We carried out a review of the data available to us about Scarborough Hall and Lodge Care Home 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 Scarborough Hall and Lodge Care Home, you can give feedback on this service.
People’s experience of using this service: Improvements had been made to the assessment, monitoring and management of risk. People who used the service were kept safe through effective systems being used for medicine management, prevention of falls and infection prevention and control.
All areas were clean, tidy and there was effective cleaning taking place to keep people safe from the risk of infection. The rooms we looked at were nicely decorated in colours of people's choosing.
People told us they felt safe and well supported. The provider followed robust recruitment checks, and sufficient staff were employed to ensure people's needs were met. People's medicines were managed safely. The uptake and completion of staff training had improved and staff received regular supervision.
The provider had introduced new ways of working in regard to risk and falls analysis which had significantly reduced the number of falls in the service over the last year. People benefitted from the proactive approach to identifying risk and reducing this where possible.
Staff had received training and development around management of dementia and demonstrated a good understanding of dementia care. They worked with people’s individual strengths to ensure their independence, wishes and choices were promoted.
Communication was effective. 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 and their relatives were supported to receive information in an accessible way either through easy read, large print and pictorial formats to enable them to be involved in their care and support.
People enjoyed good food. Their health needs were identified and staff worked with other professionals, to ensure these needs were met.
Staff knew about people’s individual care needs and care plans were person-centred and detailed.
People participated in a range of activities within the service and in the community, they also enjoyed the company of others in the service.
People were able to see their families as they wanted. There were no restrictions on when people could visit the service. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.
The service was well-led; systems were in place to assess and improve the quality of the service and complaints were responded to thoroughly. There was an open culture and learning was encouraged to drive improvement.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.
Rating at last inspection: Requires improvement (report was published 18 June 2018).
Why we inspected: This inspection was a scheduled inspection based on the previous rating. At the last inspection on 30 April 2018 there remained breaches of Regulations 12 and 18; safe care and treatment and staffing. The provider gave us an action plan outlining how they intended to meet the legal requirements. At this inspection improvements had been made in risk management and staff training and supervision. The two breaches of regulation were met.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
We undertook an unannounced focused inspection of Scarborough Hall and Lodge on 30 April 2018. This inspection was done to check that improvements to meet legal requirements had been made in respect of the warning notices. The team inspected the service against one of the five questions we ask about services: is the service well-led? Sufficient improvement had been made that at this inspection to say that the warning notices had been met.
No risks, concerns or significant improvement were identified in the remaining key questions through our on-going monitoring or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.
Scarborough Hall and Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service accommodates a maximum of 85 older people, people living with dementia and people living with a physical disability. The service does not provide nursing care. The service operates from one purpose built building with three floors. At the time of our inspection there were 78 people living at the service.
The provider is required to have a registered manager. There was a registered manager in post who had registered with CQC in November 2011. A registered manager is a person who has registered with 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.
Improvements had been made to assessment, monitoring and mitigation of risk to people who used the service. However, these changes needed time to become embedded into practice.
Medicine administration on the ground floor was noted to still be given out late during the morning round. However, staff had ensured time limited medicines such as those to be given before breakfast had been administered first.
People had access to appropriate drinks and snacks, but staff assistance with eating and drinking for people living with dementia could be improved.
Improvements had been made to the staffing levels in the service. We found that the management team were monitoring people’s needs and adjusting the staffing levels accordingly.
Improvements had been made to infection prevention and control practices so that the environment was clean and tidy. Plans were in place for the refurbishment of the dining room serveries. Staff knowledge of people’s needs had improved and there was a better understanding of how to maintain people’s privacy and dignity.
The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the registered manager was making progress in improving the quality of the service.
Scarborough Hall and Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service accommodates a maximum of 85 older people, people living with dementia and people living with a physical disability. The service does not provide nursing care. The service operates from one purpose-built building with three floors. At the time of our inspection there were 80 people who used the service.
The provider is required to have a registered manager. There was a registered manager in post and this individual registered with CQC in November 2011. A registered manager is a person who has registered with 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.
We found breaches of Regulations 12, 17 and 18 during this inspection in relation to safe care and treatment, good governance and staffing. You can see what action we told the provider to take at the back of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
The assessment, monitoring and mitigation of risk towards people who used the service with regard to medicine management, falls and infection prevention and control was not robust. This meant people were at risk of harm.
Staff training was not up to date and did not equip the staff with the skills and knowledge they needed to meet people's needs. Supervisions took place, but the lack of effective leadership and role models meant staff did not receive adequate support and guidance to promote best practice.
The management within the service did not effectively complete the quality assurance systems which were in place. Audits completed by the registered manager showed there were a number of recognised concerns with regard to documentation and people’s health and well-being. However, the registered manager had not taken action to address these, which left people at risk of harm.
The reporting of safeguarding issues was not always robust and left people at risk of harm.
