We carried out a review of the data available to us about Lodore Nursing Home 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 Lodore Nursing Home, you can give feedback on this service.
People’s experience of using this service and what we found
People felt safe at the service and relatives felt their family members were safe and well cared for by the staff at Lodore Nursing Home. Risks identified at our previous inspection regarding medicines management had been addressed and medicines were stored, managed and administered safely. Individual risk assessments were undertaken and management plans were in place to minimise and mitigate risks to people’s safety and welfare. Staff had received training on infection prevention and control and were adhering to the government guidance in response to the COVID-19 pandemic, including wearing personal protective equipment (PPE), regular testing and participating in the vaccination programme. There was a comprehensive cleaning schedule in place to ensure a clean and hygienic environment was maintained.
Staff were aware of safeguarding adults' procedures and had received regular training on this topic. The management team told us they had liaised with the local public health teams about the blanket restrictions in place during the COVID-19 pandemic and learnt from the safeguarding concerns raised about the risk and impact of social isolation on people. Individual incidents were reviewed.
The registered manager had strengthened their quality assurance processes in response to our last inspection, including implementing a more detailed medicines management audit and a robust infection control audit. There were other processes in place to review key areas of service delivery, however, we found the care records audit was limited and did not include details about the quality of care records or identify if improvements were required, what action was taken and when. We also identified that whilst care plans were regularly reviewed, the number of updates recorded on the original care plan were often difficult to read and there was a risk that any changes to people’s care and support needs may not be easily identifiable. We fed back our concerns about the care record reviews and care records audit to the registered manager and we will follow up on these areas at our next inspection.
People, relatives and staff felt well informed and involved in service delivery. They said there was open communication between themselves and with the registered manager. They felt comfortable expressing their views and felt listened to. The registered manager was clear about their role, including their CQC registration requirements. Statutory notifications about key events that occurred had been submitted, their latest CQC rating was clearly displayed and the registered manager was aware of and adhering to the duty of candour.
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 requires improvement (published 2 January 2020). The service is now rated good.
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
The inspection was prompted in part due to safeguarding concerns received about blanket restrictions regarding people staying in their rooms and being socially isolated. This inspection examined those risks.
The inspection was also prompted in part by notification of a specific incident, following which a person using the service died. The information CQC received about the incident indicated concerns about the management of medical emergencies. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe section of this full report.
At our last inspection in November 2019 we found a breach of regulation relating to Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulations 2014). The provider completed an action plan after the last inspection to show what they would do, and by when, to improve.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. As well as to follow up on the other concerns identified through the intelligence we had received. This report only covers our findings in relation to the key questions Safe and Well-led.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to good.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lodore Nursing Home on our website at www.cqc.org.uk.
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.
People’s experience of using this service and what we found
Safe medicines management processes were not always followed. Robust procedures were not in place to account for stocks of all medicines and to check people received their medicines as prescribed. Formal audits were not in place to regularly review all areas of medicines management. This put people at an increased risk of harm.
There were sufficient staff to meet people’s needs and provide them with timely support. Safe recruitment practices were in place to ensure suitable staff were employed. Staff were knowledgeable about safeguarding adults’ procedures and any concerns identified were shared with the management team and the local authority safeguarding adults’ team. Risks to people’s health and welfare were regularly reviewed and management plans were in place about how to support people safely. Staff learnt from any incidents that occurred and checked with people and relatives that they were satisfied with how an incident was handled.
People were supported by staff that had the knowledge, skills and experience to undertake their duties. Staff received regular training and supervision to ensure they were up to date with best practice guidance and well supported in their roles. Staff used recognised best practice tools to assess people’s care needs and develop their support plans. People received food and drink that met their nutritional needs and dietary requirements, taking account of their health, cultural background and religious preferences. People had access to healthcare professionals to ensure their health needs were met. Staff liaised with professionals in a timely manner and incorporated the advice given into people’s care plans. 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. A safe, clean and homely environment was provided.
People were treated with respect and dignity. Relatives told us they were thankful for the service the staff provided and they did not need to worry about their family members as they knew they would be well looked after. People were treated with kindness and compassion. Staff involved people in their care. They offered them choices throughout the day and respected their decisions. Staff respected people’s individual differences and supported them in line with their life choices, their cultural background and their religion. Staff supported people to be as independent as possible.
People received personalised care that met their needs. Staff were knowledgeable about the people using their service including their life history, what was important to them as well as their care and support needs. Care plans detailed people’s care needs and we saw these were regularly reviewed and updated in line with any changes in their health. The service specialised in end of life care. Staff discussed with people and their relatives their end of life wishes and how they wanted to be supported in their final days. Staff protected people from social isolation. There was an activities programme in place. As many people spent time in their rooms because of their health needs, activities were provided in both people’s rooms and the communal areas. At the time of the inspection, most information at the service was provided in a written format. Staff confirmed that if required information could be made available in other formats, in line with the accessible information standard.
