicines prescribed to the people who use the service were being managed effectively.

We spoke to five members of staff who all told us there were enough staff working at the home. They told us 'We are a good team here,' 'We all work well together and if anyone needs help we get involved.'

Staff told us that they had the required checks before they started work and had an induction and training that helped them do their job. Staff said that there were enough staff to help the people who lived at the home, especially at mealtimes, which ensured people's needs were met. Staff we spoke with felt that they worked well as a team and provided good care to people who use the service saying "I like the way people are looked after", "they get good care here" and "I like the team spirit".

We saw some good interactions between staff and people who use the service, with staff speaking to people in appropriate ways, explaining what they were doing.

Although policies and procedures were in place, we found that improvements were needed to the recording and administration of medication to ensure people were safe.