Arnside Lodge

Arnside Lodge is a care home providing personal care for up to 32 people. At the time of our inspection 28 people were living at the service. The service provides support to older people and people living with dementia and or mental health needs.

Arnside Lodge accommodates people in one adapted building over 2 floors. The service has a secure garden and patio area.

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

Whilst people’s felt safe and supported living at the service, the provider’s systems did not always ensure people received high quality care and support. The provider’s quality assurance systems were not fully developed to identify issues in the service and drive improvement. The provider’s systems had not identified issues we found on inspection, including with health and safety checks and staff training. The registered manager and provider did not always understand their regulatory roles and responsibilities. This put people at risk.

People were not always 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 did not always support this practice. We have made a recommendation about person-centred care.

Although people were supported by staff who knew how to respond appropriately in the event of accidents and incidents, the provider’s systems for learning lessons were not robust.

People were supported by staff who been recruited following safe recruitment processes. People’s medicines were managed appropriately. People were not always supported by staff who had received training relevant to their roles and people’s care and support needs.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 April 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. Whilst, we found some improvements had been made, the provider remained in breach of regulations.

At our last inspection we recommended that the provider review accident and incident processes and learning following these. At this inspection we found the provider had not made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

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

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 remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to good governance at this inspection.

We have made a recommendation about person-centred care.

Please see the action we have told the provider to take at the end of this report.

Follow up

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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Arnside Lodge is a residential care home providing personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 32 people.

The care home accommodates people in one adapted building.

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

We found no evidence people had been harmed but they were at risk of avoidable harm due to the ineffective governance arrangements in place. The provider’s systems had not identified issues we found, including shortfalls with staff training and infection prevention and control.

Fire safety had not always been well managed or recorded to ensure staff knew how to respond in the event of a fire and to show that appropriate checks were carried out.

Care records and risk assessments did not always identify risks to people and the support they needed to keep them safe.

Safe recruitment processes were not always followed or in place to ensure staff were suitable to work with vulnerable adults and support the safe use of agency staff.

People felt safe with staff. They told us they received their medicines when the needed them. There were sufficient numbers of staff available to support people when needed.

The service had a positive culture, where people were happy. Staff felt able to make suggestions and confident they would be listened to. Staff shared in their commitment to promoting people’s quality of life.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 09 February 2019).

Why we inspected

Initially we undertook a targeted inspection to look at infection prevention and control practices and review the provider’s response to COVID-19. This inspection identified concerns, so we widened the scope of the inspection to become a focused inspection, including the key questions of safe and well-led.

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.

We have found evidence that the provider needs to make improvement. 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 Arnside 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.

We have identified breaches in relation to safe care and treatment, good governance and fit and proper persons employed. Please see the action we have told the provider to take at the end of this report.

Follow up

We requested 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.

Arnside 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.

Arnside Lodge is registered to provide care and accommodation for up to 32 older people living with dementia and or other mental health conditions. The home is based over two floors with two stair lift access to the second floor. There were 29 people residing at the home at the time of inspection.

Although there was a registered manager in place, they were unavailable at the time of the inspection. The service was being overseen by the care manager in the absence of the registered manager.

Arnside Lodge was first inspected in May 2016. At the inspection in we identified no concerns within the care provided and the service was rated good.

At this inspection visit carried out in January 2019, we checked to see that all good levels of care had been maintained. At this inspection we found the service remained Good. We found the registered provider had continued to invest in the building and promoted excellent standards of care.

The registered provider had made significant changes within the building to promote excellent living standards for people at the home. This had included adding additional communal areas within the home, an on-site hairdressers’ and an accessible bathroom for people to use.

Additionally, the home had developed a safe outdoor space which people could access at the own free will. Design and adaptations had been researched to ensure the environment was safe and met the needs of people who lived at the home.

The service worked in partnership with healthcare professionals and families to ensure people’s health care needs were met. The registered provider took a holistic approach to meet health needs of people who used the service which had resulted in positive outcomes for people. Relatives praised the ways in which people’s quality of life had improved since their family members had used the service. We were repeatedly told staff made a difference and promoted a good quality of life for people.

Risk was appropriately addressed and managed. Risks assessments were in place to ensure staff were aware of risk to keep people safe from harm.

Since the last inspection visit a designated room had been developed for the safe storage of medicines. Medicines were stored and administered in line with good practice.

The registered provider had developed a stable staff team to support people who lived at the home. Relatives told us staffing levels were good and people were supported by a staff team who knew them well.

People and relatives told us safety was considered at all times. Staff could identify types of abuse and the associated responsibilities they had in reporting abuse.

Staff understood the importance of providing person centred activities. Activities routinely took place within the home and the wider community. Relatives told us there was always something happening at the home to keep people occupied.

