Earls Lodge Care Home

Earl’s Lodge Care Home is a residential care home providing personal care and support to up to 52 people. The service provides support to older people some of whom are living with dementia. The home is registered to provide residential and nursing care. However, the provider has taken the decision not to admit people with nursing care needs. At the time of our inspection there were 48 people living in the home.

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

People told us they were happy and safe living in the home. People received person-centred care from staff who know them and know their needs. People told us they feel that Earl's Lodge is their home.

There were systems and processes place to safeguard people from the risk of abuse. Staff had received appropriate training and knew how to report any concerns. Infection prevention and control (IPC) policies and process were in place and PPE was available throughout the home. Staff told us they had received the appropriate training.

Accidents and incidents were recorded and monitored to ensure trends and patterns were identified. Action was taken to reduce future risks occurring. The registered manager kept a record of lessons learned.

Staff were kind and caring and people told us that there were enough staff on duty to meet their needs. People were 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 supported this practice.

Visiting professionals from health and social care services talked positively about partnership working and support and care for people in the home. There was a culture of support for staff that empowered them to carry out their roles to the best of their ability. The provider was engaged in a range of community-based programmes to improve leadership in the social care sector.

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 good (27 September 2022). At our last inspection we made a recommendation about medicines and a recommendation about people's care records. The provider responded to swiftly address these issues at time of inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the number of safeguarding enquiries that we received. A decision was made for us to undertake a focussed inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions therefore we did not inspect them.

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.

The overall rating for the service has not changed. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Earls Lodge Care Home provides accommodation and care for up to 52 older people, some of whom may be living with dementia and other mental health needs. The accommodation is arranged over two floors. The home is registered to provide residential and nursing care. However, the provider has taken the decision not to admit people with nursing care needs. There were 48 people living at the home on the day of our inspection.

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

People told us they were happy living in the home and overall, people received personalised care from staff who knew them well. Overall, risks associated with people’s care were identified and risk assessments were in place to mitigate risks.

We have made one recommendation about medicines and one recommendation about people’s care records. The provider responded to swiftly address these issues.

Staff confirmed they had received training in safeguarding and knew what actions to take if they suspected abuse. The environment was well maintained and there were effective infection prevention control practices in place. Accidents and incidents were recorded and analysed to identify any trends or patterns. This helped to mitigate future risks and ensured lessons were learnt.

There were enough staff available to meet people’s needs in a timely way. The provider followed a safe recruitment procedure to make sure suitable staff were employed. We observed staff interacting with people and found they were kind and attentive.

People were 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 supported this practice.

The provider had a culture of learning and improvement and there was an effective system of governance in place to monitor and improve the quality and safety of the service. The service sought people's views about how the service could improve. The people we spoke with, their relatives and staff felt the management team were approachable and responsive.

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

Rating at last inspection

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

Why we inspected

The inspection was prompted in part due to concerns received. A decision was made for us to undertake a focussed inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has not changed. This is based on the findings at this inspection.

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

Follow up

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

We found the following examples of good practice.

¿ The service had a dedicated unit to be used as a designated setting for people with a positive COVID-19 result. The unit had a separate entrance for staff to use, away from the main home. Staff were designated to the unit and would not move between units to reduce the risk of transmission. The service had supported people with COVID-19 during a previous outbreak and had learned lessons and gained experience in how to care for people safely.

¿ All rooms had an en-suite toilet and wash basin. Staff understood the requirement to put in place enhanced cleaning schedules for all communal areas and bedrooms in the unit to prevent the transmission of infection.

¿ Staff had been trained and understood their responsibility in relation to infection prevention and control. Risk assessments on staff, visitors and professionals had been undertaken. Staff had the necessary PPE and the management team undertook spot checks to ensure they were using this correctly and undertook supervision of staff where they identified any shortfalls.

¿ The provider recognised the need to ensure people were encouraged to remain as independent as possible throughout their stay. This was to ensure people retained the skills they needed to return to their usual place of living as soon as they recovered.

¿ The management team were on call 24 hours a day to support staff. They understood their responsibilities to monitor the quality and safety of the service to ensure people who used the service and staff were safe during the pandemic.

