Archived: Russley Lodge

Russley Lodge is a residential care home. The service provides support with personal care and accommodation for up to 17 people. At the time of our inspection, 17 people used the service.

The service was providing support to people with a wide range of needs, including younger and older adults, people living with dementia and people living with mental health support needs.

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

Medicines were not managed safely. We found serious concerns which placed people at risk of harm. This included concerns around the ordering, storage, administration and disposal of medicines. Risks associated with choking were poorly managed. Standards for preventing and controlling infection had deteriorated. Staff were not always deployed safely and effectively at key times during the day. Staffing levels were reduced in the afternoon which meant there was a risk of people’s needs not being met.

People were not always supported to have maximum choice and control of their lives. We were not assured that care and support was being provided in the least restrictive way possible. Robust pre-admission assessments were not always completed which meant the registered manager could not always be sure of people’s individual needs before they moved into the home.

There was an inconsistent approach to involvement. This included missed opportunities for the involvement of external advocacy services to support people with more complex decision making. There was a lack of a joined-up person-centred approach that took full account of cultural differences, beliefs, and individual identities. This was a missed opportunity to truly celebrate and promote difference within the service. We have made a recommendation about this in the full report.

In response to Covid-19 restrictions on visiting in care homes, a wooden structure had been built in the grounds. The structure was poorly designed, exposed people to the elements and due to its location adjacent to neighbouring houses, did not enable private and dignified visits between people and their family members and friends. Gaps, omissions and errors in records were present throughout people’s care plans. This meant we could not be assured people’s needs and preferences were consistently met.

Systems for audit, quality assurance and questioning of practice were inadequate. There was an absence of meaningful overarching analysis of the governance systems that were in place. There was a failure to identify themes, trends and newly emerging risks, which placed people at an increased risk of harm. Russley Lodge has consistently been rated as requires improvement with continued breaches of regulations since March 2018. This shows the provider has failed to respond adequately to serious concerns raised by the Care Quality Commission (CQC) and has failed to implement a culture of continuous learning.

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 14 January 2020). At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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

We have identified new and continued breaches of regulations in relation to: safe care and treatment; staffing; dignity and respect; meeting nutritional and hydrational needs; premises and equipment; and good governance.

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.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 rating, we will take action in line with our enforcement procedures.

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.

We found the following examples of good practice

¿ A dedicated room had been established close to the main entrance which contained Personal Protective Equipment (PPE), hand wash facilities and hand sanitiser. Domestic and clinical waste bins were also available.

¿ Only essential visitors were permitted to enter the service. On arrival, a member of staff greeted the visitor, took their temperature, explained and provided PPE and pointed out safety information displayed within the home.

¿ A new Covid-19 care plan had been developed by the management team. This was used to good effect in ensuring people's needs continued to be met and provided guidance for staff in identifying and responding to care and support needs associated with Covid-19.

Further information is in the detailed findings below.

Russley Lodge is a residential care home. The service provides support with personal care and accommodation for up to 17 people. At the time of our inspection, there were 17 people living at the home. The service was providing support to people with a range of needs, including younger and older adults, people living with dementia and people with mental health support needs.

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

Although people felt safe at the service, we found the safeguarding systems had not always been appropriately followed. The premises had been maintained, however we found aspects of the premises were potentially unsafe. We found a low banister rail on the first floor posed as a risk of falls and two windows where there was a risk of falling from height were missing restrictors to prevent the window opening too far.

Risk assessments to protect people from unsafe care were completed, but some assessments would benefit with further detail. We also made a recommendation the service reviews their accidents and incidents systems to ensure themes and trends had been thoroughly analysed.

Procedures to support the safe recruitment of staff were followed and there were enough staff on duty day and night to provide the support people needed. People received their medicines as prescribed and systems were in place for their safe management and supply.

We noted some initial improvements to the quality and safety of the service were being actioned. However, we found aspects of the provider's quality assurance systems needed to be addressed further, as they had not identified their safeguarding procedures were not being appropriately followed and aspects of the homes safety had not been picked up in the health and safety audits.

Rating at last inspection:

The last rating for this service was requires improvement (published 25 July 2019) and there were three breaches of regulation. Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulation 12 (Safe care and treatment) by 29 July 2019.

Why we inspected

The inspection was prompted in part due to concerns received about a safeguarding incident concerning the practice of two staff members. A decision was made for us to inspect and examine those risks. At the time of this inspection this safeguarding matter was also being investigated by the Greater Manchester Police.

During this responsive inspection we also reviewed the warning notice we sent to the provider and the registered manager following our last inspection. Although we found the provider had made improvements in respect of the warning notice, we found evidence the provider needs to make improvements in other areas. Please see the safe and well-led sections of this full report.

The overall rating for the service remained the same 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 Russley Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding systems and ineffective governance systems at this inspection. 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.

Russley Lodge is a residential care home. The service provides support with personal care and accommodation for up to 17 people. At the time of our inspection, there were 16 people living at the home. The service was providing support to people with a range of needs, including younger and older adults, people living with dementia and people with mental health support needs.

The service is located in an adapted building in a residential area. Accommodation is provided over two floors of the building.

People’s experience of using this service:

There was a stable staff team that had got to know people living at the home well. People told us staff listened to them and treated them with kindness and respect.

