We carried out a review of the data available to us about Lofthouse Grange and Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Lofthouse Grange and Lodge, you can give feedback on this service.
Lofthouse Grange and Lodge is a residential care home providing personal care to people aged 65 and over. At the time of the inspection 71 people were receiving care. The service can support up to 88 people.
People’s experience of using this service and what we found
People were protected from the risk of abuse. Staff received training in this area and knew what actions to take if they suspected abuse.
There were enough staff to meet people's needs and the registered manager followed safe recruitment processes. Risks to people and the environment were considered and regularly reviewed and monitored. Staff supported people with their medicines and kept people safe from risk of harm.
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.
The registered manager had good oversight of the home and the staffing team. There were clear quality monitoring systems and processes in place. Following incidents, the provider ensured lessons were learnt to drive improvement in the service. People and staff felt included in the decisions made at the home and there was an inclusive culture.
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 09 June 2020).
Why we inspected
The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
The information CQC received about the incident indicated concerns about the management of falls. This inspection examined those risks.
We have found evidence that the provider has made improvements to the reporting of accidents and incidents and falls monitoring.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lofthouse Lodge and Grange 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.
Lofthouse Grange and Lodge is a residential care home providing personal care to 63 people aged 65 and over at the time of the inspection. The service can support up to 88 people.
People’s experience of using this service and what we found
Care plans generally contained good person centred information and were updated regularly.
There were enough staff trained and deployed to ensure people’s needs were met, however some people gave mixed feedback around staffing levels and staff not being present in communal areas. We have made a recommendation around staff deployment.
People were kept safe from abuse and harm by staff who were recruited safely and trained in safeguarding procedures. People received their medicines as prescribed.
People received good access to health and social care professionals, and their health and wellbeing was monitored and managed appropriately by staff who had been adequately trained and supported by the provider.
People and their relatives praised staff for their kindness and compassion. Staff demonstrated that they knew people well, and supported people to maintain their independence, dignity and privacy.
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.
There were adequate systems and processes to monitor and improve the quality of the service delivered. There was a new management team in post who demonstrated that they were engaging proactively with people to ensure their opinions were heard and used to improve the service.
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 12 July 2019).
Why we inspected
This was a planned inspection based on the previous rating.
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.
Lofthouse Grange and Lodge is a residential care home that was providing personal and nursing care to 47 people aged 65 and over at the time of the inspection.
People’s experience of using this service:
People and their relatives said that the service was safe and clean. They told us that there were enough staff to meet their needs. Recruitment methods for new staff were safe.
People received their medicines from trained staff. Medicines storage and administration were monitored appropriately.
Where incidents had occurred, they were investigated and recorded, and outcomes were shared with staff and partner agencies. Risks to people’s safety were assessed and instructions for staff on how to reduce them were clear.
There were quality monitoring systems and processes in place to identify how the service was performing and where improvements were required. These included daily checks and quarterly audits.
There were regular residents and relatives’ meetings, staff meetings, and the service used surveys to gather feedback from people and staff.
Rating at last inspection:
At our last inspection, the service was rated ‘requires improvement’, with two breaches identified in Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.
We undertook an unannounced focused inspection Lofthouse Grange on 13 and 14 May 2019. This inspection was done to check that improvements to meet legal requirements planned by the provider after our January 2019 inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service well led, is the service safe. This is because the service was not meeting some legal requirements.
No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.
Lofthouse Grange and Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. There were 45 people living at the care home at the time of the inspection.
The care home accommodates up to 88 people across two separate units. One of the units specialises in providing care to people living with dementia.
The service did not have a registered manager in post at the time of the inspection, however the service had appointed a manager who was in the process of registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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.
Staff, people and their relatives expressed concerns about staffing levels. Staffing dependency tools we reviewed were not always reflective of people’s current needs. Rotas we were shown did not always match actual staffing levels. However, we found that there had been improvements made with regards to staffing continuity. Levels of agency staff had reduced, and staff were able to build more effective relationships with people. People and their relatives told us that there had been improvements since the last inspection, however they were still concerned about staffing levels.
We have made a recommendation around staffing levels.
We found that medicines storage areas were clutter free, and staff used an electronic medicines administration records system which helped reduce errors. However, we found instances where practice could be improved to reduce risks to people.