¿ We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Earls Lodge Care Home is a 'care home'. The care home is purpose-built and is registered to provide care for up to 50 people. The home was providing personal care to 40 people at the time of the inspection.

People's experience of using this service:

• People were safe.

• There was a robust governance system in place to ensure the provider checked and audited the safety of the home and the quality of the care delivered.

• Prompt action was taken when things went wrong to reduce the risk of future incidents.

• During the inspection we observed care staff to be kind, caring and respectful. People were encouraged and supported to engage in a range of activities of their choosing.

• People told us the food was good and people had choice about when and what they ate.

• Staff offered people choice in all aspects of their lives, encouraged independence and provided support when needed. Staff supported people in the least restrictive way possible.

• People's care records were person centred and detailed, there was good information about people’s life histories and preferences.

• Staff were skilled and knowledgeable and training was up to date.

Rating at last inspection:

At our last inspection the service was rated requires improvement (24 October 2018).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

At our last inspection on 11 May 2017 and 1 June 2017 we rated the service as ‘Requires Improvement’ and identified three breaches of regulations related to safe care and treatment, consent and governance.

This inspection took place two months after our last inspection as we wanted to ensure people were safe using the service. We found the provider had put in place a number of improvements and had a clear vision for how to ensure the service sustained and built on these improvements.

There was a manager in post who had submitted their application to register with the Care Quality Commission. 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 manager was on annual leave when we inspected the service, however we spoke with them by telephone after the inspection was concluded.

People told us they felt safe using the service, and we saw there were sufficient staff deployed to meet people’s needs. Staff had been recruited safely, and understood how to recognise and act on concerns about any abuse which people may be at risk of.

We saw improvement in the management and recording of medicines. We identified some issues with recording of information relating to medicines on the first day of our inspection, however the provider undertook an audit which enabled them to have taken action to rectify this by the second day of our visit.

The management of risks associated with people’s care and support had also improved, although we found some known risks had not been well documented in people's care plans. We found the management of the cleanliness premises had continued to improve.

There was a robust approach to training and staff support in the home. There was a plan in place to ensure feedback from supervision and appraisal activities was used as a driver for further improvement in the service.

We saw some improvement was still needed in the approach to the requirements of the Mental Capacity Act 2005 (MCA) to ensure this was robust, and we made a recommendation about reviewing the MCA code of practice to enable the required improvements to be made.

There was improvement noted in the approach to management of people’s nutrition and hydration, although improvement to the quality of some records was still needed. People gave good feedback about the food served, however we gave some feedback about some further improvement that could be made to the dining room layout.

People said they were happy living at Earls Lodge and were complimentary about the caring nature of staff, and we observed a relaxed and happy atmosphere in the home during our inspection. We saw a good approach to the promotion of independence and diversity, and we found care plans were written in a person centred way which evidenced people and their families had been involved.

We saw improvement in the way people’s needs were assessed before they began using the service. Care plans were written to show how these needs would be met, however we found there was still some improvement required to ensure staff had access to clear guidance to show how risk could be minimised. Staff told us they were given clear information to enable them to stay up to date with changes in people’s needs.

We received good feedback about activities in the home. The activity co-ordinator had a good understanding of people’s needs and we saw they were effective in encouraging people to take part.

We found the provider had taken timely and wide-ranging action to address concerns raised at our last inspection, and we received positive feedback from people and their relatives about changes which had been made and their confidence in the care which was provided at Earls Lodge. We found there were still areas where improvement was required, however.

There was an audit programme in place which enabled the provider to assess quality in the service, and we saw people and staff were also consulted in this process. There was a service development plan in place to show how improvements would continue to be made. We made a recommendation about ensuring all areas of concern were addressed.

The home was last inspected in February 2017, at which time we found the home was failing to meet the requirements of two of the Health and Social Care Act 2008 regulations. These were in relation safe care and treatment and good governance.

At this inspection although some improvements had been made we found continued breaches in relation to safe care and treatment and good governance and a new breach in relation to the need for consent.

