This was an unannounced inspection which took place over two days on the 22 and 23 November 2016. Lypiatt Lodge provides accommodation, nursing and personal care for up to 31 older people. At the time of our inspection there were 22 people living there of whom the majority were living with dementia.The registered manager had recently left the service. 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. A new manager had been appointed and was present throughout the inspection. They were in the process of applying to become registered with CQC.
Prior to the inspection concerns had been raised about the safe and appropriate use of medicines and in particular medicines prescribed to be taken “as necessary” were being overused. We looked into these and consulted with the GP about the issues raised. Whilst we found medicines were not always administered safely and improvements were needed, we did not find evidence to uphold the concerns raised with us.
People had not been protected against the risks of employing unsuitable staff. Safe recruitment and selection procedures had not been followed. Medicines were not always administered safely and improvements to the administration and management of medicines were needed to make systems safe. These were breaches 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. The provider confirmed after the inspection they had taken action to address these issues and provided evidence to verify this.
People’s care was personalised reflecting their individual wishes, likes, dislikes and the way in which they wished to be supported. People’s care records had been kept up to date with changes in their needs and provided an individualised record of their needs. People were protected against the risk of harm and supported to take risks whilst staying as safe as possible. Their independence was promoted and they were encouraged to maintain their mobility and to do as much as they could for themselves. Staff had a good understanding of people’s needs, treating them with dignity, respect and compassion. When people were upset or unhappy staff knew how to help them to deal with their emotions. People had access to healthcare professionals and their medicines were administered satisfactorily.
People had access to a range of meaningful activities which reflected their interests and preferences. External entertainers provided music and exercise alongside craft sessions and games. Children from a local school were busy painting pictures to be displayed in the home representing the seasons of the year. People’s cultural needs and diversity were considered. People’s nutritional needs were closely monitored. If they needed support to eat their meals this was provided. People had access to health care professionals to help them to stay well.
People benefited from staff who felt supported to develop in their roles. They had access to a range of training to equip them with the skills to meet people’s needs. Specialist training had been provided with respect to the needs of people living with dementia. There were sufficient staff to meet people’s needs. Staff worked together as a team. They said they were busy and felt supported in their roles. They were confident raising concerns or expressing their views to the manager.
The feedback of people, those important to them and staff was used to monitor the quality of care provided and to drive through improvements. They took part in meetings and a new comments system was being introduced to help people to give feedback. When issues were identified actions were taken to remedy these. Quality assurance audits monitored the quality of the service provided and strove to make improvements when needed. This included the provider working alongside staff to monitor and assess the quality of the service provided. The service had been through a period of significant change and people, their relatives and staff were kept up to date with on going improvements through meetings and a newsletter.