Governance systems and processes had improved and we saw that they were beginning to have a positive impact on certain aspects of the service such as infections, weight loss and falls. However, these processes were not fully embedded and some of the issues we had previously identified in medicines management and staffing had not been addressed.
People told us they felt safe, and staff knew how to protect vulnerable people from harm. The service was clean and there was sufficient equipment in place to prevent the spread of infection such as personal protective equipment and hand gel dispensers.
Staff told us they received good support in the form of induction, training, ongoing supervisions and appraisals. Staff told us the leadership team at the service were approachable and supportive, and that morale at the service had improved since the last inspection.
People’s health and wellbeing was being monitored effectively by staff. Health professionals we spoke with were confident the service was making appropriate referrals, and any guidance or information from healthcare professionals was cascaded effectively to staff. People’s nutrition and hydration needs and preferences were recorded accurately.
People and their relatives told us staff were kind, caring and compassionate. People told us staff worked to uphold their independence and offer them choices to help empower them. Staff described how they protected people’s privacy and dignity.
People were appropriately assessed before using the service, and care plans contained person-centred information and guidance for staff which was regularly updated. People told us there was a good level of activity and stimulation on offer which took into account people’s preferences.
Staff held meetings with people and their relatives, and implemented changes where identified. Staff also demonstrated that they were responding to complaints appropriately. People told us they knew how to make complaints and were confident in the leadership of the service in acting on their concerns.
You can see what actions we told the provider to take at the back of the full version of this report.
Lofthouse Grange and 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. Lofthouse Grange and Lodge accommodates up to 88 people over two communities, referred to as ‘The Lodge’, which accommodates people living with a dementia related condition and ‘The Grange’, which accommodates people requiring residential care. There were 72 people living in the home when we inspected.
At this inspection we found four breaches of the Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any 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 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.
There was a registered manager in post at the time of the 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.
There were not enough staff to meet people’s needs effectively. There was a high turnover of staff and staffing levels were impacted due to sickness and absence. People, their relatives and staff told us they had concerns with staffing levels. There was a high number of agency staff used with the service, and people, their relatives and staff told us they had concerns about continuity of care and competence of agency staff.
Systems and processes around medicines management were not safe. Specifically, we found concerns with the safe storage, administration practice and documentation of some medicines.
Safeguarding referrals were not always made appropriately and there were a high level of falls and incidents which had not been managed effectively. This meant appropriate action had not been taken to manage known risks effectively and reduce the possibility of their recurrence
We found concerns over the cleanliness of the service through our observations and what staff told us. We found malodorous water jugs and dirty fridges. Wheelchairs and pressure mats were often unclean. Automatic hand gel and soap dispensers across the service were not working which put people at risk of cross contamination. Cleaning rotas were sometimes incomplete and had not been reviewed.
The inadequacy of the governance arrangements meant shortfalls were not identified and subsequently preventative action was not taken to mitigate risks. The shortfalls we identified during our inspection had either not been highlighted by the providers internal quality assurance processes, or had been identified with action taken but these actions were not sustained.
People, their relatives and staff told us they thought that permanent staff received good training. However, they said that agency staff were not always sufficiently skilled to meet people’s needs.
Staff gave mixed feedback on their levels of support through supervisions and appraisals. Staff were recruited safely, with appropriate identity checks and references undertaken.
The service was compliant with and acted under the principles of the Mental Capacity Act (2005).
We observed mealtimes and these were pleasant experiences, however, recording of people’s dietary needs was not always up to date.
People told us staff were kind caring and compassionate, however due to other factors the service was not always able to deliver a wholly caring service. Staff were able to describe how they would protect people’s dignity and privacy, as well as promote their independence.
People were assessed appropriately before using the service. Some care plans we reviewed contained good person-centred plans specific to their needs, however in other care plans the quality of information recorded was not always consistent.
Whilst activities were provided by the service and people enjoyed these, some people felt they could do more. Staff said they could not always give people the stimulation they felt they needed. Recording of activities was not always consistent.
There was a complaints process and policy in place. People and relatives were aware of the process but gave mixed feedback about it. Complaints we reviewed were responded to in line with the policy.
Staff told us they were not confident in the leadership of the service and that morale was low. People and their relatives gave mixed feedback on the management of the service.
You can see what action we told the provider to take at the back of the full version of the report.