Stockton Lodge Care Home

Stockton Lodge Care Home is a residential care home providing personal and nursing care to up to 42 people. The service provides support to adults, some of whom are living with dementia. At the time of our inspection there were 33 people using the service.

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

People we spoke with were happy living at Stockton Lodge and felt the staff took good care of them. One person told us, “I am very well cared for. I’ve liked being here. It’s safe.”

Medicines were managed safely. There were systems for ensuring people's safety, however we found some records did not include all necessary information. Following our feedback the registered manager made the necessary improvements straight away. There were enough staff to meet people’s needs and support them safely. The provider had systems and processes in place to protect people from the risk of abuse. The provider had appropriate measures in place to minimise the spread of infection. Lessons were learned following accidents and incidents.

Most people’s care records were up to date and accurate, however, records for those people at the home for a short stay needed to include more detail. The registered manager acted on this straight away. Staff demonstrated a good knowledge of the people they support and considered people’s communication needs when delivering care. People were able to maintain relationships with friends and relatives. Staff supported people to take part in a range of activities. The provider had a complaints procedure in place and any concerns were dealt with appropriately.

Staff felt supported in their roles and told us morale amongst the staff team was good. Staff, people using the service and their relatives told us the manager was approachable and all felt they could go to them with any concerns or ideas. The provider asked for feedback via surveys and questionnaires and action was taken in response to comments received. The registered manager was conducting regular audits and when issues were identified work was done to rectify them. The registered manager and staff liaised with external professionals to ensure people had access to the support they needed.

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 and update

The last rating for this service was requires improvement (published 20 August 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. 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 carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

We carried out an unannounced inspection of this service on 9 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 Stockton Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Stockton Lodge is a residential care home providing personal care to adults and older people, some of whom were living with dementia. At the time of the inspection there were 29 people living at Stockton Lodge but the service can support up to 42 people.

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

Medicines were not always managed safely. Risks to people were assessed but records were not always fully complete. Effective infection prevention and control systems were in place.

People received person centred care but care records were not always up to date or accurate. One person told us, “I’m quite satisfied with my care. They are all good, I can talk to them about anything, what I like and don’t like”.

Quality assurances processes had not identified or resolved the issues we found during our inspection.

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 19 August 2019) and there were two breaches of regulation. 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/ sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the breaches of regulation and other concerns identified at the last inspection had been addressed. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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. This is because they do not assess all areas of a key question.

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.

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 have identified continuing breaches of regulation in relation to safe care and treatment and good governance. 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.

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

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.

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 contained some inaccurate information and had not been followed up in a timely manner. This person’s nutrition care plan did not accurately reflect their current dietary needs.

People spoke very positively about the food they received. There was a relaxed atmosphere at mealtime and we also observed drinks and snacks being served throughout the day.

Training records confirmed that all essential training was up to date. Staff were also supported with regular supervisions and appraisals.

There were some adaptations around the building to assist people with dementia to find their way around and retain their independence but this could be improved and the provider planned to address this in future refurbishment.

People were supported to maintain their health and wellbeing. People's care records contained evidence of visits and advice from a variety of health professionals.

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.

We observed staff treating people with kindness and compassion. People and their relatives were happy with the care being delivered. Staff treated people with dignity and respect and in a way that supported and encouraged independence.

At the time of our inspection nobody at the service was using an advocate but procedures were in place to support people to access advocacy services where needed. Advocates help to ensure that people’s views and preferences are heard.

People told us they were treated as individuals and felt able to make choices for themselves. People’s religious and spiritual needs were assessed and people were supported to continue practising their religion should they wish.

A daily meeting took place between the deputy manager and the ‘heads of department’ to try to ensure good communication between all staff at the service.

Records indicated people were involved in the planning and review of their care if they wished to be. Some care plans contained a good level of person centred information so staff were aware of life history, likes and preferences. Other care plans needed more of this information.

At the time of our inspection one person was receiving end of life care but had no specific end of life care plan in place.

There was a varied programme of activities and we saw a group of people engaged in bingo and singing in the main lounge area. Some people were also supported to engage in individual hobbies such as wool craft. People were happy with the activities on offer within the home. However, some people said they would like the opportunity to go out more.

Complaints had been handled in line with the provider’s policy and staff knew how to support people to make a complaint.

A programme of audits was undertaken but this was not always effective and had not picked up all of the issues we found. Records relating to the care and treatment of people were not always complete, up to date or accurate.

Feedback was sought from people using the service and their relatives. Staff meetings were held monthly and a recent staff survey contained no negative feedback.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This is the first time the service has been rated Requires Improvement.