Sonia Lodge

Sonia Lodge is a residential care home providing personal care to up to 28 people. The service provides support to older people including people with dementia. At the time of our inspection there were nine people using the service. People lived in one adapted residential building which was split over two floors. There was a lift to ensure the second floor was accessible to people.

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

People who used the service and their relatives were positive about the service. One person said, “I feel well cared for here. I feel it is safe living here. I am happy.” A relative said, “I am happy with the home. The staff are really nice.”

There had been significant improvements since the last inspection. However, there were still some improvements to make. Quality assurance checks had not identified that recruitment processes had not been updated to ensure information on staff employment history was complete. The provider had not always ensured safety was prioritised as gas safety checks had not always been up to date. Some care plans needed more detail about the support people needed. However, staff knew what support people needed.

Medicines management had improved, and people were receiving their medicines as prescribed. People felt safe living at the service and staff knew how to raise concerns if needed. The service was clean, and people were protected from the risk of infection. The recording of incidents and actions taken to reduce risk had improved. There was a system in place to analyse if there were trends of patterns of accidents.

There was enough staff to support people. Staff engaged with people well and chatted to people throughout the day. Staff moral had improved, and the atmosphere was happier. People were positive about the service and liked the staff who were supporting them. Staff told us they felt supported.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported people to make choices as appropriate.

People and their relatives could feed back their views about the service though surveys and meetings. Where people had made suggestions about improvements the provider had listened and acted. The service worked in partnership with other services to drive forward improvements and respond to changes in people’s health needs.

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 inadequate (published 06 July 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some areas had improved. However, some further improvements were needed, and the provider remained in breach of regulations.

This service has been in Special Measures since 20 April 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 02 March 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, dignity and respect, good governance, staffing and recruitment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. 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 changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make further improvement. Please see the safe and well-led sections of this full report.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sonia 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 monitor the service and will take further action if needed.

We have identified a breach in relation to good governance.

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

Follow up

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

Sonia Lodge is a residential care home providing accommodation and personal care to up to 28 people. At the time of the inspection 14 people were living at the service. The service provides support to older people, many of whom are living with dementia. People lived in one adapted building which had a garden at the rear and was set in a residential area.

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

Some people living at the service told us they were not happy. Some relatives also expressed concern. One relative said, “Up until recently [my relative] was happy. In the past month they have been saying they don’t want to stay there.”

People were not being supported safely. Staff were not always following people’s care plans. Where people expressed their emotions through behaviour this was not well managed and was allowed to escalate. Medicines were not well managed and medicine records were not well kept. Incidents continued not to be analysed for trends.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There continued to not be enough staff to support people. Staff were busy and not able to provide reasonable standards of care. People were not provided with mental and physical stimulation during the day.

Cleanliness of the service had improved since the last inspection. However, the service did not smell clean and needed further improvement. Staff wore appropriate personal protective equipment (PPE). Staff knew how to raise concerns about abuse and whistleblow. However, systems had not been effective in reducing the risk of abuse by neglect.

The culture of the service needed to be better, to improve outcomes for people. Staff were not always happy in their role and did not always feel supported. People continued not to be treated with dignity and respect.

Following the last inspection, we received an action plan from the provider. This had not led to improvements and the standards of care had deteriorated. Auditing was not effective at ensuring quality was maintained. The provider told us relatives had been asked for feedback but was not able to evidence this. Relatives did not always feel well informed. Record keeping was poor and not always accurate.

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 requires improvement (published 28 October 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety and management of the service. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. However, prior to the inspection we also received concerns about the standards of care at the service, infection control and the management of the service.

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 changed from requires improvement to Inadequate. This is based on the findings 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.

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

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 Sonia 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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment including the management of medicines, dignity and respect, good governance, staffing levels, and staff recruitment at this inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Sonia Lodge is a residential care home providing personal and nursing care to 16 older people at the time of the inspection. The service can support up to 28 people in one large adapted house with a passenger lift between floors.

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

People and relatives told us they were happy with the care they received. However, the provider has not always been compliant with the duty of candour. They had not been open and transparent when things had gone wrong.

The culture within the service was not always positive in promoting person-centred care and positive outcomes for people. Staff did not always treat people with respect, using derogatory language when speaking about people and their needs.

We observed staff not wearing masks in line with guidance on our arrival at the service. The service was not clean, communal areas were dirty and some areas smelt of urine.

There was not always enough staff to meet people’s needs. People’s social needs were not being met; they were not involved in meaningful activities.

Risks to people’s health and welfare were assessed. However, some risk assessments had not been changed when people’s needs changed, and some information was contradictory. There was clear guidance for staff to support people with diabetes and epilepsy to keep them safe. Staff knew how to support people safely and had taken appropriate action when required.

Checks and audits had been completed but had not been effective in identifying the shortfalls found. The provider had not completed audits on the quality of the service since April 2021.

People were supported by staff who had been recruited safely. Medicines were managed safely. People and staff had been asked their opinions on the quality of the service. People were referred to healthcare professional when their needs changed. Staff knew how to report any concerns about abuse or discrimination.

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.

