Archived: Ernehale Lodge Care Home

Ernehale Lodge Care Home is a residential home providing personal and nursing care to 13 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

The provider was aware that improvements were still needed to the care planning and risk assessment process. They had an action plan in place to address this. Local authority commissioners commented on improvements at the home, although, they also required evidence of the capability of these improvements to be sustained.

The were some improved management and governance procedures in place. A new manager, with a history of improving struggling homes was now in place. They, along with the provider, had implemented new procedures to help continually act on concerns. This led to improved feedback from people and staff. Staff commented on the improvements the manager had made since she came to the home.

Improvements had been made to the premises and equipment used to provide people with the care and support they needed. The home was clean, tidy and obvious hazards to people’s safety had been removed. This included a safe, secure and tidy garden space for people and staff to use. Some improvements to the décor of the home had been made, although further improvements were still required. The immediate risk to people’s health and safety had been reduced.

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 7 July 2021)

At this inspection there was not enough evidence to show that the improvements had been made in all areas and the provider was still in breach of regulations.

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection unless all of a key question have been assessed.

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.

Ernehale Lodge Care Home is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

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

There were widespread and significant shortfalls in the way the service was led. There were three breaches of the Health and Social Care Act 2008 (Regulations) 2014. The delivery of high-quality care was not assured by the leadership, governance or culture in in the home

Staff felt unable to raise concerns with the provider. Staff did not feel listened to or that their views mattered. Overall governance of the home was ineffective. Limited or no action was taken to address known risks. The environment in which people lived and staff worked was unsafe in places. The provider had not acted to address this.

People’s care records did not always reflect their current care needs and increased the risk to their health and safety. People who needed continuous supervision were provided with the staff to keep them safe; however, staff were not provided with the guidance needed to support them in a way that reduced the risk of them presenting behaviours that may challenge. This resulted in increases in agitation and anxiety for these people. It was noted that the provider had ensured staff supported one person with this care whilst an application for funding from the Local Authority was being made. This helped to reduce the immediate risk to the person's safety.

People’s medicine records were not always correctly completed. The clinical room where medicines were stored had damaged and/or broken furniture. Robust infection control procedures were not always followed. This increased the risk of the spread of infection. People did not always receive the support they needed to maintain good nutritional health.

Accidents and incidents were reported to the relevant agencies; although little action was taken to support staff with learning from mistakes made. Staff supervision was not consistently provided. Staff felt unsupported by the management.

Safe recruitment processes were followed; however, when agency staff came to work at the home, no formal induction was provided. Staff responded quickly to call bells and other requests for assistance. People were not left alone and unsupervised. People told us when they asked for help from staff, they always responded quickly.

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 home 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 good (published 3 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the home, infection control and people’s safety. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ernehale Lodge Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, premises and equipment and governance at this inspection.

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.

Please see the action we have told the provider to take at the end 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.

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.

Ernehale Lodge Care Home is residential care home which provides accommodation for up to 30 people who require nursing or personal care. At the time of the inspection 14 people were living at the home.

People’s experience of using this service:

Since our last inspection improvements had been made in all areas where we had highlighted significant concerns to people’s health and safety.

Improvements had been made to the way risks associated with people’s care were assessed and acted on. People were now provided with safe care and treatment. People were now protected from the risk of avoidable harm and abuse. The provider ensured the relevant authorities were now informed of all incidents that could affect people’s safety. People told us they felt safe with staff. There were enough staff to support people safely. The risk of the spread of infection was now safely managed. The provider had systems in place to help staff to learn from mistakes. People’s medicines were safely managed.

People were now 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 received care in line with their assessed needs. Staff were well trained and felt supported to carry out their role effectively. People received the support they needed to maintain a healthy diet. People had access to other health and social care agencies where needed. The home was well-maintained and adapted to support people living with dementia or disability.

People praised the approach of staff. They liked them and had formed positive relationships with them. People and staff commented on an improved atmosphere at the home. Our observations supported this. People were treated with dignity and respect and their independence was supported and encouraged. People felt able to give their views and they would be acted on.

