The Lodge

The Lodge is a residential care home providing accommodation and personal care for up to 20 people. At the time of our inspection there were 18 people living in the home.

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

Improvements were needed to the governance systems as they failed to bring about the required improvements to the service people received and drive improvements to the overall rating for the service. At the previous three inspections, the service has been rated requires improvement or inadequate.

Risks were not always monitored accurately, and some risks assessments were out of date or missing. These concerns were not systemic across the service, but this placed people at risk of receiving inappropriate care that didn't meet their needs safely. We have made a recommendation about this.

We identified issues of concern with infection prevention and control practices being followed within the kitchen area and the use of PPE. We have made a recommendation about this.

Medicines management had improved, and people had their medicines as prescribed. Staff had received training on administering medicines and their competence was regularly checked.

People and their relatives told us staff were kind and caring towards them and they felt safe living at the service. Staffing levels were good and appropriate to ensure people's needs were met in a safe, timely and consistent way.

Safety checks of the premises and fire safety checks were undertaken and there were plans in place in the event of an emergency evacuation. Staff had completed individual personal emergency evacuation plans for people to support with safe evacuation.

Staff were knowledgeable about people's health needs and the provider worked in partnership with other health professionals as a measure of providing the appropriate level of support.

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 and update

The last rating for this service was requires improvement (published 17 December 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, whilst some improvements have been made, the provider remains in breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

We have identified a breach in relation to good governance and oversight of the home.

We have made recommendations about the systems in place for monitoring risk, accurate recording of peoples diet and fluids, infection prevention and control measures.

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

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 Lodge is a residential care home providing accommodation and personal care for up to 20 people. At the time of our inspection there were 15 people living in the home.

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

A lack of robust managerial oversight and ineffective governance systems had resulted in a number of issues being identified in relation to recording of information and medicines management. The registered manager, who was also the provider, acknowledged that whilst much improvement had been made since the previous two inspections, there were still areas that needed addressing in order to improve the overall rating of the service. Action was taken during the inspection process to address the issues identified but it should not have required an inspection to identify these.

Medicines were not always managed safely. We identified issues in relation to stock levels, disposal of medicines no longer required and records relating to 'as required' medicines. We found no evidence that people had come to harm and immediate action was taken to address the issues found. Staff responsible for the administration of medicines had received appropriate training and had their competency assessed on a regular basis.

Assessments of people's individual risks and needs had been completed in detail and staff had access to information and guidance to ensure people's health and well-being were maintained. However, some assessments did not accurately reflect people's current needs or risks. Other records reviewed, suggested people were receiving the right care and support from staff; this was further confirmed through feedback from people and family members.

We had some concerns with systems to prevent and control the spread of infection; particularly in relation to COVID-19. Not all staff were following current COVID-19 testing guidance; records showed gaps in the frequency of PCR tests. Immediate action was taken to address this and ensure staff followed current guidance. The home was clean and well-maintained, however cleaning schedules were difficult to follow and showed gaps in some daily cleaning tasks. The registered manager was working with domestic staff to implement more effective systems.

Safe visiting procedures were in place to prevent the spread of infection and family members told us they were required to complete a COVID-19 test and health questionnaire prior to any visit to the home. In addition, they were provided with masks to be worn during each visit.

Whilst staff had received training the provider deemed mandatory to their role, we identified gaps in training such as wound care, diet and nutrition and practical manual handling. Following inspection, we were provided with evidence of training being organised. People and family members told us they felt staff were competent at their role and provided people with the right care and support.

People told us they liked living at The Lodge and felt staff treated them well. One person told us, "They [staff] look after me." Family members were reassured their relatives were well looked after by staff who they described as 'caring', 'lovey', 'calm' 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.

We received positive feedback from family members about the registered manager and their level of support and communication. Some family members told us they had noticed improvements in their relative's overall health and well-being since moving in to The Lodge. They told us they felt engaged with at all times from staff and managers. Staff told us they liked working at the home and felt supported by the registered manager.

The registered manager was open and transparent throughout the inspection process and recognised that improvements were needed. Prior to our inspection, they had already identified some shortfalls and were in the process of implementing new staffing structures to address these.

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 (report published 22 August 2020). At a previous inspection (report published 21 November 2019), we rated the key question of Effective inadequate and identified multiple breaches of regulation. At our inspection in 2020, this key question was not inspected. The provider completed an action plan to show what they would do to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service has been in Special Measures since November 2019. The improvements found during this inspection now mean the service is no longer in Special Measures.

Why we inspected

A decision was made for us to inspect, examine and follow up on what improvements had been made since we last visited the service. As a result, we undertook a focused inspection to review the Key Questions of Safe, Effective and Well-led only. Our report is only based on the findings in those areas at this inspection.

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 (IPC) 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 assurances 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 The Lodge on our website at www.cqc.org.uk.

Follow up

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

The Lodge is a residential care home providing accommodation and personal care to 11 people aged 65 and over at the time of the inspection. The service can support up to 20 people.

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

People and relatives we spoke with all commented on how happy they were with the service being delivered and stated, “it’s just like a family.”

People's risk assessments and care plans provided more detailed and up to date information for staff about how to safely care for each person. However, we identified that the daily monitoring information regarding care was not always completed.

