The Lodge

The Lodge is a residential care home providing personal and nursing care to up to 36 people. The service provides support to adults and people living with dementia. At the time of our inspection there were 27 people using the service.

The care home accommodates people in one adapted building across three floors. There are communal living areas, bathrooms and a dining space. The home also has a garden with has several seating areas.

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

Risks to people were assessed, and measures were taken to mitigate risks to ensure people received care and support in a consistent and safe way. Staffing rotas evidenced there were enough staff deployed to provide people with the care and support they required; the provider had reviewed and increased staffing levels following our previous inspection.

Medicines were safely managed and administered by trained nurses and senior care staff, staff received regular observations of their practice. Staff were recruited safely, and people were protected from the risk of abuse.

There was a positive, person centred approach to the planning and delivery of people's care. Staff knew the people they were supporting well and understood how to support people in line with their preferences and wishes. The provider and manager had quality assurance systems in place which ensured all aspects of the service were regularly audited. Where issues were identified, action plans were put in place to improve the quality of the service.

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 1 February 2022). 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 also received concerns in relation to the safety of the service. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk.

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.

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 based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge 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.

The Lodge is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 36 people.

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

There were not always enough staff on duty to meet people’s needs in a safe and timely manner. Staff interactions with people, although kind and caring were short, and task orientated because staff were so busy. Risks to people’s safety were assessed but measures recorded to reduce the risks were not always followed. When there were concerns of abuse there had not always been an investigation completed in a timely manner.

Staff had not always completed training as per the guidance in the provider’s training policy. The manager was supporting staff to complete the required training. People who could not eat food of a normal consistency were not always supported to choose their what they ate and drank.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There was not always records of decisions made having been made in people’s best interest.

People told us staff were caring however, as staff were so busy they did not have the time to offer companionship or engage in meaningful conversation. There were times when staff were not available to respond to people who requested help.

There was not always the opportunity for people to take part in activities they enjoyed. Activities were offered but people told us this was not as often as they would like. People’s communication needs were assessed, and information was provided to them in a format they could understand.

The Lodge was going through a period of improvement and change. The manager had been in post for five months. They had written and were working towards an action plan of improvements.

People, relatives and staff spoke highly of the manager. The manager was supported by the area manager and provider. All were working towards continuing to implement, embed and drive forwards improvements within the home. The manager completed meaningful audits that identified where improvements were required.

There were plans to prevent and manage outbreaks of infection. All staff were vaccinated against Covid-19. People and staff were supported to undergo testing appropriately.

Healthcare professionals who regularly visited the home gave positive feedback about timely medical referrals and staff following the advice they left. People’s bedrooms were decorated and furnished in a way that met their individual needs and preferences.

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 December 2017)

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service was allegedly subject to abuse. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the recognition and management of potential abuse.

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 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.

We have identified breaches in relation to safety and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

We served the provider with a warning notice against regulation 18 (Staffing). This means the provider was asked to review the staffing levels before 13 January 2022. The provider did this and gave assurances of increased staffing levels from there on.

Follow up

We will request an action plan from 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.

At our previous inspection in October 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Regulations 11,12 and 17 relating to consent, medicines and governance. We asked the provider to complete an action plan to show what they would do and by when to improve the rating to at least ‘good’. At this inspection we found improvements had been made.

The Lodge is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Lodge accommodates up to 36 people in one adapted building. At the time of our inspection 27 people lived at The Lodge.

The service is required to have a registered manager. 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 the time of our inspection there was a registered manager in post and the provider had notified us about a period of absence they were taking. In the registered manager’s absence, arrangements had been made for the deputy manager to provide management cover.

Arrangements to ensure sufficient staff were consistently available had not yet been fully embedded. This had resulted in occasions of insufficient staffing. Actions were being taken by the provider to help keep staffing levels sustainable.

People made their own decisions in relation to their care and support. Where they needed support to make decisions their rights were protected under the Mental Capacity Act 2005. People understood their care and support because they received information in a format that met their needs.

Medicines were managed safely and practices were in place to prevent and control any infections.