Care files were not completed in a consistent manner. Care plans were not up to date and documentation was not fully completed. This meant staff did not have appropriate records to show how they were meeting people’s needs.
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.
The completion of food and fluid charts was inconsistent and the risks to people around hydration and nutrition were not always fully identified and reviewed by the care staff.
The majority of people felt their privacy and dignity was respected and maintained by the care staff and care practices within the service. However, for one person their care fell short of expected standards and their dignity was compromised. We have made a recommendation in the report about staff training with regard to people’s dignity.
People told us they felt safe and were well cared for and recruitment of staff was carried out safely. Staff were knowledgeable about people’s individual care needs and there was a range of social activities available, which people enjoyed.
Scarborough Hall and Lodge is registered to provide residential care for up to 85 older people who may be living with dementia. There were 82 people resident on the days of the inspection. The service is purpose built and has all single rooms over three floors; ground, first and second. There were older people living on the ground floor and people living with dementia on the first and second floors. There is a passenger lift to enable people to reach the upper floors. The service has pleasant grounds surrounding the home with themed gardens, a conservatory and well-maintained pathways.
There was a registered manager employed at the service. 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 recruited safely and there were sufficient staff on duty to meet people’s needs.
Staff were clear about what it meant to safeguard people and were aware of the procedure to follow when alerting senior staff about any incidents.
Accidents and incidents were reported and analysed to identify any patterns and themes.
Health and safety checks had been carried out and equipment serviced. The service was clean and tidy and the registered manager carried out regular checks of the environment to ensure this was maintained. There was a fire risk assessment in place and checks of the fire safety equipment had been carried out. Staff had received training in fire prevention and safety.
The environment was modern but at the same time homely. Signage was used as a wayfinding aid for people and there were rummage boxes and other items for people to use to recall memories.
Medicines were administered and managed safely.
Feedback about communication between staff and families was inconsistent but professionals said that communication between themselves and the service was good. Improvement in this area would benefit relationships between relatives and the service.
The level of training provided for staff allowed them to provide the care required. They had a thorough induction where they completed training and shadowed more experienced staff. Senior staff provided supervision every two months and appraisals were carried out annually.
The service was working within the principles of the Mental Capacity Act 2005. When people were unable to make their own decisions their families and professionals were consulted.
When people needed support with healthcare needs staff made sure that their GP was aware and that referrals were requested.
Families and friends told us that they believed that staff cared but expressed frustration about what they saw as a lack of communication. Professionals told us that they had witnessed caring staff. Our own observations identified that staff were caring.
The staff were trained in palliative and end of life care in order to support those people who were reaching the end stage of their life. They were supported through training and visits by staff from the local hospice.
People were invited to share information through care planning. They could share their views by completing surveys, attending meetings or by talking to the registered manager.
People who used the service had a care plan and risks to their health had been identified. The care plans were reviewed and evaluated monthly. In addition reviews were carried out with social care and health professionals. Some of the relatives we spoke with told us that they had attended reviews.
A varied programme of activities was available for people who used the service. In addition there was a hairdressing salon on the premises which was open four days a week and visits within the local community organised.
Complaints were managed according to the service's policy and procedure.
There was a quality assurance system in place. Audits were carried out regularly and feedback gathered through surveys.
We carried out an unannounced comprehensive inspection of this service on 13 February 2015. We found that the registered person had not protected people against the risk of cross infection. Areas of the home were not clean, cleaners did not work to schedules, and the laundry was not run is a way which minimised the risk of cross infection. This was in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.
We undertook this focused inspection 8 December 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Scarborough Hall and Lodge on our website at www.cqc.org.uk.
Scarborough Hall and Lodge care home is registered to provide residential care for up to 85 older people. There is a passenger lift to assist people to the upper floors and the home is set in pleasant grounds. The home 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.
We found that the service was now clean and hygienic and that it was no longer in breach of regulation 12 of the Health and Social Care Act. This meant people were protected by the infection control practice of the home.
This inspection took place on 13 February 2015 and was unannounced.
Scarborough Hall and Lodge care home is registered to provide residential care for up to 85 older people. There is a passenger lift to assist people to the upper floors and the home is set in pleasant grounds.
The home 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.
People told us they felt safe at the home. Risks to people were managed well without placing undue restrictions upon them. Staff were trained in safeguarding and understood how to recognise and report any abuse. Staffing levels were appropriate which meant people were supported with their care and to pursue interests of their choice. People received the right medicines most often at the right time and medicines were handled safely. However, we noted one instance where a medicine had not been administered at the correct time. We have made a recommendation about this in the main report.
The home was not managed in a way to ensure that people were properly protected from the risks of cross infection. You can see what action we told the provider to take at the back of the full version of the report.
Staff were usually deployed in a way which ensured that people received the care they needed, however, sometimes we observed that care staff were engaged in activities which were not focused on people. We have made a recommendation about this in the main report.
