Background to this inspection
Updated
13 July 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 29 and 30 May 2018 and was unannounced. The inspection was undertaken by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Prior to the inspection we reviewed the information we held about the service, including statutory notifications received. Providers are required by law to submit statutory notifications about key events that occur at the service. We did not ask the provider to complete a provider information return (PIR) prior to this inspection due to the short timescale between inspections. A PIR is a form that asks the provider what they do well and what improvements they plan to make. We reviewed the action plan submitted after our last inspection in which the provider outlined the improvements they planned to make in order to address the breaches of legal requirements.
During the inspection we spoke with two people, four relatives and ten staff, including the registered manager, care staff, the chef and domestic staff. We reviewed four people’s care records and six staff records. We looked at records relating to the management of medicines and the management of the service. We undertook general observations and used the short observation framework for inspection (SOFI) at mealtimes on both days. SOFI is a means of gathering people’s experiences for those unable to express their views verbally. We also spoke with three visiting professionals including representatives from the local hospice, the care home support team and the GP practice. We received feedback from the local authority and received copies of reports from recent quality monitoring visits.
Updated
13 July 2018
St Mary’s Lodge Residential Care Home for the Elderly 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. St Mary’s Lodge Residential Care Home for the Elderly does not provide nursing care. St Mary’s Lodge Residential Care Home for the Elderly accommodates up to 40 older people in one adapted building. At the time of our inspection 19 people were using the service. However, three of these were currently in hospital following a period of ill-health.
At our previous inspection on 5 and 14 December 2017 we found eight breaches of legal requirements. We rated the service ‘inadequate’ overall. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. At this inspection we rated the service ‘requires improvement’ overall and for each question.
A registered manager remained in post. 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 this inspection we found sufficient action had not been taken to address all of the previous breaches of regulations and the provider remained in breach of three regulations.
Improvements had been made to the safety of the service since our last inspection. However, further improvements were required in regards to fire safety, supporting people with their mobility and planned work to replace the boiler. We also saw sufficient action had not been taken to ensure recruitment procedures were robust and ensure suitable staff were employed.
Improvements had been made to the service and the provider had completed the majority of actions following our last inspection. However, there were still areas requiring improvement and a robust governance framework was not in place. The provider had started to analyse information relating to incidents but this information was not yet being used to improve service delivery.
Despite the continued beaches of regulation we did find improvements had been made and the provider had taken sufficient action to address the other five breaches of regulations.
Safeguarding procedures were now adhered to and any concerns about a person’s welfare were reported to the local safeguarding adults’ team. The maintenance of the service had improved and we saw equipment was being regularly serviced to ensure it was in good working order. Improvements had been made to the delivery of training to ensure staff had the knowledge and skills to undertake their duties. Supervision and appraisal processes had also been reviewed and improved. The registered manager submitted statutory notifications to the CQC about key events that occurred at the service and were displaying their CQC rating. People, relatives and staff found the registered manager to be open, honest, approachable and accessible.
The registered manager had taken on board advice from us, the local authority quality team and community professionals to improve practice. However, there was an acknowledgement that the recruitment of a new manager would further strengthen the management and leadership of the service. Nevertheless, we would recommend that registered manager continues to attend local authority and clinical commissioning group meetings to enable them to stay up to date with best practice guidance and keep their knowledge and skills refreshed.
Improvements had been made to the quality of care records. These were updated regularly and provided detailed information about people’s needs. Staff were supporting people with their end of life choices and were working with specialist palliative care staff. Improvements had been made since our last inspection regarding staff’s interactions with people and we found staff were kind and caring. More information had been made available about people’s individual interests and life histories. However, we found mealtimes were disorganised and did not always enable people to be as independent as they could be. Staff were not dedicating their time to support one person at a time and this could be confusing for people.
The activities programme had been developed and there were daily group activities delivered. However, we felt further improvements were required to engage and stimulate people living with dementia and to provide further one to one support. Our previous recommendation still remains and we recommend the provider consults and implements best practice regarding the stimulation and engagement of people living with dementia.
The environment had been improved, including removing heavily patterned carpet which could be confusing for people living dementia and completing building work to make the service more accessible. However, whilst improvements had been made to the environment we saw further action was required to provide a dementia-friendly environment. We recommend the provider continues to consult and implement best practice guidance to provide a dementia friendly environment.
Medicines management processes were safe and people received their medicines as prescribed, including in relation to topical creams. There were sufficient staff to meet people’s needs and prompt assistance was provided in response to call bells.
People received prompt support with any dietary requirements and there was regular access to food and drinks. Staff regularly liaised with healthcare professionals to ensure people’s health needs were met. Staff adhered to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
Visitors were welcomed at the service and staff supported people to stay in touch with their families. People’s privacy and dignity was respected. Staff were supportive of people’s culture, religion and sexuality.
A complaints process remained in place. The staff had received a number of compliments since the last inspection.
You can see what action we have asked the provider to take in response to the continued breaches of regulation at the back of the main report.