People, relatives and staff were regularly consulted about their views of the service through meetings and completion of surveys. Any areas for improvement identified were acted upon. The staff were aware of their regulatory duties and their duty of candour. They were open and honest about the service and any incidents that occurred were discussed with those involved, their relatives and the local authority. The management team worked well with other agencies and managers from similar services. They shared experiences to support each other in continuous improvement and in case of an event that stopped the service there were business continuity plans in place.
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 8 June 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach of regulation in relation to the management of medicines.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for 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.
Lodore Nursing Home provides accommodation with nursing and personal care for up to 36 people. This includes palliative and end-of-life care. At the time of our inspection there were 29 people using the service.
The service was required to have a registered manager in post but did not have one at the time we carried out this inspection. A manager had been in post since November 2016 and was undergoing the process of registration with the Care Quality Commission.. 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 a range of checks and audits to monitor the quality of the service. However, one of these audits had not identified an anomaly with medicines’ recording which we found during this inspection. The manager took prompt action to address the anomaly. Notwithstanding the issue above, people received their medicines as prescribed.
The provider gathered information prior to people being admitted into the home to help ensure they were able to meet people’s needs. Care plans were developed which were specific to each person and described how the person wished to be cared for.
People were encouraged to make choices for themselves whenever possible this included, being able to choose if they wanted to participate in activities. Where people did not want to take part in group activities, there were opportunities for staff to engage on a one to one level with for people.
There were measures in place to help ensure only suitable people were employed by the service. Staff received training which was refreshed regularly so they were up-to-date with the relevant training. Enough staff were deployed to effectively meet people’s needs.
People had support to access appropriate healthcare and their nutritional needs were met according to their needs and preferences. The provider was able to offer appropriate end of life care to people.
The provider worked within the remit of the Mental Capacity Act 2005 (MCA). Staff were aware and knowledgeable about the MCA and how it impacted on people who used the service. Staff sought consent from people prior to providing care. Staff generally treated people with dignity and respect.
There were assessments in place which identified possible risks to people and others and action that needed to be taken to minimise the risks. These included measures to prevent the risk of infection and to help ensure people were protected from possible harm and the measures they needed to take if they were concerned about someone’s welfare.
There were a number of ways people could comment on the quality of the service. There were annual postal surveys and resident and relatives meetings. People knew how to make a complaint if they were unhappy with the service and told us they felt able to approach the manager or operations director with their concerns.
The inspection took place on 28 January 2015 and was unannounced. The last inspection of the service was on 21 February 2014 and there were no breaches of legal requirements at the last inspection.
Lodore Nursing home is a care home providing personal and nursing care to up to 36 older people, it specialises in care for people at the end of their lives. There was a registered manager 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 and associated Regulations about how the service is run.
The service had policies and procedures in place to make sure people were kept safe. Staff were knowledgeable about the actions they should take if they suspected abuse. Staff had been appropriately recruited and all employment checks had been completed prior to them starting work. People received their medicines as prescribed.
There were systems in place to make sure the service complied with the Mental Capacity Act 2005 and to ensure the service did not deprive anyone of their liberty without proper safeguards being in place.
There were enough staff employed to keep people safe and to meet their needs. The provider had ensured that staff had sufficient skills to do their jobs. The new manager had identified the need for formal meetings and appraisals with staff to consider professional development.
People were supported to maintain good health and access healthcare professionals as needed. They were provided with a varied and balanced diet and their nutritional needs were assessed and monitored. People received their medicines when they required them. People at the end of their life received compassionate and appropriate care.
People were asked for their consent to care and treatment. Where people did not have the capacity to consent, the provider had acted in accordance with legislation and guidance.
The staff were kind and caring, they had positive relationships with the people they cared for based on respect.
People received care which was individualised and met their assessed needs. They were given opportunities to voice their opinions on the service so the provider would get information on the quality of service people received.
People were encouraged to be as independent as possible and there were systems in place for them to participate in tasks of daily living even though they may have been risky to them. There was a range of activities for people to participate in, if they wanted to.
The provider monitored their service to make sure people received high quality care at all times.
People told us they received "lots of information about everything" and we found evidence that people were involved in planning their care. Staff told us ways in which they ensured people's privacy and dignity were respected.
We found that people had comprehensive assessments of their needs and that care was planned to reflect both these and any assessed risks. People told us 'they see to us if anything is wrong with our health' and 'they are very good to me and always have been.'
Staff told us how they would respond to any allegations or suspicions of abuse. There was a safeguarding procedure in place and we found evidence of staff training in safeguarding people from abuse. People told us they felt safe at the home.
Appropriate checks were undertaken before staff began work. We found evidence that staff went through an appropriate recruitment procedure before working at the home.
We found evidence that the home used surveys and meetings to capture the views of people and their relatives and these were acted on. One person told us, 'they listen to what we want: we don't have to report to the matron.'