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 17 November 2018).

Why we inspected

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 received concerns in relation to concerns about the provider’s integrity. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

The overall rating for the service has changed from good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

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 Sonia 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 infection control, staffing levels, dignity and effectively monitor the quality of the service at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and the 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Sonia Lodge continued to provide good quality care. The kind and supportive culture was clear to see. People were engaged in different activities and there was a sense of mutual respect between people and staff. People greeted staff with warmth and staff told us about people and their backgrounds with fondness and sensitivity.

People were protected from harm and abuse. Risks continued to be assessed and lessened to provide people with the least restrictive and best possible quality of life. Staff continued to be recruited safely and there continued to be an appropriate level of trained staff to meet the needs of people living at Sonia Lodge. Staff told us that they felt supported and listened to informally and through supervisions and appraisals. Medicines continued to be stored and given to people safely. Staff had appropriate training and the registered manager conducted spot checks to ensure staff were safe to give people medicines. Protocols and checks ensured that people continued to be protected from the spread of infection.

The care and support provided to people continued to be person-centred and in line with best practice guidance. The registered manager attended local forums and learnt from visiting professionals. People and their families were given the time and support to be involved in all aspects of their care. Regular reviews ensured people were given the support they needed to meet their changing needs. Training continued to be tailored to take into account peoples individual and changing needs. Staff were knowledgeable of peoples dietary and hydration requirements and appropriate referrals were made to professionals when required.

People always had alternative options for meals and staff sought people’s ideas when creating the menus. When people were unwell, staff responded quickly and contacted the relevant professionals. Policies and procedures were in place to support a consistent level of care when people went to hospital or visited health professionals. The premises continued to meet the needs of people living at Sonia Lodge, rooms were personalised to peoples taste and people had access to different areas to relax or socialise in. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager sought feedback from staff, relatives, health professionals and people using the service and an accessible complaints procedure was available. Regular checks and audits were carried out to ensure issues were identified and resolved. Complaints, compliments, feedback, errors and incidents were recorded and these were collected and analysed by the registered manager to identify if lessons could be learnt.

People were asked about their end of life preferences and their personal information was kept securely. Staff continued to respect people's privacy, dignity and confidentiality.

Further information is in the detailed findings below.

Sonia Lodge provides care for up to 28 older people some of whom may be living with dementia. People also had sensory, communication and mobility needs. On the day of the inspection there were 26 people living at the service.

The service is located in Walmer near Deal. On the ground floor there is one large communal lounge, a dining room/second small lounge and a conservatory that is also used as a dining area. Bedrooms are located on the ground and first floors. A passenger lift is available for access to the upper floor. There is a secure garden at the rear of the premises.

The service had a 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.

People felt safe in the service. Staff understood how to protect people from the risk of abuse and the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. The registered manager responded appropriately when concerns were raised. They had undertaken investigations and taken action. The registered manager followed clear staff disciplinary procedures when they identified unsafe practice. Visiting professionals told us that people were cared for in a way that ensured their safety and promoted their independence.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People indicated that they were satisfied and happy with the care and support they received. People received care that was personalised. Peoples care plans contained the information and guidance so staff knew how to care and support in the way people preferred. The registered manager said that they were planning on re-writing all the care plans to make them more person –centred.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. The service was planned around people’s individual preferences and care needs.

Staff understood people’s specific needs and had good relationships with them. Most of the time people were settled, happy and contented. Throughout the inspection people were treated with dignity and kindness. People’s privacy was respected and they were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people. People were comfortable and at ease with the staff. Staff encouraged and involved people in conversation as they went about their duties, smiling and chatting to people as they went by. When people became anxious staff took time to sit and talk with them until they became settled. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly. People were involved in activities which they enjoyed. Staff said they would like there to be more activities for people. The registered manager had just appointed a person to carry out more activities and was waiting for their safety checks to be completed.

Staff were familiar with people’s life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively. Staff asked people if they were happy to do something before they took any action. They explained to people what they were going to do and waited for them to respond.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised. When new risks had been identified the registered manager had taken action to prevent them from re-occurring. They had updated risk assessments and passed the information to staff so that people would be safe. During the inspection we observed a couple of incidents which could have posed a risk to people but staff intervened quickly and took the appropriate action to keep the risks to a minimum.

The registered manager and staff also carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements as a result. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Safety checks were carried out regularly throughout the building and there were regular fire drills so people knew how to leave the building safely.

People received their medicines safely and when they needed them. They were monitored for any side effects. Some people received medicines ‘when required’, like medicines for pain or medicines to help people remain calm. There was some guidance for staff to tell them when they should give these medicines but it did not contain lot of detail. This is an area for improvement. The effects of the medicines people received was being monitored. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

People were supported to have a nutritious diet. Their nutritional needs were monitored and appropriate referrals to health care professionals, such as dieticians, were made when required. Care and consideration was taken by staff to make sure that people had enough time to enjoy their meals. Meal times were managed effectively to make sure that people received the support and attention they needed.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLs applications had been made to the relevant supervisory body in line with guidance and had been approved.

