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Stockton Lodge Care Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 19 June 2019

During a routine inspection

About the service

Stockton Lodge care home is a care home which provides personal care for up to 42 people who are young adults or adults aged 65 and over. On the first day of inspection 34 people were using the service. The service was a purpose-built building which accommodated people on one floor.

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

Staff were not effective managing people who displayed behaviours. This increased the risk of harm to people. Some risk assessments were generic and did not show how to reduce risk. Medicines were not safely managed. We made a recommendation about staffing levels. There was evidence of lessons learned. Systems to manage the risk of infection were in place. People said they felt safe living at the service.

An improved quality assurance system was in place; however, actions were not always addressed. Staff did not always apply new practices designed to improve the overall quality of the service. There was a lack of oversight by senior staff which impacted on improvement. The quality of record keeping needed to be improved.

Care records were not accurate or up to date. This increased the risk of potential harm. People had good access to a range of activities which reduced their risk of social isolation. Everyone knew how to make a complaint. Where complaints had been made, they had been addressed.

People were supported with their nutritional needs. They spoke positively about the food provided. People had regular access to health professionals. Staff had good links with health professionals. Staff were supported to carry out their roles. Further improvements were planned to update the environment.

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.

Staff had good knowledge of people’s needs; their practices promoted people’s independence and well-being. People were involved in all aspects of their care. They told us their care was individualised and dignified at all times.

Rating at last inspection and update

The last rating for this service was requires improvement (Published 1 June 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches in relation to safe care and treatment and good governance. This meant safe practices were not always in place. The systems in place at the service did not continually support improvement.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Inspection carried out on 26 March 2018

During a routine inspection

The inspection took place on 26 March and 12 April 2018 and the first day was unannounced.

This was the service’s first inspection since it had been taken over by this provider.

Stockton 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.

The service accommodates 48 people in one purpose built building. At the time of our inspection there were 33 people using the service.

There was no 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. The provider had appointed an acting manager on a part time, temporary basis and was in the process of recruiting a permanent manager. Following the inspection we received confirmation that the successful candidate had accepted the post and would begin the registration process as soon as possible.

Medicines were stored in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). Staff responsible for administering medicine had received appropriate training.

We found MARs were fully completed, contained required entries and were signed to confirm administration. Controlled drugs were stored securely and stock counts were accurate. We found a number of stock discrepancies in other medicines and as a result of the findings daily stock checks were introduced. Guidance for staff was not in place for all medicines prescribed ‘as required’.

There was a business contingency plan in place that covered a variety of situations including keeping a correct temperature within the home. One of the boilers within the service had recently failed however room temperatures were not checked or recorded. This meant the provider had not taken steps to ensure the temporary solution of using portable heaters had been effective in maintaining a safe and comfortable temperature for the people.

The records of one person who required regular checks due to a pressure area showed that necessary positional changes had been missed. On one occasion there was a 14 hour gap instead of the recommended four hours. As a result of these findings a safeguarding alert was raised with the local authority and an internal investigation was to be undertaken.

People and their relatives told us they felt safe living at Stockton Lodge. Policies and procedures were in place to safeguard people from abuse. People were protected from discrimination, particularly in relation to protected characteristics under the Equality Act.

Fire evacuation training had been conducted by an external trainer but in-house fire drills were not conducted in line with the provider’s statement of purpose, policies and procedures.

Observations during the two days of inspection and people’s comments indicated there was a sufficient number of staff on duty to care for people safely. However, the way people’s dependency levels were calculated was not very precise. The provider was planning to develop a new method for setting staffing levels.

Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken.

Care records contained detailed risk assessments. People had individual personal emergency evacuation plans in place. Accidents and incidents were recorded and analysed monthly to look for patterns or trends. Regular maintenance checks and repairs were carried out and all areas of the service were clean and tidy.

We saw in one person’s records they had lost a significant amount of weight in recent months. A dietician referral had been made but this c