Archived: Walkley Lodge

Updated 30 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

A scheduled inspection took place on 23 November 2016. This was an unannounced inspection which meant the staff and the provider did not know we would be visiting. The inspection team consisted of two adult social care inspectors.

Before our inspection we reviewed the information we held about the service and the provider. For example, notifications of safeguarding and incidents. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales. This helped to inform us what areas we would focus on as part of our inspection. We also reviewed the provider information return the provider submitted. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We gathered information from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used a number of different methods to help us understand the experiences of people who lived in the service. We spent time observing the daily life in the service including the care and support being delivered. We were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Two people spoken with were able to share a small amount of their experience of living at the service. We also spoke with two relatives of one person living at the service. We spoke with the registered manager, two team leaders, two support workers and an administrator. We looked round different areas of the service; the communal areas and with their permission where able, some people’s rooms. We reviewed a range of records including the following: three people’s care plans, six people’s medication administration records, six staff files and records relating to the management of the service.

Updated 30 August 2017

This inspection took place on 23 November 2016. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. This service was last inspected on the 25 June 2015; we found the provider in breach of the following regulations: Regulation 11, Need for consent, Regulation 9, Person centred care, Regulation 12, Safe care and treatment, Regulation 18, Staffing and Regulation 17, Good governance. The registered provider was asked to send us a report saying what action they were going to take to achieve compliance. The registered provider sent us a report and told us all the action would be completed by 30 November 2015. We carried out this inspection to check whether the registered provider had completed these actions and that these actions had been embedded into service practice and sufficient improvements had been made.

We found the action taken by the provider had not been embedded into service practice and sufficient improvements had not been made. We found the service in continued breach for Regulation 9, Person centred care, Regulation 11, Need for consent, Regulation 12, Safe care and treatment, Regulation 18, Staffing and Regulation 17, Good governance.

Walkley Lodge is a care service that provides care for up to seven people. It is a listed building which has been converted into a home. At the time of our inspection six people were living at the service. On the day of the inspection one person was staying with their family. People living at the service had complex needs and had behaviour that may challenge others.

Since the last inspection the registered provider had appointed a new manager and they had registered with the Care Quality Commission on 21 July 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new regional manager had also been appointed to oversee the running the service.

We were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Two people were able to share a small amount of their experience of living at the service. One person did not want to speak with us, but later in the day they were able to confirm they were happy living at the service and everything was “good”. Another person told us they did not have a lot of time to speak with us because they were interviewing applicants for a support worker post and they wanted to go out later. They told us they were happy living at the service.

We spoke with relatives of one person living at the service, they told us they were satisfied with the quality of care their family member had received. They also made positive comments about the registered manager and staff.

After the last inspection the registered provider told us they would take the following action to improve the service: ‘the evaluation of all risk assessment and care plans to be routinely carried out monthly or where changes in care needs occur’. Our findings during the inspection showed the action taken by the registered provider had not been embedded into service practice.

We looked at the risk assessments for people who had challenging behaviour. We saw that risk assessments needed to be more detailed, prescriptive and give staff clear guidance to staff on what to do if a person was getting agitated. It is important that consistent strategies are in place for preventing and reducing anxieties and when behaviour escalates.

We found the advice received from external healthcare professionals on the responsive supportive action that should be taken by staff when a type of behaviour was seen and heard had not been included in one person’s care plan. This showed there was a risk that people’s behaviour was not managed consistently and the risks to their health, welfare and safety are not managed effectively.

At the last inspection we found that the storage of medicines required improvement. We found sufficient action had been taken to improve the storage of medicines. However, we found new concerns in regards the management of medicines and found people were not protected against the risks associated with the unsafe use and management of medicines.

Staff we spoke with were knowledgeable about their roles and responsibilities in keeping people safe from harm.

The registered manager told us the provider was using agency staff to cover for staff absence. On the day of the inspection there were three agency staff working at the service to cover for staff absence. It is important that people with complex needs are supported by staff who know them well, whose competency has been checked and maintained. The registered manager told us the registered provider was actively recruiting new support workers for the service.

We found that all staff involved in recruitment would benefit from a greater level of awareness of the evidence required to complete satisfactory checks as set out in Schedule 3 of the Health and Social Care Act 2008.

At the last inspection we found the support provided to people was staff led rather than person led. The registered manager told us that since they had started working at the service their aim had been to change the way in which support was delivered so it was person centred and person led.

We saw that care plans needed to be more person centred, clear about people’s conditions and how they wished to be supported. They needed to include information about what is important to the person, how the person communicates and how best to support the person to make decisions.

After the last inspection the registered provider told us the following action would be taken to ensure that all staff working at the service received appropriate training: ‘training modules relevant to the service to be delivered to all staff’ and ‘training plan to be implemented and adhered to, to ensure ongoing compliance’. We found the provider had not made sufficient improvements to ensure all staff were trained appropriately.

Although staff we spoke with told us the registered manager was very supportive, we saw that some bank staff did not receive supervision in line with provider’s policies and procedures.

We found the decision to administer a medicine covertly had been made for one person without appropriate legal processes being followed.

There was a complaints procedure available to people and their relatives. The service had received one complaint since the last inspection which had been referred to the local safeguarding authority.

Relatives we spoke with told us they would speak with the registered manager if they had any complaints or concerns. They told us they felt confident the registered manager would listen and take appropriate action to address their concerns.

Accidents and untoward occurrences were monitored by the registered manager to ensure any trends were identified.

Our findings during the inspection showed that some of the checks in place to assess, monitor and improve the quality of the service were still ineffective in practice.

We found the service had not ensured that each person had accurate and contemporaneous records.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.