Archived: Lily Wharf Lodge

Updated 25 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

One inspector, and one Expert by Experience undertook day one of the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector and one medicines inspector visited on day two.

Service and service type

Lily Wharf Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Lily Wharf Lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

There was a newly recruited manager in post at the time of the inspection. However, since the inspection they have left their employment at the home. The regional manager told us they were covering the service full time and they had commenced the recruitment for a new registered manager. The regional manager confirmed they would submit a notification of the changes of management.

Notice of inspection

Day 1 of the inspection was unannounced, day 2 was announced.

What we did before the inspection

Prior to the inspection we looked at the information we held about the service. Including, feedback and notifications which the provider is required to send to us by law. We asked for feedback from professionals about their views. We also checked whether Healthwatch had undertaken an inspection of the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people who used the service and 6 relatives as well as 1 visiting professional. We toured the building and undertook observations in the communal areas. We spoke with 17 staff. These included, housekeepers, a senior housekeeper for the provider, maintenance staff member, 1 chef, the activities co-ordinator, hospitality staff member, 1 nurse, and 4 care staff. As well as a member of the quality team, the regional quality manager who was also the regional manager for the service and a supporting manager from another service in the company. We also spoke with the manager who undertook overall responsibility for the daily operation of the home.

We also asked for feedback from some staff via email. We reviewed a range of records. These included, 4 electronic care files, 3 staff files, training and supervision records, audits and monitoring in relation to the operation and management of the service. We also reviewed 13 medicine administration records and looked at medicines related documentation. We ob

Updated 25 October 2022

About the service

Lily Wharf Lodge is a residential care home, providing accommodation and nursing care for up to 80 older people living with a dementia, and/or a physical disability and younger adults. There were 22 people living in the service at the time of the inspection. The service is purpose built over two floors which is split into four separate units, with communal facilities on each. Both ground floor units were occupied at the time of the inspection.

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

People told us they felt safe and staff understood what action to take if abuse was suspected. Not all incidents and accidents were dealt with in a timely manner. The manager and regional manager took immediate action to ensure these were investigated and acted upon. We made a recommendation about this. Environmental checks and servicing were taking place. There was a very high use of agency staff in the service. Staff told us they needed more permanent staff, but agency staff were being used. Most agency staff told us they had worked in the service previously. We made a recommendation about this. Staff were recruited safely. The service had addressed medicines issues from the last inspection.

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 was some evidence of consent recorded in care records. Staff confirmed people were asked for permission before undertaking any activity. The service spacious and all bedrooms were ensuite. Staff training was ongoing, the regional manager told us of their plans to ensure all staff were fully trained working in the service. People’s healthcare needs were reviewed by professionals, and we saw people attending clinic appointments during the inspection. There was evidence of assessments being undertaken for most people. However, one person’s assessment had not been completed on arrival to the service. The manager told us this had been done as soon as possible as there was a login error with the computer. They told us the staff had access to relevant information to look after people effectively.

Electronic care records had been developed, the provider was aware improvements were required in their content and reviews and were taking action to address this. Systems were in place to deal with complaints, we discussed the progress of an ongoing complaint. Aids were available to support communication; pictorial aids were used in some areas. Activities were on offer however, one person fed back they used to undertake exercise, but this had not been taking place recently.

People were positive about the care they received. We noted mostly kind interactions. The management took action to ensure one person’s privacy and dignity was respected. We made a recommendation about this. Electronic records as well as paper records were held securely. People’s choices were being discussed and agreed. The manager took immediate action to ensure all people had access to their call bells at all times.

The manager who was new to post left the service soon after the inspection. The regional manager told us they were based in the service and recruitment was ongoing for a new registered manager. A range of audits and monitoring was taking place. Whilst some actions had been recorded not all were noted. Observations, daily walk arounds and night checks were noted. There was some evidence of the actions taken in the form of ‘you said, we did’ on display. A range of policies and guidance was available and statutory notifications were submitted.

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 on 20 October 2021. We found breaches in relation to the training and supervision of the staff team, infection prevention and control and, good governance. 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 the provider remained in breach of regulations.

At our last inspection we also recommended about the management of complaints and concerns, maintaining a balanced diet, the management of medicines, staff recruitment and support, assessments and care planning.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to ensuring systems or processes were monitored and ensure the service had consistent management in place to ensure the service was safe and monitored at this inspection.

We have made recommendations in relation to ensuring incidents and accidents were acted on appropriately in a timely manner. And to ensuring sufficient and suitable staff were recruited to work in the service, strengthening the medicines audit processes to check medicines records are completed correctly so that people receive their medicines safely as prescribed. And to ensure people received care in accordance with their needs, promoting privacy and dignity and good governance.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.