People told us that staff understood their individual care needs. We found that people were supported by staff who were well trained. All staff received mandatory training in addition to specific training they may need. The home had effective links with specialists and professional advisors and we saw evidence that the home sought their advice and acted on this. However, we noted that there were occasional times when health professionals could have been contacted earlier to ensure people received the attention they required. We have made a recommendation about this in the main report.
People’s nutritional needs were met. People were enabled to make choices about their meals and snacks and their preferences around food and drink were respected. However, we noted that staff were sometimes rushed at meal times and that they were engaged in tasks at this time such as washing dishes, which meant that people were not always assisted in a timely way or given the attention they required at this time. We have made a recommendation about this in the main report.
The home was clear about its responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), staff were suitably trained and supported people to make informed decisions about their care.
The home had developed effective links with healthcare professionals, and specialists were involved where necessary to ensure people had access to expert advice. However the arrangements in place to contact health care professionals could have been improved to ensure people always received medical assistance when they needed it. Staff with authority to contact such professionals were not always on duty and sometimes health professional advice was not fully implemented.
Staff had developed positive relationships with people and were kind and caring in their approach. We observed that they responded to people’s care needs and attended to them politely and with kindness. However, people told us that some staff were not as kind as others and could sometimes be abrupt and rushed. We have made a recommendation about this. People were given choices in their daily routines and their privacy and dignity was respected. People were supported to be as independent as possible.
People were assisted to take part in activities and daily occupations which they found both meaningful and fulfilling. People told us that they enjoyed the activities which had been organised with individuals in mind. Staff had put thought into arranging an environment which would stimulate people’s interests. For example we saw rummage boxes of interesting objects and interesting pictures on the walls which may stimulate reminiscence. Activities ranged from one to one time, group outings and clubs.
People were encouraged to complain or raise concerns. The home supported them to do this and concerns were resolved with learning points recorded to improve the quality of care.
The leadership promoted an open culture and people told us that the manager was approachable and responded to their comments. However, some people told us that the manager was not very visible around the home and that they would appreciate a more proactive approach. Communication at all levels was clear and staff understood their roles and responsibilities which helped the home to run smoothly. The provider understood the home’s strengths, where improvements were needed and had plans in place to achieve these with timescales in place.
Systems were in place to assess and monitor the quality of the service. However, we have made a recommendation in the main report about ensuring that information gathered during auditing is used to improve the service.
People we spoke with said: 'The home is spotless.' and 'I have no complaints. It is clean and pleasant.' Staff told us they had worked hard to address the issues we had identified during our last inspection. They said 'We have tried our best to put things right.'
We saw that people had individualised care records and risk assessments in place which helped staff to understand and meet people's needs. Everyone we spoke with told us they were generally happy with the care and support they received. One person said 'If I need help I can ask for help. They are trying to keep me as independent as possible.' Another person said 'The care is good here." People who could not give us their views were seen to be well dressed and looked well cared for.
People were not protected from the risk of infection because appropriate guidance had not been followed. We have asked the provider to address this.
During our visit we saw that there was enough skilled and experienced staff to meet people's needs in a timely way. This was confirmed by observation and by speaking with people. One person said 'I get on well with the staff; they are there when I need them.'
People were made aware of the complaints system. People we spoke with said they could raise issues if they felt they needed to, but said they had no complaints to make.
We spoke to three people who use the service and were able to talk to tell us about their experiences. Their comments about the home included 'very nice, I've no complaints at all', 'it's very nice, I like living here', 'very polite, knock on the door before they come in, nice girls' and 'they are very kind and very thoughtful'. They confirmed that there was a choice of meals, for example 'if you don't like what's on the menu they'll get something else'. Comments made to us about the home's staff included 'they are alright, yes, I've no complaints at all', 'the staff are good' and 'it's organised, they are very good with us all'.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed staff interacting well with people and providing care and support in kind and friendly ways. For example, we saw a staff member get down to one person's level, stroke their hand and provide comfort and reassurance when they became distressed. We also saw staff offering people a choice at meal times by showing them the different foods that were available and asking what they wanted. This helped people to make up their own minds and have a real choice.
We spoke to the relatives of three people, who told us that the home kept them informed and involved with their relatives care. Comments made to us included 'I was involved in the assessment and decision making because (name of person) is unable', 'they ring me if they are concerned, they are on the ball like that' and 'his specific carer rings regularly and we've had lots of discussions about his care'. Comments made to us about the care included 'I think the care is good basically' and 'they are kind with her'.
We also spoke to three of the home's care staff, the recreation and leisure coordinator and the home's manager. Staff told us that they were well trained and supported by management and thought that the home provided a good service.
While we were visiting the home we had the opportunity to talk to a social care professional who works for the local authority. They told us that staff appeared to understand people's needs and that the service communicated well if they were experiencing any difficulties with someone's care.