People now received care and treatment in accordance with their likes, dislikes and preferences. Care records were improved and provided staff with person-centred information which enabled them to care for people in their preferred way. Activity provision had improved and people no longer felt socially isolated. Efforts had been made to provide people with information in formats they could understand. People felt staff responded to complaints or concerns raised. The complaints procedure did not contain the correct details of who could investigate complaints if they were not satisfied with the outcome. End of life care was provided where required. Efforts were being made to ensure that all people had the opportunity to have their wishes recorded.

Significant improvements had been made in the way the home was managed. Quality assurance processes had improved since our last inspection. The registered manager and provider now worked together to identify and act on risks to people and the environment. We had confidence that these improvements were sustainable.

The registered manager had been in place for almost twelve months; people and staff commented on the positive impact they had had on the home. Our observations supported this. The registered manager and provider had a good knowledge of the regulatory requirement to report concerns to the CQC and had improved the reporting process. People’s views about the quality of the service provided were requested and acted on to aid continual improvement and development.

Rating at last inspection and update:

The last rating for this service was inadequate (published 10 July 2019). The service’s rating has now changed to good.

This service has been in Special Measures since 17 December 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

People’s experience of using this service: The service was not safe. People were placed at risk of harm as risks associated with their care and support and the environment were not managed safely. Opportunities to learn from accidents had been missed which meant people had been exposed to the risk of avoidable harm. People were not protected from the risk of infection. Although people told us they felt safe, action had not always been taken to protect people from improper treatment and abuse. Overall there were enough staff, however, there were concerns about night time staffing levels. Safe recruitment practices were followed.

People’s rights under the Mental Capacity Act 2015 were not protected. Staff required more effective training and support to enable them to provide high quality care. We have made a recommendation about this. Mealtimes were positive experiences; however, more work was needed to ensure risks were managed safely. People had access to a range of health care professionals. Overall, the home was adapted to meet people’s needs, but further work was needed to ensure the environment was well maintained.

People’s right to privacy and to be treated with dignity were not always upheld. People told us that staff were kind and caring. However, care plans lacked information about people which meant staff did not always have enough information to provide person centred care. There was an inconsistent approach to involving people in decisions about their care and support.

People did not consistently receive personalised care that met their needs. People were not consistently provided with opportunity for meaningful activity. People were supported to raise issues and concerns and there were systems in place to respond to complaints.

Ernehale Lodge Care Home was not well led. There had been a failure to identify and address issues with the safety and quality of the service. Systems to monitor and improve the quality of the service were not effective. Where audits had identified areas for improvement action had not been taken to address issues. This failure to identify and address issues had a negative impact on the quality of the service and for people living there.

The service met the characteristics of Requires Improvement in three areas and Inadequate in two areas; more information is in the full report.

Rating at last inspection: Inadequate (report published on 8 January 2019). At the last inspection September 2018, we asked the provider to take action to make improvements in relation to promoting dignity and respect, risk management, staff recruitment and governance and leadership. At this inspection we found action had been taken in some areas but not others. You can see what action we told the provider to take at the back of the full version of the report.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: You can see what action we told the provider to take at the back of the full version of the 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.

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.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

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

Accommodation for up to 30 people was provided over two floors. The service has 20 bedrooms, ten of which are intended for shared use. There were 26 people using the service at the time of our inspection. Ernehale Lodge Care Home is designed to meet the needs of older people living with or without dementia.

The last inspection was on 5 and 6 June 2017, when we rated the service as Requires Improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well-Led to a rating of at least Good. On this inspection, we found these improvements had not consistently been made.

People were not protected from risks associated with their health needs. Risks associated with the service environment had not always been assessed and mitigated. There was no comprehensive system to enable the registered manager or provider to review accidents and incidents. People’s medicines were not always managed safely. People were not kept safe from the risks associated with infection. The provider had not carried out thorough recruitment checks to ensure staff were suitable to provide personal and nursing care. Staff did not have training the provider identified as necessary to do personal and nursing care effectively.