Earls Lodge provides care for up to 50 older people some of whom live with a diagnosis of dementia and all of whom require nursing or personal care. The accommodation is offered over two floors. On the ground floor is the Glenn unit which offers residential care for up to 23 people living with dementia beds and on the first floor is the Dale unit which offers 27 nursing beds. The home has a secure external garden and patio areas, which can be accessed by people who live at the home on the ground floor.

There was no registered manager at the time of the inspection, and the service had not had a registered manager since September 2016. 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 a number of manager’s in post since this time however they had not registered with the Care Quality Commission. There was a newly appointed manager in post who had been promoted from the position of deputy manager between the first and second days of the inspection. The newly appointed manager had been employed by the provider for 12 months. There was also a Head of Clinical Governance, an operations manager, an HR Director and the Managing Director who were offering support to the new manager.

Medicines management was not safe in all cases, and there was evidence people had been without prescribed medicines as these had not been ordered in a timely manner.

Staff had undertaken training including safeguarding and could demonstrate their understanding of the training they had undertaken.

The home was not always working with the Mental Capacity Act 2005 as information about people’s mental capacity was conflicting, and people’s rights were not always protected as a result. There were Deprivation of Liberty Safeguards in place for people in the home who had been assessed as needing these.

People gave us mixed feedback about the food.

Staff were observed to be kind and caring when supporting people and we saw they knocked on people’s doors before entering.

Care records were not completed in a timely or accurate manner. Care staff were creating daily care records for people from memory as they had not recorded key information at the point of care. This meant some daily care records were incomplete and inaccurate.

There were some processes in place to monitor the quality and safety of the service.

All bedrooms are single and include en-suite facilities. Each floor has a communal lounge and dining room, as well as shared bathrooms, toilets and shower rooms. At the time of this inspection there were 44 people living at the home.

Earls Lodge was last inspected in April 2016. At that time it was rated as ‘Requires Improvement’ overall, with a ‘Good’ rating in the domains of caring and responsive.

The home did not have a registered manager. The current home manager had been in place since May 2016; they were in the process of applying to be registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Not all issues with medicines documentation identified at the last inspection had been addressed. The home did not have meaningful protocols for ‘when required’ medicines and could not evidence people were receiving some of their topical medicines as prescribed. Other aspects of medicines administration and management were done well.

Issues with inconsistency in how risks to people were assessed and managed identified at the last inspection persisted. We saw examples of poor moving and handling practice.

We found numerous instances where people’s care plans did not reflect the care and support they needed. This was a finding at the last inspection. We noted this was more of an issue on the first floor. The home manager told us they were aware of this and were already taking action.

A system of audit and monitoring for safety and quality was now in place at the home. There was regular quality monitoring by the registered provider. However, we found issues that had not been identified and addressed by the audit process; some of these had been identified at the last inspection.

People told us there were enough staff; however, two people who use the service felt that it would be unfair to request a bath more than once a week because of the number of people staff had to care for. A dependency tool was in use at the home which showed there were sufficient staff. We observed that whilst staff were busy, people’s needs appeared to be met. The home manager said they would encourage people to ask for a bath or shower whenever they wanted one.

We found people’s personal emergency evacuation plans were not sufficiently detailed or person-centred to be useful.

However, we found not all people who lacked capacity to consent to care and treatment had assessments and best interest decisions in place for the support they received.

People’s care records did not always evidence their relatives who said they had lasting power of attorney, had been granted this by a court. We also noted a person with behaviours that may challenge others did not have a person-centred behavioural management care plan in place.

People enjoyed the food and drinks served at the home; kitchen staff could describe how they accommodated people’s specialist dietary requirements. However, we found people’s nutrition care plans did not always detail their specific needs and could thereby put people at risk of unsafe care.

People told us they felt safe. Staff could demonstrate they had the knowledge they needed to keep people safe from abuse. Recruitment procedures at the home were robust.

Accidents and incidents had been documented and investigated properly. Regular checks had been made on the home’s equipment, utilities and facilities to make sure they were safe.

People and their relatives told us, and we observed, the home was clean and tidy. An intermittent unpleasant odour coming from the sluice on the first floor had been investigated. Further measures had been planned to try and resolve it permanently.

Staff had received the training and supervision they needed to meet people’s needs. Annual appraisals were planned. This was an improvement on the last inspection. Staff were very happy with their access to additional courses and the career development opportunities these provided.