People and relatives told us staff were caring. We observed staff providing care and found they were patient, kind and caring. The registered provider understood the importance of effective auditing systems. Audits were routinely carried out and action was taken when concerns were identified.

Care plans for people were person centred, in depth and detailed. Care plans provided staff with the correct information to enable them to care for people in a person-centred way. The principles of the Human Rights Act were embedded throughout service delivery.

Infection prevention and control processes were embedded throughout the home. We found the home was maintained to an excellent standard. Relatives agreed hygiene standards within the home were excellent.

There was a whole home approach to training. Both staff who provided direct care and support and ancillary staff in the kitchens and housekeeping were expected to complete a range of training to ensure they all had a good understanding of the needs of the people who lived at the home. This enabled the service to deliver responsive care. Staff praised the training provided and the opportunities made available to them to enhance their career.

Staff told us the management team was supportive. They told us Arnside Lodge was a good place to work and said staff morale was good.

People and relative praised the quality of the food provided. Good practice guidance had been considered and the service worked innovatively to ensure people’s nutritional needs were met.

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.

Consent to care and treatment was routinely sought. When people lacked capacity to make their own decisions good practice guidance was followed to ensure best interest decisions were made on behalf of people.

People and relatives said they had no complaints and were more than happy with the standard of care provided.

Relatives and staff, we spoke with told us they considered the service to be well-managed. They praised the commitment of the registered provider in ensuring services were person-centred and of exceptionally high quality. We were repeatedly told the home was like an extended family and was focussed on outcomes of people, not profit.

The registered provider liaised with health professionals when people required end of life care at the home to ensure people received care in line with good practice.

Staff told us prior to being employed at the home, recruitment checks took place, to ensure staff were of good character and had the correct skills for working with people who could sometimes be vulnerable.

The registered provider was committed to ensuring the service was well-led. Since the last inspection visit the home had been reassessed by an external accredited body. The external assessor concluded the service was well-managed and invested in staff.

The registered provider continued to demonstrate they understood the importance of networking with other similar groups and professionals to ensure good practice was shared and followed.

Further information is in the detailed findings below.

Arnside lodge is situated in a residential area of Morecambe and is near to the shops and sea front. Accommodation is on two floors. There are two lounges and two dining rooms for people to use.

There were 24 people who lived at the home on the day of inspection.

There was 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 was first registered with the Care Quality Commission in October 2015. This was the first inspection of the home under the management of the new registered provider. The registered provider has a further two homes in the Morecambe area.

At this inspection carried out in May and June 2016, feedback from relatives and visitors was positive. People praised the way changes had been made since the new provider took over the home. Extensive building work was in progress to improve the living conditions for people who lived at the home.

People who lived at the home and relatives spoke highly about the quality of service provision on offer.

Staffing levels were conducive to meet people’s needs. We observed staff demonstrating patience with people and taking time to sit with them to offer companionship and comfort. People were given time to carry out tasks as a means to promote independence and were not rushed.

People who used the service expressed concern about the number of different staff working at the home. The registered manager explained this was a short term plan. Their aim was to match staff by skills and interests and develop multi-skilled staff. Relatives told us the changes in staffing did not affect the quality of care provided.

Arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. During the inspection we identified some errors in reporting of safeguarding incidents to the Care Quality Commission. The registered provider took immediate action and implemented a new procedure for reporting incidents. We have made a recommendation about this.

Robust recruitment procedures were in place to ensure staff were correctly vetted before employment was secured.

Suitable arrangements were in place for managing and administering medicines. Regular audits of medicines were carried out by staff.

People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when health needs changed. Feedback from health professionals was positive.

Systems were in place to monitor and manage risk. Staff were encouraged to identify and respond to risk in a timely manner.

Detailed care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required. Consent was gained wherever appropriate.

Feedback on the quality of food provided was consistently positive. People praised the skills of the cook and the variety of foods on offer.

The registered manager had implemented a range of quality assurance systems to monitor the quality and effectiveness of the service provided.

The service provided a variety of social activities for people who lived at the home to keep them occupied and entertained. The registered provider kept a record of all activities undertaken. People had access to minibus trips out. We saw people visiting the home to carry out activities.

Staff were positive about the way the home was managed. Staff described the home as well-led and praised the commitment of the registered provider.

Staff had received training in The Mental Capacity Act 2005 and the associated Deprivation of Liberty Standards (DoLS.) We saw evidence these principles were put into practice when delivering care.

The registered manager had a training and development plan in place for all staff. We saw evidence that staff were provided with relevant training to enable them to carry out their role. Staff praised the development opportunities offered by the registered provider.

The registered manager had adopted an open culture within the home and had built links with the local community and other providers in the area. This allowed good practice to be shared.

Staff, people who lived at the home and their relatives all described the home as a good place to live.