Haslington Lodge Care Home

Haslington Lodge Care Home is a residential care home providing personal care to up to 46 people with varying care needs, including people living with dementia, in one adapted building. At the time of our inspection there were 39 people using the service.

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

People living at Haslington Lodge Care Home told us they felt safe and relatives felt the same way. Staff knew how to keep people safe. People’s records provided guidance to staff on how to manage individual risks. People’s medicines were administered and managed safely. When people had accidents or incidents, these were reported and investigated to enable lessons to be learnt. People had sufficient staff to meet their needs. We were assured by the infection control measure in place.

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.

People received person centred care by staff who had time to get to know them well. People were helped to join in activities to prevent boredom through the day, this included trips out for those who could go. When people or relatives had a complaint to make, these had been investigated and responded to following the provider’s policy. People who agreed to, had their wishes for the end of their life recorded.

An open culture was evident. We had good feedback from people and their relatives about the manager and staff and the support provided. Staff said the manager was approachable and they were available to listen, and act where needed. Monitoring and auditing systems to check the quality and safety of people’s care were robust. Feedback was sought from people and relatives so the provider could listen and make improvements.

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 20 May 2021). No breaches of regulation were found at that inspection.

At our last inspection we recommended the provider review their processes for obtaining feedback from stakeholders to be able to take action to make improvements. At this inspection we found a survey had been undertaken so improvement had been made.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

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.

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

Haslington Lodge is a residential care home providing personal care to up to 46 people. At the time of the inspection there were 27 older people living at the service with varying needs including dementia.

Haslington Lodge accommodates people across three floors in one adapted building. Each floor had its own communal areas.

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

The provider had quality assurance processes in place to monitor the quality of care. However, it was not always clear that actions were being taken when an issue had been identified. When actions were taken this was not always in a timely manner.

Feedback from staff included that improvements could be made around communication. Areas people identified included timeliness of responses and ensuring issues raised were addressed. We have made a recommendation about obtaining feedback to shape the service.

Regulatory requirements had not always been met by the registered manager. We discussed the requirement to notify the Care Quality Commission (CQC) and following the inspection the registered manager had submitted notifications.

Accidents and incidents had been recorded, although, the detail in these varied. The provider had a plan to address this. Records were analysed so that trends could be identified and learnt from to reduce the chance of repeat occurrences.

People told us they felt safe living at the service. Staff were aware of how to safeguard people from abuse and felt able to raise concerns to the manager. Staff knew the risks to people; these were monitored, and action was taken to minimise them.

At the last inspection we found that medicines were not always managed safely. At this inspection the provider had addressed the shortfalls and medicines were now managed safely.

Infection Prevention and Control policies and procedures were being followed with additional measures in place to minimise the risks posed by COVID-19 in line with current guidance.

The home appeared in need of renovation, recent work had been completed on the ground floor and there was an action plan in place for the ongoing refurbishment of the home.

Staff knew people well and felt confident to carry out their roles. Training updates were planned with a deadline of April 2021.

People’s needs had been assessed and their care plans provided guidance on how best to support them. Referrals were made to other health care professionals to support staff in meeting people’s needs.

People were supported to have choice and control of their lives. Staff supported people who were unable to make certain choices for themselves in the least restrictive way possible and in their best interests.

People told us staff were caring. On our inspection we observed kind and caring interactions between staff and people living at the home. People were supported in a way that gave them maximum independence.

Relatives told us staff knew their loved ones well. Care planning and delivery was person-centred. The registered manager used an online platform for events to further personalise activities for people and had made good links with the local community. There had been no recent complaints about the service although information about making complaints was displayed around the home.

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 24 November 2020) and there was a breach of regulation. 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.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

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.

Haslington Lodge is a care home providing personal care for up to 46 older people. At the time of our inspection, there were 33 people using the service. Some of the people using the service were living with dementia and various other needs. Accommodation is arranged over three floors, people with similar needs were accommodated on the same floor. A lift provides step free access to each floor.

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

People and their relatives spoke positively about the home and were complimentary about the staff and new manager. Comments included, “ I admire the dedication of the staff and the support provided” and, “ We were concerned about the last report, but must say that our experience has been very positive.” One person told us, “I can’t fault them on anything, I am here for assessment and hoping to return to my home, I’ve had no falls since I have been here”.

We found the home had improved since our last inspection, however, two areas remained that required further improvement. Medicines were not always managed safely, on one occasion a person had not received their prescribed medicine and management of bottled liquid medicine did not always meet published guidance.