A registered manager was in place. The provider had notified us of a period of absence taken by the registered manager; they had arranged for the deputy manager to provide oversight of the service in their absence. The deputy manager understood their responsibilities for the management and governance of the service.

Systems were in place to monitor and improve the quality of the service provided. These informed the deputy manager who had identified where further improvements were required. The service was focussed on achieving good quality outcomes for people. The service was managed with an open and transparent culture where care was centred on the individual person and staff were valued.

People were kept safe and the risk of abuse was minimised because the provider had systems in place to recognise and respond to allegations or incidents. Other risks were assessed and actions taken to reduce known risks. Pre-employment checks were completed on staff to check their suitability for the role. Staff received support for any needs identified in relation to protected characteristics of the Equalities Act (2010).

Staff received training in areas relevant to people’s needs and in line with the aims of the service. Staff received support through supervision and staff meetings. People’s health and any associated risks were monitored and responded to; referrals to other healthcare services were made where this would be of benefit. Staff provided care to help people maintain a balanced diet.

The premises had been adapted so as to be accessible to people with mobility aids. Signage had been used to help orientate people around the premises.

People were cared for by care staff who were kind and caring. Staff respected people’s privacy and dignity. People were supported with their independence by staff and had control over their choices.

People were involved in decisions, as well in the planning of their care and support. Staff were aware of people’s interests, hobbies and preferences. People received support for any needs identified in relation to protected characteristics of the Equalities Act (2010).

People knew how to raise issues and complaints and where they had done so these had been investigated and people had received a response. People’s views had been actively sought and used to improve the service.

There is a requirement for The Lodge to have a registered manager and there was a registered manager in place at the time of this 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 service is registered to provide nursing and residential care for up to 36 people, including some people living with dementia. At the time of our inspection 33 people were using the service.

Systems and processes to check on the quality and safety of services provided to people were not always effective at identifying shortfalls.

Medicines were not managed and stored safely in line with good practice. The provider could not demonstrate that people, whose fluid intake was monitored, received sufficient fluids. In addition, some people required repositioning at regular intervals to prevent and reduce the risks associated with pressure areas. The provider could not demonstrate these people were always repositioned at the frequency identified as required by the provider.

Policies and procedures were in place for the Mental Capacity Act 2005 (MCA). Applications for assessments using the Deprivation of Liberty Safeguards (DoLS) had been made when required. However care plans for people who lacked the capacity to consent to their care, did not contain a mental capacity assessment and best interest’s decision to inform the provision of care and support.

People were supported to enjoy mealtimes and received sufficient food and drink. However, staff did not know one person had diabetic needs and not all lists in the kitchen included people’s diabetic needs.

People were supported by staff who were compassionate and caring. Staff listened to people and respected their choices and decisions. Care and support respected people’s privacy and dignity. People’s independence was supported.

People received responsive and personalised care from staff who understood them and their interests. People were supported to engage in enjoyable interests and activities. People were asked for their views and people knew how to raise concerns or make suggestions.

The registered manager had taken action to recruit new staff to ensure they could provide sufficient numbers of staff to meet people’s needs. Any risks to people were identified and assessed and monitored.

Staff were supported through supervision and training. Staff received training in areas that were relevant to the needs of people using the service. People were supported to access other health care services as required.

The registered manager was viewed as being open and approachable and involved in the day to day management of the service. The registered manager was supported in their leadership by motivated and supportive staff.

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

People told us the care they received at The Lodge was good. One person said, "I feel quite at home here." Another person's relative told us they were , 'Very happy. The staff are very supportive and caring.'

We found the home was being refurbished and decorated. The premises were generally safe, comfortable and accessible, including for people with mobility difficulties. We saw that sufficient equipment was available to provide people's care. The provider had ensured equipment was safe for people to use.

We saw that people's consent was obtained for their care, and that the deputy manager was working to ensure proper procedures were used if they could not make their own decisions, for example due to dementia.

We saw that plans were in place describing how people should be cared for and any risks that could affect them were assessed. The deputy manager had made improvements to some aspects of people's care, including when they were at the end of their lives. This meant that people received consistent, safe and appropriate care that met their needs and ensured their welfare.

We found that adequate systems were in place at The Lodge for dealing with complaints and comments about the service.