Archived: St Mary's Lodge Residential Care Home For The Elderly

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.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was also one of the provider’s directors.

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 a 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 accommodates up to 40 people across two adapted buildings that are joined together. Accommodation is provided on two floors with lift access between them. The service provides care and support for older people who are living with dementia. There were 33 people using the service at the time of our inspection.

This inspection was prompted following receipt of information from the local authority which raised concerns for the safety and welfare of people living at the service. These concerns related to a lack of heating and access to hot water. We looked at these concerns as part of this comprehensive inspection.

The registered manager had not provided evidence that they were fit to undertake their duties and had not learnt from previous CQC inspections they had been involved with under a different provider. There lacked management oversight of the service and there were insufficient processes in place to review and monitor the quality of the service. The registered manager had not consistently adhered to the requirements of their CQC registration and had not submitted notifications about key events as required.

Staff were unclear about their roles and responsibilities and there was not a clear vision or values in place regarding service delivery. The registered manager did not use feedback from people and/or their relatives to improve the quality of the service.

People were not provided with a safe and well maintained environment. People had gone a number of weeks without access to appropriate heating and hot water due to a boiler breakdown. The registered manager had not appropriately identified and managed environmental risks. The premises were not sufficiently maintained and effective systems were not in place to monitor and reduce the risk of infection. The design and layout of the premises did not fully promote people’s independence and consider the needs of people living with dementia.

Whilst the majority of medicines were stored securely and appropriately administered, recorded and disposed of, we saw safe practices were not followed regarding the storage and application of topical creams. The provider did not appropriately follow safeguarding adults’ procedures to protect people from harm.

Staff recruitment checks were not fully completed and therefore there was a risk that people were supported by unsuitable staff. The provider’s training matrix showed significant gaps and inconsistencies in staff’s completion of these courses and did not correlate with staff training certificates that we were shown. We could therefore not be fully assured that people were supported by suitably trained staff who had the appropriate skills and knowledge to support their needs. We found staff were not always adequately supported. Our inspection of supervision records demonstrated a lack of appropriately structured staff supervision and staff had not received an appraisal of their work since 2016.

Relatives told us people on the whole had built caring relationships with staff. Staff had asked relatives for information about people’s likes, interests and life histories. However, we saw inconsistencies in the recording of this information and did not see many examples of where this information was used to provide people with meaningful engagement and interactions.

The activities coordinator provided a programme of activities. However where people chose not to engage with activities we saw there was little alternative stimulation and engagement provided for people. An example of this was where people were living with dementia. We recommend the provider consults and implements best practice regarding the stimulation and engagement of people living with dementia.

Staff supported people to make choices and took account of people’s communication and sensory limitations when supporting people to make decisions. Staff respected people’s privacy and maintained their dignity. There were no restrictions in place regarding visitors and relatives told us they felt welcomed by staff to visit their family members.

There were sufficient staff to meet people’s needs and risks to people’s individual clinical needs had been identified and managed. The care records we sampled contained detailed information about people’s assessed needs and how support was to be delivered. However, we received information from the local authority that this was not consistently available. They found care records were not always updated in a timely manner to ensure they reflected people’s current needs.

People were provided with adequate support to ensure their nutritional, hydration and health needs were met. The provider participated in the NHS England vanguard ‘red bag’ initiative to improve consistency of care when people required hospital admission. Staff supported people in line with the principles of the Mental Capacity Act 2005, including application of the Deprivation of Liberty Safeguards (DoLS).

A complaints process was in place to ensure any concerns raised were recorded and investigated.

The provider was in breach of legal requirements relating to safe care and treatment, safeguarding, staffing, fit and proper persons employed, good governance, premises, requirements relating to the registered manager and the submission of statutory notifications.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and 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.