We carried out a review of the data available to us about Washington Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Washington Lodge, you can give feedback on this service.
Washington Lodge is a nursing home which provides nursing and personal care for up to 65 people, some of whom are living with dementia. There were 45 people living there at the time of this inspection.
People’s experience of using this service and what we found
People and their relatives were very positive about the care provided. People told us they felt safe and staff had the skills to support them. Relatives provided positive examples of how staff had helped improve people’s lives since moving to the home.
Staff were safely recruited and received an induction followed by training from the provider. Training was monitored and staff were supported with regular meetings and supervisions. Staffing capacity was enough to meet service user needs.
People and relatives were involved in every stage of care planning. Systems and records were in place to ensure people received person-centered, safe care.
The registered manager had an effective quality assurance system in place. Regular audits and checks were done. These were used to identify relevant action and lessons learnt. People, relatives, staff and professionals were offered opportunities to provide feedback about the care provided at the home.
All staff ensured people living in the service were happy with the environment and found ways to promote their independence; their passions and interests were maintained wherever possible.
The service was following safe infection prevention and control procedures to keep people safe
Medicines were managed safely. Risks to people were assessed and action taken to reduce the chances of them occurring. The registered manager acted on feedback immediately. People were safeguarded from abuse.
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 requires improvement (published 4 August 2021)
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
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.
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.
¿ Systems were in place to help prevent people, staff and visitors from catching and spreading infection.
¿ There was enough PPE such as aprons, gloves and masks. Staff were wearing these appropriately when we visited. Staff had undertaken training in putting on and taking off PPE.
¿ Staff and people were tested regularly for COVID-19. A COVID-19 vaccination programme was in place.
¿ Visitors to the home underwent the appropriate checks to reduce the risk of spreading COVID-19 to others.
Further information is in the detailed findings below.
Washington Lodge is a nursing home which provides nursing and personal care for up to 64 people, some of whom are living with dementia. There were 51 people living there at the time of this inspection.
People’s experience of using this service and what we found
Systems were in place to monitor the quality and safety of the service, but these were not always effective in identifying issues with staff practices or the operation of the service.
Medicines were not managed safely, and improvements were needed in relation to the recording documents used to support safe medicines management.
Staff recruitment procedures needed to be strengthened to ensure staff were employed safely. We discussed with the registered manager where refinements could be made to the audit systems for recruitment to ensure all necessary information was obtained.
The provider had recently reviewed the induction process for agency staff and identified improvements needed to be made. We found the new induction records needed to be further enhanced.
Overall people were protected from harm as risks had been assessed and plans put in place to mitigate these. However, these needed to be developed and extended to cover how to support individuals and those around them when people displayed behaviour, which may challenge.
Care staff, in general, adhered to COVID-19 guidance on working in a care setting. Staff had undertaken training in putting on and taking off PPE, but this needed to be refreshed.
New care records had been developed but these needed further work to ensure they supported staff to work with people who had more complex needs.
There were enough staff on duty and additional staff were available to provide one-to-one support for people when this was needed. Agency staff, particularly nurses were regularly used. Relatives found this led to a lack of consistency in care. The provider was working to recruit permanent staff to cover the vacancies.
Generally, relatives felt the care was safe and staff were compassionate. People were happy at Washington Lodge. People were protected from abuse by staff who understood how to identify and report any concerns. Interactions between people and the staff team were very positive and relatives also said they were made very welcome at the home. People were treated with kindness, dignity and respect.
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 4 February 2018).
We completed a targeted inspection of this service 8 March 2021 looking at infection prevention and control measures. We were assured the provider had appropriate measures to manage the risks posed by the COVID -19 pandemic.
Why we inspected
We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion 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 coronavirus and other infection outbreaks effectively.
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.
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.
We have identified a breach in relation to regulation 17 (Good Governance). The breach concerned the management and monitoring of the service.
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 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.
We found the following examples of good practice.
¿ Systems were in place to help prevent people, staff and visitors from catching and spreading infection.
¿ There was enough PPE such as aprons, gloves and masks. Staff were wearing this appropriately when we visited. Staff had undertaken training in putting on and taking off PPE.
¿ Staff and people were tested regularly for COVID-19. A COVID-19 vaccination programme was in place.
¿ People who used the service and relatives spoke positively about how the staff had supported them. A relative explained how via the virtual relatives meeting they had been kept informed of developments in the home and had formed a good support network.
¿We observed positive interactions between staff and people. One person told us, "The staff are great, and I do like it here. I think I would prefer to stay here, rather than going home."
Further information is in the detailed findings below.
Washington Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Washington Lodge accommodates up to 65 older people in one adapted building across two floors. Some of the people were receiving nursing care and some were living with a dementia type illness. On the days of our inspection, there were 39 people using the service.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.
Washington Lodge had not previously been inspected by CQC under the current provider.
Accidents and incidents were appropriately recorded and investigated, and risk assessments were in place for people who used the service that described potential risks and the safeguards in place to mitigate these risks. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.
Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.
The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.
There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and an annual appraisal.
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 protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.
People who used the service and family members were complimentary about the standard of care at Washington Lodge. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.
Support plans were in place that recorded people’s plans and wishes for their end of life care.
Care records showed people’s needs were assessed before they started using the service and support plans were written in a person-centred way.
Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local community.
People who used the service and family members were aware of how to make a complaint however there had been no formal written complaints recorded at the service.
The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.