A new audit system was in place to check the quality of the service. However, at the time of this inspection, it had not been in place long enough to become fully effective. Although issues had been identified and measures taken to enable change and improvement, not all areas identified had improved. Accidents and incidents were reviewed, however, records, investigation and action taken to make sure they did not happen again varied in detail.

Care plans provided clear guidance to staff, care had been planned to reduce risks to people as much as possible. Where some people had specific health conditions, or experienced behaviour which could be challenging, guidance about how to best support them was in place. Staff worked with other professionals to ensure people’s needs were met. Food and fluid intake was monitored when needed and timely referrals to healthcare professionals were made to ensure people received the support required.

Staff had received training about safeguarding and people were protected from abuse. Potential safeguarding matters been brought to the attention of the manager and been referred to the local authority safeguarding team as needed.

The manager was relatively new in post. People and staff told us they felt supported by them. One member of staff commented, “The service has noticeably improved, but we need to make sure the improvements are sustained.” People and staff had been asked for their views about the home. Some staff felt management feedback could be further improved, so they were fully aware of planned changes and improvement at the home. The manager was working through an action plan to improve the quality of the service.

The service was working within current infection control guidance and staff were wearing personal protective equipment (PPE) as required. The service was clean and chemicals were being stored safely.

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 25 March 2020) and there were breaches of Regulations. The breaches were in relation to Regulation 9 Person Centred Care, Regulation 12 Safe Care and Treatment, Regulation 17 Good Governance and Regulation 18 Staffing. 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 improvement had been made, however, they remained in breach of Regulation 12 in relation to medicines.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led. 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 coronavirus and other infection outbreaks effectively. 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 remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Haslington Lodge Care Home on our website at www.cqc.org.uk.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well- led sections of this report.

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 one breach in relation to the safe management of medicines at this inspection.

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.

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

People told us they felt safe living at Haslington Lodge, they were positive about the staff who supported them. Staff were knowledgeable about people’s recorded needs, they treated people respectfully and with dignity.

However, we found medicines were not always safely managed. There were gaps in administration records for some medicines staff had given and some protocols, about medicines people required occasionally, were missing. Other aspects of medicine management did not meet published guidance.

There were not always enough staff to meet people’s needs. Some staff spoke of difficulty in being able to monitor some people because of the need to provide other people with support. Staffing levels did not meet the number the registered manager had assessed was required.

Records of the daily care were not always detailed enough to reflect if some people’s specific support needs were fully met. Where people needed particular support, for example, with behaviours that could challenge themselves or others, strategies for staff were not recorded in care plans. Accidents and incidents were recorded and investigated.

Staff reacted quickly in getting support for people where they had concerns about weight loss and put appropriate measures in place to monitor what people ate and drank. However, people did not always receive the support needed to eat. On the day of our inspection, most people did not enjoy their lunch; a lot of meals were returned to the kitchen unfinished and staff were not always available to support some people to eat.

Staff had received training about safeguarding people from potential abuse. However, despite knowing people were at risk from less than assessed staffing levels, they had not raised this as a possible safeguarding matter.

People’s needs had been assessed and, where possible, they or family members were involved developing and reviewing their care plans. However, some aspects were incomplete, for example, a section called ‘This is Me’ which is intended to provide information about people’s history, likes and dislikes and other essential information. In addition, some people had not been given an opportunity to discuss their end of life preferences if they wished to do so, or their unwillingness to do so had not been recorded.

Staff worked with health care professionals to support people to stay as healthy as possible. 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. However, where people no longer had capacity to make some decisions for themselves, decisions made on their behalf were not always recorded in line with legislation.

Appropriate recruitment checks were completed, and people were supported by staff who had been recruited safely. People were protected from the risks of abuse and discrimination by staff who were trained to recognise the signs of abuse and knew how to report any concerns.

Some of the shortfalls identified during the inspection had been found during audits, but timely action had not been taken to address them. Other shortfalls had not been identified during the auditing process.

People and their relatives told us the staff were kind and caring. Staff spoke respectfully about people. People’s privacy and dignity were respected, and their independence was promoted.

People told us they did not have any complaints and knew how to complain should they need to. People, their relatives and staff felt the service was well-led. The registered manager and staff worked closely with the local authority and other health care professionals to provide joined-up care and support.

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 Inadequate (published 4 September 2018). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on our current inspection programme.

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.

Enforcement:

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