Archived: Fleetwood Lodge

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 the last inspection, although the provider had made improvements to systems to monitor quality and safety within the service, sufficient time had not passed to ensure that these improvements were fully embedded to effectively monitor quality and safety in the service.

At this inspection we found the provider’s quality assurance systems had been developed and were effective in identifying service improvements. Audits were completed monthly and any identified actions were included in the home’s overall improvement plan, which contained dates for completion of identifiedactions. Evidence we reviewed showed actions had been completed within prescribed timescales.

The provider had taken prompt action in response to safeguarding concerns raised by healthcare professionals. The registered manager and staff had worked collaboratively with health and social care professionals to identify and address poor practice to ensure people received safe care.

People were protected from harm or abuse from appropriately trained staff who used the provider’s robust reporting systems. Risks to people were assessed and managed safely by appropriately trained staff.

People were supported to take part in their preferred activities and to have choice in their lives so that their independence was promoted and their freedom respected. Sufficient numbers of staff were deployed to meet people's needs and there were safe practices in place to ensure that people received medicines safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported according to their needs and preferences by appropriately trained staff. Care plans and risk assessments were regularly reviewed and updated and reflected people’s individual needs.

Staff liaised effectively with healthcare professionals to support people's health and wellbeing. People received consistent support from caring staff who knew them well and treated them with respect. Staff supported people to express their preferences about how they wished their care to be delivered.

The provider had a complaints policy in place and complaints were responded to and investigated promptly.

No-one at the home was receiving end of life care at the time of the inspection, however, people’s care and support documents contained information about what people wanted to happen in their last days.

The provider demonstrated an inclusive, to delivering care which was understood and shared by staff.

Further information is in the detailed findings below.

Fleetwood Lodge is a care home providing accommodation and personal care for up to 51 older people. Most people living in the home were living with dementia. When we visited there were 39 people lived in the home. Fleetwood Lodge is a converted residential dwelling with accommodation over two floors. People live in single or shared rooms.

The service had a registered manager in place. 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 service is required by a condition of its registration to have a registered manager.

Our previous inspection on 26 and 27 October 2015 identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had taken action to address the concerns we had identified. Sufficient improvement had been made for the provider to meet the requirements of the two previously breached regulations in relation to good governance (Regulation 17) and requirements relating to workers (Regulation 19).

The provider had introduced new quality assurance systems and additional checks had been put in place to support the registered manager and staff to continually evaluate the quality and risks in the service. We found these systems had been effective in driving improvements for example, in staff training and supervision and monitoring of health and safety requirements in the home. However, more time was needed to ensure recently implemented improvements made by the provider in relation to the records kept for people, staff and the management of the home, were fully completed and sustained.

The provider had improved their recruitment practices and we found all the required staff pre-employment checks had been completed to ensure staff would be suitable to work at the home.

People received their prescribed medicines safely and had access to healthcare services when they needed them. People liked the food and told us their preferences were catered for. People received the support they needed to eat and drink enough.

Staff had a good knowledge of their responsibilities for keeping people safe from abuse. Staff sought people’s consent before they provided their care and support. Where people were unable to make certain decisions about their care the legal requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to know what support people required. Staff received training and supervision to support them to meet the individual needs of people effectively.

The provider had adapted the home environment to better meet the needs of people living with dementia. The dementia friendly environment supported people to orientate themselves in the home and maintain their independence.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy. The staff were committed to enhancing people’s lives and provided people with positive care experiences.

People knew how to make a complaint. People told us the manager and staff would do their best to put things right if they ever needed to complain.

We observed how staff supported people, and looked at documents including people's care plans, training records and management reports. We considered how the service met key outcomes, including providing for people's care and welfare, staffing, gaining people's consent, supporting staff and assessing and monitoring the quality of care provision. We used the information we gathered to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

We spent time observing the interaction between staff and people in the dining room and in some of the bedrooms where people were cared for in bed. We saw that staff treated people with compassion and kindness. Most of the staff were familiar with people's likes and engaged positively with people who found it difficult to converse. Staff spoke of people with respect and empathy.

Is the service responsive?

The service was responsive to people's needs. People's care and support needs were assessed prior to their admission to the service. Nurses reviewed their needs regularly to ensure that changes to people's needs were appropriately supported. People were supported to access relevant health services. One nurse told us 'The GP comes when we need him but the Monday list ensures that we note everyone that requires to be seen as part of our clinical monitoring. This way we ensure that they will be attended to'. Most care workers were aware of each person's needs and wishes, and ensured these were met. The home was taking action to ensure that care plans were personalised.

Is the service safe?