We found additional improvements had been made in recruitment and governance processes. Regular reviews and audits had been carried out and action plans had been developed and acted on.

The internal and external environment had improved. However, additional improvements were needed. The registered manager was fully aware of this and discussed the plans that were in place.

We also found that improvements had been made in regard to medicines. However, we have made a recommendation that the provider considers current guidance on administering topical medicines and takes action to update their practice.

Accidents, incidents, safeguarding issues and complaints were managed appropriately and monitored by the management. Infection control standards were monitored and managed appropriately.

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. We found that people, and if appropriate their families, were consulted about all aspects of their lives. People and families had knowledge of care plans and were involved in decision making.

Rating at last inspection and update: The last rating for this service was inadequate (published 20 November 2019) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 20 November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall however is still rated as inadequate in the effective domain as this domain was not inspected during this inspection. Therefore, this service is still in Special Measures.

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since we last visited the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only. Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive Key Questions were not looked at on this occasion.

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 inadequate to requires improvement. 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 The 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.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

The Lodge is a care home that provides accommodation for up to 20 people who need help with their personal care. At the time of the inspection 17 people lived in the home.

People's experience of using this service

At the last inspection, the provider was rated good. At this inspection, we identified serious concerns with the management of people’s care and the running of the service. This meant the rating for the service has deteriorated to inadequate.

There was a lack of robust checks in place to monitor the quality and safety of the service. This resulted in people being exposed to ongoing risks. The registered manager did not demonstrate that they had a full understanding of the care people required or of their regulatory responsibilities.

People’s care plans did not contain enough information about people’s needs, medical conditions and other risks crucial for the delivery of good care. Professional advice in respect of people’s nutritional needs was not always followed and there was limited knowledge and understanding of people’s skin integrity needs.

Staff recruitment was not safe. Staff training had not always been completed and the competency of staff not always routinely assessed.

Medicines were not always stored securely and medication management overall required improvement.

Some people did not have a call bell in their bedroom to enable them to call for help when they needed it. The checks on people’s welfare in the absence of a call bell were not adequate.

Parts of the premises were in need of repair. Some of the equipment in use was not clean. The garden area of the home was not secure and was accessible to unauthorised persons.

The systems in place to support people’s ability to consent to specific decisions about their care where there were concerns about their capacity to do so, did not comply with the principles of the Mental Capacity Act 2005.

The number of staff on duty was sufficient to meet people's needs. People told us they felt safe and that staff were kind and caring. Relatives confirmed this. Staff knew how to protect people from the risk of abuse.

We saw that staff treated people kindly. They supported people at their own pace and it was obvious they had good relationships with the people they supported. The atmosphere at the home was relaxed and homely.

The registered manager was open and transparent and acknowledged that significant improvements needed to be made. They displayed a positive and committed attitude to making those improvements in a timely manner.

Rating at last inspection and update

The last rating for this service was good (published 02 December 2017). At this inspection it has declined to inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service will be placed in special measures. ‘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.

This inspection was the first for this newly named service with its new provider. The home required a registered manager and there was one 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.

The registered manager (who was also the new provider) of this service had been the home manager of the previous home and many of the staff still worked the newly registered home. This meant that people received support and continuity of care from staff who were familiar with their needs and who knew them well.

The Lodge Care Home is in a large detached period house situated in a quiet suburban area in Hoylake. It is close to local shops and near to local public transport. The home provides residential accommodation for up to 18 people with personal care needs. At the time of our inspection, there were 18 people living there.

The home has 18 large bedrooms, all with en-suite facilities and is arranged over three floors with passenger lift access. The home has been re-furbished by the new provider and the accommodation is light, clean and has a homely feel to it. People have personalised their own rooms and these had been decorated to their choice.

The provider had employed additional staff. The home was clean and tidy and smelt pleasant . The buildings maintenance was carried out by a team of tradespersons which the provider had immediate access, to if urgent work was needed.

The required safety checks on things such as gas, electrical, lifts and fire installations and equipment had all been carried out in a timely manner and any improvements suggested had been completed. The kitchen had a food hygiene rating of five, which is the highest rating attainable. A variety of food was prepared and served according to people’s needs and preferences.

People and their visitors told us that the home felt safe. They all told us that big improvements had been made at the service in the last year, since registration. They also told us that the staff were supportive and caring and that the manager was approachable and transparent.

Staff said they were well supported and trained and we saw that safe recruitment practices had been followed. Medication was correctly stored and administered and staff were trained in this area.

Staff were supervised on a regular basis and their yearly appraisal had been scheduled for October 2017.

The provider followed the Mental Capacity Act and its associated deprivation of liberties safeguards (DoLS). At the time of our inspection, there were no people living at The Lodge who were the subject of a DoLS.

Care plans were completed and regularly reviewed. They were person centred and contained risk assessments which had identified any risks to people’s safety and well-being.

People were able to participate in a wide variety of activities and their cultural and religious needs and preferences were respected and enabled.

The management had made changes to the way some aspects of the service had been run under the previous provider. There were still some improvements to make but there was a good rapport and understanding between staff and the managers and people living in the home and their visitors and relatives, told us that they appreciated the improvements.