Archived: Spinnaker Lodge Limited

Accommodation is arranged over two floors with stair lift access to the second floor and there were two communal areas available for people to socialise.

The inspection was conducted on 30 May and 4 June 2018 and was unannounced. At the time of the inspection there was a registered manager in post who was also the provider. Throughout this report we will refer to them as the ‘Provider’.

At our last inspection in March 2017, we gave the service an overall rating of ‘Requires improvement’ and identified a breach of regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to display the CQC ratings in the home. The provider wrote to us, detailing the action they would take to address the concerns. At this inspection we found that ratings were displayed appropriately and therefore were no longer in breach of this regulation.

However, at this inspection additional concerns were noted. For example, safe and effective recruitment processes were not always followed. Staff employment histories and appropriate references were not always being obtained. This meant that the provider could not be assured that the staff they employed were of suitable character to work with the people they supported. Additionally, although oral medicines were managed safety, we found that where people were prescribed topical creams these were not always managed safety.

Environmental and individual risks to people were managed effectively. There was a process in place to monitor accidents and incidents that occurred in the home to identify any patterns or trends and mitigate risks.

People were protected from the risk of abuse and staff knew how to identify, prevent and report abuse. Staff understood how to keep people safe in an emergency.

There were enough staff to keep people safe and meet their needs in a relaxed and unhurried way.

People’s needs were met by staff who were competent, trained and supported appropriately in their role. Staff followed the principles of the Mental Capacity Act 2005 (MCA) and sought verbal consent from people before providing care.

People were supported to have enough to eat and drink and had access to health professionals and other specialists if they needed them. Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

Staff showed care, compassion and respect to people who spoke positively about the attitude and approach of staff. There was a relaxed and calm atmosphere within the home. People were cared for with dignity and respect and their privacy was respected.

People were encouraged to be independent and the staff supported people to meet their cultural and spiritual needs.

The service was responsive to people’s needs. Staff demonstrated that they knew people well, understood their needs and had knowledge of their likes and dislikes. There was a person centred, individualised approach to care.

People told us they were provided with appropriate mental and physical stimulation that met their needs and wishes. People were listened to by staff and their views and wishes were respected. People were encouraged to make decisions about their care.

People and their relatives felt the service was run well. Staff were organised, motivated and worked well as a team. There was a clear management structure in place and the provider had access to appropriate support.

People described an open and transparent culture within the home, where they had ready access to the management and visitors were welcomed at any time.

A registered manager was not 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. There had been no registered manager in post in the home since September 2015. The nominated individual for the registered provider had begun the process to apply to be the registered manager of the home.

We carried out a comprehensive inspection of this service in January 2016 and found the registered provider was not compliant with Regulation 11 (need for consent), Regulation 12 (safe care and treatment) and Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection the registered provider sent us an action plan stating they would be compliant with all the required regulations by 9 May 2016. At this inspection we found the registered provider had taken sufficient action to be compliant with these regulations.

People were supported by staff who understood how to keep them safe, identify signs of abuse and report these appropriately. Processes were in place to check the suitability of staff to work with people although some improvement was required in the records associated with this. There were sufficient staff available to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Medicines were administered, and ordered in a safe and effective way. We have made a recommendation with regard to the storage of some medicines.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People received nutritious meals in line with their needs and preferences and their nutritional intake was closely monitored to ensure they received a balanced diet.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

Systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People spoke highly of the nominated individual and their team of staff. However the registered provider had failed to display the rating from their inspection in January 2016 which is a legal requirement of registered providers.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we have told the registered provider to take at the end of this report.

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At the time of our inspection a registered manager had not been in post for three months. 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 nominated individual for the home told us they would be applying for the role of registered manager for the home. Throughout the report we have referred to this person as the manager.

Infection control practices at the home were not sufficient to ensure the safety and welfare of people and other risks associated with the care people required had not always been assessed.

Medicines were administered and stored in a safe and effective way.

Staffing numbers were sufficient to meet the needs of people and staff knew people in the home very well. External health and social care professionals were involved in people’s care as required to meet their needs.

Staff had a good understanding of how to keep people safe, identify signs of abuse and report these appropriately. Processes to recruit staff were in place which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs.

Where people were unable to consent to their care the provider was not always guided by the Mental Capacity Act 2005. Further work was required to ensure care records accurately reflected people’s ability to consent to their care and to identify people who had the legal authority to make decisions on another person’s behalf.

We have made a recommendation about a dementia friendly environment for people.

People’s nutritional needs were met in line with their preferences and needs. People who required specific dietary requirements for a health need were supported to manage these.

Care plans in place for people were personalised but needed further clarity to ensure they accurately reflected people’s needs. Staff understood people’s needs well. They were caring and compassionate and knew people in the home very well.

There was a system in place to allow effective response to any complaints which were made in the home; however there were not effective systems and processes in place to assess, monitor and improve the quality and safety of the services.

The manager of the home provided an open, honest and transparent culture in the work place, where people, relatives and staff felt supported to participate in the running of the home. However systems were not always in place to assess, monitor and improve the quality of the service provided at the home.

You can see what action we told the provider to take at the back of the full version of the report