Earlfield Lodge

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

People were not supported to have maximum choice and control of their lives. The staff did not support them in the least restrictive way possible and in their best interests. We found evidence during the inspection of restrictive practice. Some people’s bedrooms were located in a secure corridor of the home. The registered manager told us this was to keep them safe. However, mental capacity assessments and best interest decisions were not in place to support these decisions. The appropriate DoLS applications had not been submitted to the local authority for two people who lacked capacity and were unable to leave freely without the staff.

Governance processes were not always effective. Although some improvements had been made to the audits in place, these had not always highlighted the shortfalls we identified during the inspection. Some actions recorded on the homes action plan had not been undertaken in a timely manner. For example, the redecoration of the home had not been completed, with many areas outstanding. Improvements had been made, but further work was required.

Improvements had been made relating to staffing levels at the home. A dependency tool was in place which had taken into account the environment. Staffing levels during the night had increased to three staff due to three floors being open. Half of the building remained closed; however, the provider gave us assurances they would continue to monitor staffing levels and increase them as the occupancy increased. People felt safe and medicines were managed well. People and their relatives told us the staff were kind and looked after them well.

Improvements had been made with monitoring risks within the home. The maintenance person carried out regular checks of the home’s fire doors and they tested the fire alarm weekly. Fire drills were taking place and a fire log was kept of the staff that participated in each fire drill. Each person had an individual personal evacuation plan in place. Environmental risk assessments were taking place monthly.

People were supported with foods and drinks they enjoyed. People were supported to access healthcare services and staff had good working relationships with external professionals. Each person had a care plan in place which was stored electronically. The electronic care records system had been fully embedded by the staff.

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 10 June 2022). We found there were breaches of four regulations.

We found at this inspection that improvements had been made with two breaches met, however, other areas of concern was identified. Some other areas needed further improvement. This meant the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 April 2022. We identified several shortfalls. The provider completed an action plan after the last inspection to show what they would do and by when to improve the home.

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, effective, responsive and well-led which contain those requirements.

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 remains 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 Earlfield Lodge on our website at www.cqc.org.uk.

Enforcement

At this inspection, we have identified breaches in relation to the requirements of the Mental Capacity Act 2005 not been adhered to, the environment and its decoration and the monitoring of the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the home, which will help inform when we next inspect.

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

Systems to monitor and audit the home were not effective and had not identified the improvements that were required. The provider visited the home weekly, but no formal audits had been completed which would have helped to identify any shortfalls and to monitor any actions identified. Quality assurance systems were not robust.

The provider had failed to identify or act to mitigate the risks to people. We identified through our inspection that the home did not have safe staffing levels. The manager showed us a dependency tool which they used. This did not take into account the design of the building and allow for changes in people’s needs. We received consistent feedback from staff and relatives that the home did not have enough staff.

Safety monitoring and management checks of the building were taking place. However, we found inconsistencies and improvements were required. Records evidenced fire door checks were not taking place. Staff had not attended a fire drill for some time. The records kept of fire drills did not show who had attended a fire drill and when. Personal evacuation plans were in place for each person. However, we could not be satisfied these were effective because they had not been tested. The home was in need of re-decoration and furniture to be replaced. No firm plans were in place of how and when works would commence.

Staff training was in need of improvement to ensure staff were suitably trained and their competency checked. The provider maintained a training matrix of courses completed by staff, which they considered were mandatory. This identified a number of staff had not completed training in some areas. This included for example, manual handling, first aid and safeguarding.

The manager told us they were currently using three systems which recorded information about people’s planned care. This included a paper based system and computer based system. It was therefore difficult to navigate through the systems. We were told that staff were undergoing training in how to use the new computer system which they planned to transfer over to. Care records were reviewed on a regular basis. People knew about the home's complaints procedures and knew how to make a complaint.

Medicines were being managed safely with improvements made to the medicines system in recent weeks. Processes to safeguard people from abuse were in place along with infection control measures to help keep people safe. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people.

Staff were caring, and people were treated with kindness and respect. Staff knew people well and understood how to communicate with them. People's privacy was respected, and their dignity and independence promoted. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner.

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 home supported this practice.

Staff were enthusiastic and happy in their work. They felt supported by the manager within their roles. We received consistent feedback from staff that they felt the manager was supportive of them and had made lots of positive changes at the home since they started in post. Staff described working together as a team to help people achieve their potential.

Rating at last inspection

The service was taken over by another provider and registered with us on 30 April 2021. This is the first inspection.

Why we inspected

This was a planned inspection to check whether the provider was meeting legal requirements and regulations, and to provide a rating for the service as directed by the Care Act 2014.

Prior to this inspection we were made aware of some concerns by the local authority who had visited the home. The home was working on an action plan which had been put together by the local authority. We used this information as intelligence and to help us plan 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this report. You can see what action we have asked the provider to take at the end of this report. The overall rating for the service is requires improvement. This is based on the findings at this inspection.

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 breaches in relation to the service response in ensuring safe levels of staffing, managing risks, the environment which people lived in, staff training and around good governance. This meant that improvements were required to ensure quality monitoring and management and that provider oversight was more effective.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

We found the following examples of good practice.

There had not been any outbreaks of COVID-19 in the home. At the time of the inspection all residents and staff tested negative.

When staff came on shift, they sanitised their hands and put on personal protective equipment (PPE). Staff walked through the building to the staff room for hand over. They did not carry out temperature checks or change into their uniform. The registered manager told us they would review this and ask staff to come to work in their own clothes and complete a temperature check. The registered manager confirmed staff will get changed prior to entering the building. This will further reduce the risk of cross contamination.

Staff had good knowledge of infection prevention and control (IPC). All staff had received IPC training, including how to safely put on and take off PPE such as gloves, aprons, and face coverings. A staff member said, “Senior staff regularly refresh the training to remind us.”

The home was clean and tidy. The provider employed a team of housekeepers seven days a week. There was a robust cleaning schedule that included disinfecting touch points several times a day. However, some chairs and bedside tables were stained, and damaged. This meant furniture was permeable, allowing liquids to pass through so bacteria could lodge in the damaged areas and prevent them from being thoroughly cleaned. We discussed this with the registered manager who assured us any damaged furniture will be replaced.

We saw staff wearing PPE correctly. All rooms we saw, had foot operated bins to dispose of clinical waste. There were PPE stations kept on each floor. Staff removed PPE before leaving people’s bedrooms.

The homes visitor’s policy was clear and in line with national guidance. However, staff did not follow the policy, for example, staff did not carry out temperature checks. The registered manager implemented this on the day of the inspection.

Visitors were required to follow the home’s infection control procedures. There was a visitor’s room that was accessed from the garden. The visitor’s policy had been reviewed and updated to reflect the new guidelines that will now allow up to five people visiting.

The home was split into five floors. The registered manager explained how they would implement zoning as each unit could be closed off in the event of an outbreak. There was a contingency plan in place that described key people to contact in the event of an emergency. The registered manager said they had received support from their GP surgery and the local commissioning team during the pandemic.

The registered manager was admitting people to the home. The registered manager said no one would be admitted without a negative test and their belongings would go into isolation for 72 hours prior to the person moving in. Once people were admitted, they were isolated in their rooms for 14 days. The homes admissions policy confirmed this was the correct process for the home.

The registered manager ensured regular testing was carried out, weekly for staff and monthly for people living in the home. This was in line with COVID-19 testing guidance. People living at the home and some staff had received their vaccinations. The registered manager had recorded consent in line with the Mental Capacity Act 2005.