People were encouraged and supported to engage in activities. The activities co-ordinator recognised the value that activities could have in building people’s confidence and preventing social isolation.

People told us they liked food. The chef had a good understanding of people’s likes and preferences and discussed this with people living at the home. People’s dietary needs and preferences were met.

Whilst we observed there were enough staff to support people during our visit, the same level of support was not maintained at weekends. After 2pm at weekends, there were two care staff on duty until the following day. Given the needs of people living at the home, this would make it difficult for staff to always respond promptly to people needing support. We recommended the provider reviews their staffing levels and ways of working out how many staff they need on duty.

The provider carried out all risk assessments ‘in-house’, including those relating to fire and legionella. We found the legionella risk assessment was not sufficiently detailed. We also found the required safety check of the passenger lift was overdue. The bannister on the first-floor landing was also very low (below waist height), and the provider agreed to address this. We recommended the provider reviews good practice guidance in relation to managing risks in relation to premises and equipment.

In most cases staff had assessed risks in relation to people’s care needs. However, we found two cases where staff had not recorded a risk assessment in relation to significant potential risks. Not all staff were always aware of relevant information contained in people’s risk assessments to help keep them or others safe.

We found some poor practices in relation to the safe management of medicines. During our visit we observed medicines being left unattended and accessible to people living at the home on multiple occasions during a medicines round. Staff were not always recording quantities of medicines in stock accurately which meant we were not always able to check if people had received their medicines as prescribed.

Staff felt supported and listened to. They were encouraged to give their thoughts about how the home could be improved.

We found shortfalls in relation to staff keeping accurate and complete records of care. The provider had not acted on concerns raised by CQC at our last inspection in relation to this, or on the advice of the local authority.

Rating at last inspection:

At our last inspection of the service in March 2018 we rated the home requires improvement (report published 16 May 2018). This is the second consecutive time the home has been rated requires improvement.

Why we inspected:

This was a planned inspection scheduled based on our timescales for returning to services rated requires improvement. Following our last inspection, we requested an action plan from the provider to tell us how they would address the breaches of the regulations we had found. We followed up whether the required improvements had been made at this inspection.

Enforcement/Requirements:

Please see the ‘action we have told the provider to take’ section towards the end of the full report.

Follow up:

We will continue to monitor the service and may return prior to the next scheduled comprehensive inspection to check whether improvements have been made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Russley Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Russley Lodge is registered to provide care to up to 17 older people, including people who may be

living with dementia. Accommodation is based over two floors and there is a passenger lift between the floors. At the time of our inspection there were 16 people living at the home.

There was a registered manager at Russley Lodge. 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.

At this inspection we found breaches in the regulations for consent, good governance and not notifying the CQC of an incident at the home. The Deprivation of Liberty Safeguards (DoLS) for two people had expired and not been re-applied for and a DoLS application had not been made for one person who was restricted from leaving the home. A formal assessment of people’s capacity to consent to their care and support was not completed, although people signed their consent to their care plans when deemed to have capacity.

Care plans and risk assessments were in place. Not all risk assessments had been updated in a timely manner and so were not reflective of people’s current needs. Individual daily logs were not kept. A system of audits was in place but these were not completed on a regular planned basis and were not sufficiently robust to identify concerns identified during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were administered as prescribed; however the medicine administration records did not clearly identify when people self-administered their medication or creams and staff had not signed to record they had applied all prescribed creams. We have made a recommendation that guidelines are written as to when ‘as required’ medicines are to be administered and for the quantity of controlled drugs held at the service to be regularly checked.

We were shown copies of people’s life story books which contained details of people’s families, previous jobs, hobbies and interests. We have made a recommendation that these are made readily available for care staff so they have the information to build meaningful relationships with people living at the home. People’s person centred care plans and care files contained information about people’s likes, dislikes and preferences. Staff knew the people living at the home well.

People said they felt safe living at Russley Lodge and that staff were kind, caring and treated them with dignity and respect. People said they were supported to maintain their independence by completing the tasks they were able to do themselves.

Staff received the training and support they needed to undertake their role. Regular supervisions and team meetings were held.

A safe recruitment system was in place to recruit staff who were suitable to work with vulnerable people. There were sufficient staff on duty to meet people's assessed care and support needs.

People were supported to maintain their health and nutrition. Culturally appropriate food was prepared for those people who wanted it. Visiting health professionals said staff had the information they asked for and followed any guidance they were given. Referrals to health professionals, such as GPs and district nurses were appropriately made.

People’s end of life wishes were documented, including whether they wished to remain at Russley Lodge at the end of their lives if possible. People’s culture needs were also recorded.

Accidents and incidents were recorded and reviewed by the registered manager to reduce the likelihood of a re-occurrence.

The home was clean throughout and equipment was serviced and maintained as per the regulations and manufacturer’s instructions.

An activities co-ordinator arranged activities each afternoon, including arts and crafts or games. People showed the inspector paintings they had completed. Trips out had previously been arranged; however the home’s access to a minibus had stopped. During our inspection the registered manager arranged for alternative transport to be available and said they were due to arrange some trips out in the future.

Surveys were carried out for relatives, people living at the home and staff. The results we were shown were positive; however they were not available for the people living at the home or their relatives to review.

Staff, relatives and people living at Russley Lodge said that the registered manager was approachable and always available to talk with. They were able to raise any concerns directly with the registered manager and these were dealt with.