People, relatives and visiting professionals felt comfortable in complaining and when they did complain they were taken seriously and their complaints were looked into and action was taken to resolve them.

The registered manager made sure the staff were supported and guided to provide care and support to people. New staff received a comprehensive induction, which included shadowing more senior staff. Staff had regular training and additional specialist training to make sure that they had the right knowledge and skills to meet people’s needs effectively. Staff said they could go to the registered manager and they would be listened to. Staff fully understood their roles and responsibilities as well as the values of the service.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

People, staff, relatives and visiting professionals told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within the service. Staff were clear about their roles and responsibilities and felt confident to approach senior staff if they needed advice or guidance. They told us they were listened to and their opinions counted.

The registered manager had sought feedback from people, their relatives and other stakeholders about the service. Their opinions had been captured, and analysed to promote and drive improvements within the service. Informal feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible.

There were had systems in place to monitor the quality of the service. Audits and health and safety checks were regularly carried out by the registered manager and these were clearly recorded and action was taken when shortfalls were identified. The provider visited the service every week to check how everything was and identified but their auditing records that identified shortfalls had been addressed and improvements made had not been completed for over six months. This is an area for improvement.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered manager was aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported. Records were stored safely and securely.

The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Below is a summary of what we found.

Is the service safe?

The service was safe. Practices in the service generally protected people using the service, staff and visitors from the risk of harm.

Safeguarding procedures were in place and staff understood how to safeguard the people they supported. People told us that they felt safe living at Fassaroe House. One person said, 'The staff always tell me what they are going to do. They explain everything. I trust them'.

The registered manager did the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded when required.

Each person had a care plan detailing their support and care needs. We saw that there was guidance for staff to follow to reduce risks and implement strategies to make sure people were as safe as possible

Is the service well-led?

The service was well- led. There was a clear management structure in place. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was improving. A relative told us, 'The standard of care has improved considerably over the past few months. There is of course still room for improvement'.

Is the service effective?

The service was effective. People told us that they were happy with the care that had been delivered and that their care needs were met. One person we spoke with told us, 'They are all very pleasant, I get everything I need'. We saw that staff were attentive to people using the service and responded promptly when needed.

People's health and care needs were assessed with them, and they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Staff received the training and support that they needed to carry out their roles effectively and safely.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People were given care and support by staff in a way that suited them best.

Is the service responsive?

The service was responsive. People and their relatives knew how to make a complaint if they were unhappy. They told us if they had any concerns they would speak to the registered manager or the provider. They were confident that their complaint would be taken seriously and acted on. We looked at a complaint that had been received by the service and how they had dealt with it. We found that the responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

People's care was reviewed regularly and any changes to their care and support needs were identified and the relevant changes to their care and support was implemented.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

At this time we issued a warning notice to the provider. In response to the notice and other compliance actions the provider agreed to stop taking admissions to the service and had developed an action plan demonstrating how they planned to become compliant with the regulations.

A new manager had been recruited and had been working at the service for a month.

At this inspection we looked at the outcome area where the warning notice was issued.

We spoke with people and also observed the interactions between people and staff.

There were 21 people using the service at the time of our inspection, two people were receiving treatment in hospital.

We observed how people reacted and responded to see if people indicated they were happy, bored, discontented, angry or sad. Everyone we spoke with expressed that they were happy living at Fassaroe House.

We found that people's privacy, dignity and independence were respected. There was engagement and conversation with the people being assisted by staff, especially at mealtimes. When people asked for help they were responded to quickly. People told us that their independence was prompted and they were supported to do as much as possible for themselves. People had choices about what they could do and where they could sit.

We found that people’s privacy, dignity and independence was not respected. There was little engagement and conversation with the people being assisted by staff, especially at mealtimes. People were at times ignored when they asked for help. People told us that they had lost their independence. Peoples choices were limited about what they could do and where they could sit.

The service had not taken action to ensure each person's care was safe and met their needs. Care was not consistently planned and delivered in response to people's changing needs. This meant that people may not be receiving the care and support that they needed.

People told us that at times they did not feel safe at the service. They said they were frightened to be in their bedrooms. The service had not taken the appropriate action to report some incidents of abuse. This meant that people could not be sure they would be fully protected from all types of abuse.

There was enough staff on duty to meet support and meet people's needs. However they did not have the competencies and skills to care for people in the way that suited them best.

Staff were receiving guidance from the provider, however not all staff had received the necessary training to undertake their roles effectively and safely. Staff competencies to undertake their roles was not monitored.

People told us that they had the care and support they needed to remain well and healthy. One person told us that the staff were taking them to a hospital appointment. They said that the staff always went with them if they have to attend any appointments. Everyone we spoke to said positive things about the staff like, 'They are kind and patient.' and "They always tell me what is going to happen'. The staff speak to me nicely, nothing is too much trouble for them.'

People said they liked living at the home and they were involved in decisions about their care and support.

People and their relatives told us that they thought that there was enough staff on duty. They told us they did not have to wait long if they wanted anything.

People and visitors told us that they had been asked by the staff if they were happy and had the opportunity to voice their opinions about the care being provided.