The home required some improvement to ensure it was safe. We found though the home had systems in place to assess and monitor the risks associated with care delivery these had not always been robustly implemented. For example concerns identified in a medication audit in May 2014 had at the time of our inspection not been resolved. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The manager had reviewed whether any applications needed to be made in response to the Supreme Court judgement in relation to Deprivation of Liberty Safeguards and had submitted these for authorisation to the local authority. Nursing homes are required by law to apply for authorisation were restrictions had been imposed on people to keep them safe when people do not have the capacity to consent to these restrictions. These include for example constant supervision of people or where it had been assessed to be in people's best interest to live in the nursing home.

Care workers were aware of risks to people's health and wellbeing, as these were documented in their care plans. Care workers were provided with training and guidance to ensure they supported people safely.

Is the service effective?

We found the service was effective in the care it provided. Clinical audits and monitoring confirmed that people had been supported to manage risks relating to their weight, wounds and falls in line with professional guidelines. People's care plans recorded any specialist support required, such as dietary needs, or pressure relief to maintain good skin condition. We saw care workers followed guidance to ensure people's health was promoted. Staff were trained to ensure they could support people effectively and safely.

Is the service well led?

The service required some improvement to ensure it was well led. We saw though the provider had taken action following our last inspection to implement quality monitoring systems, the systems were not yet bedded into the home practices and coordinated to ensure an overall consistent approach. A new manager had been appointed and they were in the process of applying to become the registered manager of the home. A project manager was supporting the new manager to ensure checks and audits were undertaken as required by the provider.

At the time of our visit 25 people lived at the home. The provider had told us, in response to concerns noted at our inspection in January 2014, that they would plan and deliver people's care and treatment in a way that would ensure people's safety and welfare by 31 March 2014. Though the provider had taken positive action we found that following assessment, people's care had not always been planned and therefore staff did not always have the information to ensure that people's needs were met and their risks managed consistently and in line with professional guidance. We saw that some people's appearance were not in accordance with promoting their dignity. We could not ascertain whether people's appearance was through choice as care plans did not identify people's preferences relating to their dress or sexuality as a need.

We found that people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection.

We saw that parts of the home were in need of redecoration and the communal areas did not always create a homely, attractive environment in which to live. The home was in the middle of a refurbishment and reconfiguration programme which included considerable investment to create a 'dementia care unit'. Therefore until the refurbishment had been completed by summer 2014 some parts remained in need of upgrade and refurbishment.

Since our last visit in January 2014 the provider had introduced quality and risk monitoring systems and supported the manager to monitor the quality of the service being delivered. The quality monitoring systems had been introduced two months prior to our inspection and the manager acknowledged that more time would be required to embed these systems, to ensure effective operating of the systems were sustained.

People did not experience effective, safe and appropriate care and treatment and although care was planned it had not been delivered in a way that ensured a person's safety, health and welfare. People were safeguarded from abuse because procedures were in place and staff were aware of their responsibilities to ensure people were safe.

People were encouraged and supported with their meals and they appeared to enjoy the meal time. People who could express a view told us they enjoyed the food. One person told us, 'Always lots of good food here. I can have something to eat when I want and they are always offering us drinks.'

The arrangements in place to minimise the risks of infection were effective and people were cared for in a clean and hygienic environment.

Staffing levels were inadequate and people were at risk of not having their needs fully met. People spoken with told us there was never enough staff. One told us "Oh the staff are good, but they are always so busy. I did not have a bath for almost three weeks." Another person said "There are never enough staff on duty and those that are here do try their best to look after everybody well and it's a hard job".

The arrangements in place for monitoring the quality of the service were poor. The provider had failed to support the registered manager as they had not undertaken regular monitoring visits at the home.

"SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us."

People were treated respectfully and their views were taken in to account by staff. People who could communicate with us in a meaningful way told us staff were caring. One person said 'The staff are very kind and good'. Another person said 'I've been here for three years. Everything works. I am very happy here. We have hiccups but we get over them'.

Risks to people's health and welfare were assessed and care was planned and delivered according to people's needs.

People were encouraged and supported with their meals and they appeared to enjoy the meal time. One person said "The food at the home is good." Another person said 'The food could be hotter' and another told us 'I like the food very much'.

People told us staff shortages had been an issue. One person said 'No definitely not enough staff'. A member of staff said 'The staffing levels can vary. Sometimes four, or three or even five carers are on duty and a nurse'. On the day we observed that people received their care in a timely manner.

The provider's statement of purpose was current and provided people with the information they required about the services provided at the home. Records were kept confidential and stored securely.

People told us that they felt there were not enough staff. We observed that staff were busy and at times people were not given prompt assistance when they required it.

People's comments about the standard of food served were varied. The dining experience for people at their midday meal was chaotic and did not promote people's rights to respect and dignity.