People were not consistently supported to have enough to eat and drink to maintain a balanced diet. People were not always supported to have their daily personal hygiene needs met. People sharing bedrooms did not have their privacy and dignity needs considered. People did not always have their privacy and dignity considered when receiving care. Written information about people’s care was not stored securely.

People and relatives were not consistently supported to participate in making decisions about planning or reviewing of their or their family member’s care. Information in people’s care plans was not consistently kept up to date. This meant there was a risk staff did not have the information they needed to provide personal or nursing care people were assessed as needing.

There was limited evidence the provider undertook any surveys with people or staff at the service to identify what was working well and what improvements they would like to see. There was a risk that the views or people, relatives and staff were not used to drive improvements in the service.

The service was not well-led. During this inspection we identified shortfalls across all of the key questions we ask about services. Systems in place to identify whether people were receiving the care they were assessed as needing had not identified the issues we found on this inspection. Feedback had not been acted on to improve the quality of care for people living at the service. The provider had not taken steps to demonstrate the quality of the care people received was reviewed as part of an effective governance process.

People and relatives said they felt safe living at the service. People were kept safe from the risk of abuse. The systems in place to identify and deal with concerns worked to safeguard people from abuse. People and relatives had mixed views about staffing levels. The provider reviewed people's care needs and adjusted staffing levels to ensure people received the care they required. People were supported to access their GP and other external healthcare when they needed. Feedback from external healthcare professionals was positive regarding staff seeking medical advice in a timely way. People and relatives knew how to raise concerns or make a complaint. They felt they would be listened to, and changes made as a result.

The provider was planning work to improve the building, and had taken steps to ensure the environment was suitable for people's needs. People spoke positively about the activity opportunities available, and had support to maintain interests and hobbies.

People's consent to care was sought for daily personal care activities. 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 provider was working in accordance with the Mental Capacity Act 2005 (MCA), and people had their rights respected in this regard. People's right to private and family lives were respected. People and relatives were supported to discuss their end of life care, and staff knew how to support people and their relatives in the way they wanted.

The service had a registered manager at the time of our inspection visit. 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 four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

Ernehale Lodge had been taken over by a new provider at the start of April 2017. The registered manager and staff team had been transferred over from the previous provider.

The service had a registered manager in place at the time of our inspection. 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.

During our inspection we found the systems in place to reduce the risks associated with people’s care and support were not always effective. People were not protected from risks associated with the environment and the service was not clean and hygienic in all areas. People received their medicines as prescribed; however medicines were not always stored or managed safely.

There was a risk that people may not receive the support they required as there were not always sufficient numbers of staff deployed. Safe recruitment practices were not always followed. Staff did not always receive suitable training or support to enable them carry out their duties effectively and meet people’s individual needs. Staff were provided with regular supervision.

People’s rights under the Mental Capacity Act (2005) were not respected at all times. In addition, people could not be assured that they would be supported in the least restrictive way possible. Where people had capacity they were enabled to make decisions and their choices were respected.

People were not protected from the risk of dehydration and malnutrition as people’s food and fluid intake was not always appropriately monitored. However people told us they enjoyed the food and had enough to eat and drink. People had access to healthcare and their health needs were monitored and responded to.

People’s right to privacy was not respected at all times and they were not always treated in a dignified manner.

Staff were kind and caring and had an understanding of what was important to people living at the home. People felt involved making choices relating to their care and were supported to maintain their independence. People were supported to maintain relationships with family and friends and visitors were welcomed into the home.

People could not be assured that they would receive the support they required as care plans did not always contain accurate, up to date information. People were not consistently provided with the opportunity for meaningful activity. However there were plans in place to make improvements in this area.

People were supported to raise issues and concerns and there were systems in place to respond to complaints. People and staff were involved in giving their views on how the service was run.

Systems in place to monitor and improve the quality and safety of the service were not effective. Action had not been taken to review and update important policies and documents relating to the running of the home. Sensitive personal information was not always stored securely. The provider had plans in place to improve some aspects of the service.

The above concerns in relation to the quality and safety of the service resulted in us finding multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to privacy and dignity, safe care and treatment, staffing, consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.