People told us, and records evidenced, they had access to a range of healthcare professionals to help maintain and promote their wider health needs. We received positive feedback about the home from healthcare professionals we spoke with during and after the inspection.

Efforts had been made to investigate and implement current evidence-based practice around good dementia care. This included the use of wall and door colours, pictures and memorabilia, activities and signage.

People and their relatives thought the staff at the home were kind and caring. We saw staff respected people’s privacy and dignity, and promoted their independence.

People had access to advocacy services if they needed independent help with decision-making. People and their relatives told us they were involved in decisions about their care.

Some staff had received in-depth training around end of life care. Care workers we spoke with could describe what good end of life care involved. Feedback from relatives of people who had received end of life care at Earls Lodge was very positive. The home had purchased a memorial tree so relatives could return to the home and remember their loved ones.

Records showed people were assessed thoroughly before they were admitted to the home to ensure their needs could be met.

People gave us positive feedback about their access to activities. We observed people had lots of opportunities to socialise and have fun.

No formal complaints had been made since the last inspection in April 2016. People and their relatives told us they felt able to raise concerns with the home manager if they needed to.

Statutory notifications had been made by the home manager, when required, and the ratings from the last inspection were displayed at the home and on their website.

People, their relatives and staff at the home received annual questionnaires to feedback about the service. There were regular residents’ and relatives’ meetings at the home and staff had regular meetings too.

The home manager had nominated employees for awards and highlighted the contribution made by the so-called ‘unsung heroes’, the kitchen and domestic staff at the home. We saw the registered provider’s philosophy of care underpinned the support provided by staff to people at Earls Lodge.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Earls Lodge provides care for up to 50 older people some of whom live with a diagnosis of dementia and all of whom require nursing or personal care. The accommodation is offered over two floors. On the ground floor is the Glenn unit which offers 23 residential EMI (Elderly Mentally Infirm) beds and on the first floor is the Dale unit which offers 27 nursing beds. The home has a secure external garden and patio areas which can be accessed by people who live at the home on the ground floor.

There was no registered manager at the time of the inspection; however there was a manager in post who had applied to become registered with the Care Quality Commission. 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.

Staff had a good understanding of how to safeguard people, however there was one person for whom consistent reports had not been made for each incident, which made them vulnerable.

There were current safety checks and certificates in place which showed the building and the environment were safe and well maintained.

Accidents and incidents were recorded appropriately and the manager reviewed each incident and the action taken by staff to ensure this was appropriate and thorough.

There were sufficient numbers of staff on duty to meet people’s needs safely and in a timely manner.

Medicines were managed safely. There were regular checks carried out on the storage areas for medicines to make sure they were of the correct temperature to maintain the efficacy of the medicines.

The home was clean and there was personal protective equipment throughout the home for staff to use. The home was pleasantly decorated and presented.

Staff were appropriately trained and skilled to carry out their roles effectively. Staff were well supported by the management team.

There were not always appropriate assessments of people’s mental capacity to make their own decisions and people whose liberty was being restricted were not always subject to an authorisation from the local authority to ensure the restriction was being carried out legally

This was a breach of Regulation 13 (5) Safeguarding service users from abuse and improper treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as action had not been taken to ensure assessments had been carried out adequately and applications for Deprivation of Liberty Safeguards had been made in line with the Mental Capacity Act 2005

People had access to a good range of nutritious food and drinks, to maintain their nutrition and hydration needs.

Staff were kind, caring, thoughtful and considerate in their interactions with people. People were treated with dignity and respect and their privacy was maintained.

People who were approaching the end of their lives had detailed care plans which recorded their personal wishes to ensure staff complied with their choices.

Care plans were detailed and person centred. There was evidence care plans were reviewed regularly, although changes were not always made to the care plans to reflect alterations to the support needed.

There was leadership and management presence visible throughout the inspection. Staff felt the management team were supportive and approachable.

There were no processes in place to monitor the quality and safety of the service provided to people who lived at the home. There were health and safety checks taking place.

This was a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the registered provider had not put in place systems to ensure the quality and safety of the service and therefore did not have oversight of the service.

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