Archived: Washington Lodge Nursing Home

Washington Lodge Nursing Home was inspected on 30 and 31 July 2015 where we identified breaches in regulation 9, 11 and 17. A further inspection was carried out on 31 May 2016 which confirmed all improvements had been made. This inspection took place on 13 December 2016 and was unannounced. This meant the provider did not know we were coming.

Washington Lodge Nursing Home is in the process of being sold. The application for registration with the new provider has been submitted to the Commission.

The service did not have a registered manager. ‘The deputy manager was in a managerial role with support from the area manager. They will be referred to as the manager throughout the report.’

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 been safely recruited with relevant checks completed prior to them starting work. Staff were provided with training to enable them to care effectively for the people they supported. Staff told us they felt supported by the manager and found them to be open and approachable.

The manager kept a log of all accidents, incidents and safeguarding concerns and audited these for patterns and themes.

Staff had an understanding of how to recognise and report any concerns or allegations of abuse and described what action they would take. Staff felt confident the manager would respond to any concerns.

Risks to people had been managed safely. Records demonstrated when risk had been identified, and what action had been taken to reduce them wherever possible.

We found policies and procedures were in place to manage people's medicines safely. Medicines were administered by trained staff who had their competency to do so checked regularly.

The manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect them from harm.

There were staff on duty with the necessary skills and experience to support the people using the service. The provider was actively trying to recruit nurses and was using agency staff to ensure safe staffing levels. Training was up to date with staff completing some training electronically. Staff received regular supervision and some had received an annual appraisal. Where appraisals were out of date steps had been taken to address this.

Relatives and people felt staff were caring. Staff treated people with respect and dignity and promoted people's independence wherever possible, offering choices and options.

People were provided with a varied and nutritious menu. Staff supported people to eat and drink if required and encouraged independence were ever possible. They ensured people at potential risk of undernutrition received adequate nutrition and hydration.

The provider had information about advocacy services available for people and their relatives.

Care plans were personalised enabling people to receive care and support that was responsive to their individual needs. People were provided with access to health care appropriate to their needs.

The registered provider had a process in place to obtain the views of people and their families by using a survey. Where people had communication needs a pictorial survey was available.

People had access to activities within the service such as taking part in crafts or board games. We saw people accessing the community to visit the local day centre with staff. Previous trips included a local attraction to see the illuminations.

The registered provider had a system in place to monitor the quality and effectiveness of the service provided to people and their families in order to drive improvement. The provider had a policy and procedure in place to manage complaints and kept electronic records of all complaints and concerns. Relatives and people knew how to make a complaint. One relative told us, “I know how to complain but never had to.”

The manager submitted statutory notifications to CQC when necessary. People's personal information was kept safely and securely in line with Data Protection Act.

The provider had a business continuity plan in place to ensure staff had guidance and contact numbers in case of an emergency. People had an up to date personal emergency evacuation plan (PEEPs) on their file.

Breaches of legal requirements were found because people’s care plans did not always reflect their individual needs. People’s capacity to make decisions had not always been clearly assessed, and the home’s audit procedures did not always identify areas for improvement, and where they did clear timescales were not always identified.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the regulations relating to person centred care, assessing people’s mental capacity and good governance processes.

We undertook this focused inspection on 31 May 2016 to check that they had followed their plan and to confirm that they now met the legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Washington Lodge on our website at www.cqc.org.uk.

We found the assurances the registered provider had given us in the action plan had been met.

Care records had been reviewed in line with the home’s care plan tracker. Risk assessments were completed and new care plans developed. The activity programme had been developed to meet the needs of people living with dementia.

Training records confirmed all staff had completed additional Mental Capacity Act training. A training matrix was in place which confirmed the date training had taken place and the date when training needed to be updated. Care plans had been written to guide staff about how to support people with decision making. These were specific to the individual needs of each person.

The home’s audit procedures identified areas of improvement. Care plan audits were completed in line with timescales. Meetings had been organised with relatives and people with a set agenda. Relatives’ survey results were used to develop the service.

People told us they were happy with the service. They said "They are lovely', 'I feel safe' and 'I can go to someone if I am worried". Another said "The staff are lovely, they always check with me before they do anything to help". A visitor told us they thought the service was "Good" and they were "Impressed with the manager who is really pleasant and supportive", and they were 'Happy with the care her relative received'.

During the inspection staff were speaking with people in a kind and respectful way. We observed people were clean and well groomed. People were living in a well maintained and decorated home which met their needs and gave them a pleasant place to spend their time.

We saw effective recruitment and selection processes. We looked at records of four staff and found a robust system for making sure appropriate staff were appointed. This meant staff were appropriately skilled and fit to carry out their role safely.

We looked at how records at the home were managed. They were accurate and kept securely. For example, patient records, recruitment of staff and the safety of the building records.