Gordon Lodge Rest Home

At the last inspection in March 2017 we found two breaches in Regulation. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Effective and Well-Led to at least good. At this inspection improvements had been made and the breaches in Regulation had been met. Staff now met with a manager for regular one to one supervision to aid their personal development. Checks and audits were in place and records were accurate and complete.

Gordon Lodge Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service is in a quiet residential area and provides accommodation, care and support for up to 33 older people. There were 24 people living there when we visited.

The provider was also the registered manager and was supported in the day to day running of the service by a manager. A registered manager is a person who has registered with CQC 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.

People said they felt safe living at the service. They were protected from the risks of abuse, discrimination and avoidable harm by staff who had been trained about keeping people safe. Risks to people were assessed, identified, managed and reviewed. People received their medicines safely and on time. Accidents and incidents were monitored and reviewed.

People were supported by a regular staff team who had been safely recruited. Staff knew people, their needs and preferences well and were trained and knowledgeable.

The service was clean and tidy and regular checks were made to make sure the environment and any equipment was safe and well maintained.

People were involved in planning their care and their physical, mental health and social care needs were assessed before they moved to the service to make sure that staff would be able to provide the right support. People were offered the support of an advocate if they required additional support to help them make decisions about their care.

People were supported to maintain a healthy diet and encouraged to drink plenty. Staff worked with health care professionals to make sure people stayed as healthy as possible. They followed any guidance given to them.

People had access to communal areas of the service and to the garden. They could choose if they wanted to spend time with others or if they wanted to be alone. Their choices were respected by staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People said the staff were kind and caring. Staff knew people well and spoke with them in a compassionate way. Staff treated each other kindly and supported each other.

People’s privacy and dignity were promoted and respected by staff. Records were stored securely to protect people’s confidentiality. People were supported to remain as independent as possible. People’s friends and relatives were able to visit when they wanted to and were made to feel welcome.

Care plans gave staff the guidance they needed to provide people with the right support in the way they preferred. People were encouraged to stay active and to take part in organised activities. People and their relatives knew how to complain and told us they had no complaints. They were confident the registered manager would handle any concerns appropriately.

People’s preferences for their end of life care were discussed and recorded to make sure staff could follow their wishes. Staff supported people’s relatives and each other in a caring and compassionate way at this time.

People, their relatives and staff felt the service was well-led and were involved in making changes at the service. The culture was one of openness and inclusivity. The leadership of the service was visible. The registered manager understood their responsibilities and notified CQC according to guidelines. Checks and audits were completed to monitor the quality of service and, when needed, action was taken to drive improvements. The staff team worked with health care professionals to promote joined up care.

The inspection took place on 10 March 2017 and was unannounced.

Gordon Lodge Rest Home is a large detached house in a quiet residential area. It provides care and support for up to 33 older people, some of whom are living with dementia. There were 24 people living at the service when we visited.

The provider was also the registered manager at the service and was supported in the day to day running of the service by a manager. 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.

We last inspected this service in September 2015. There were no breaches of the regulations identified at that inspection and the service was rated Good. We carried out this inspection sooner than we planned as we had received concerning information about how people were being treated and cared for.

Risks to people were identified but staff did not always have the guidance required to manage the risks and keep people safe. People had care plans in place but these were not consistent, some care plans contained people’s life histories, what people could do for themselves and how they preferred to be supported, others did not. Some people’s care plans contained information about other people and there was a risk people could receive the wrong support. People’s health needs were responded to quickly by staff, but care plans did not give guidance about signs for staff to look out for when people’s health deteriorated.

Staff did not have regular supervision meetings with their line manager and did not have all the training they needed. Although staff offered people day to day choices, the registered manager and staff did not always understand how the Mental Capacity Act (MCA) 2005 was applied. Decisions made for people without capacity were made in their best interests; however some of the mental capacity assessments needed updating to reflect people’s fluctuating capacity. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager had applied for DoLS authorisations; however applications had been made for everyone including people who did not require them.

The management team did not have a clear oversight of the service; audits had been completed but did not identify the shortfalls found at this inspection. Records were not always available or completed fully. Staff said although the management team were accessible, they did not always feel valued or listened to. The registered manager told us that no complaints had been received. However, concerns had been raised but there were no records of what they were or how they had been responded to.

Staff knew people well and had built positive and caring relationships with them and their families. Throughout the day we heard laughter and joking between people, their loved ones and staff. People had access to a variety of activities which were based on people’s interests. Staff treated people with dignity and respect, taking time to listen to people and offer reassurance when needed.

People were supported to have a balanced diet; they had input into the menu and could choose what they ate each day. Some people had guidance from speech and language professionals around the consistency of their food and fluids to prevent choking. Staff followed this guidance and supported people safely. People’s fluid intake was recorded but the amounts were not totalled and there were no target levels for people to have each day. People’s medicines were managed safely.

The management team completed audits to identify environmental risks. Fire drills were completed and people had a personal emergency evacuation plan (PEEP) in case of a fire. There were enough staff to meet people’s needs and they were recruited safely. Staff knew how to recognise different types of abuse and who they would report any concerns to but did not feel confident their concerns would be responded to by the management team. Staff understood confidentiality and people’s records were stored securely.

The management team sought advice from local health professionals and attended local forums for managers to increase their knowledge.

We made some recommendations about understanding of MCA and DoLS, the contents of PEEPS, the management of complaints or concerns and staffing levels.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

The service was safe. Practices in the service generally protected people using the service, staff and visitors from the risk of harm.

Systems were in place to make sure that managers and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

Each person had a care plan detailing their support and care needs. We saw that there was guidance for staff to follow to reduce risks and implements strategies to make sure people were as safe as possible.

Is the service effective?

The service was not always effective. People told us that they were happy with the care that had been delivered and that their care needs were met but this was not always in a timely manner. One person we spoke with told us, 'There are not enough staff; I have to wait a long time if I need something'. We saw that staff were attentive to people using the service but were not always able to respond promptly when needed.

People's health and care needs were assessed with them and /or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person's needs.

Is the service caring?

The service was not always caring. People were not always supported by kind and attentive staff. People we spoke with said they did not always feel that staff respected them or their privacy and dignity and staff were not always polite and caring.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led for most of the time. There were clear quality assurance processes in place. Staff told us they were not always clear about their roles and responsibilities but they told us they did feel supported by the management team. Systems were in place to ask people who used the service, relatives and staff for their views about the service. Audits of the care plans had been completed to assess the quality of the care being provided.

The staff Knew what support people needed and they respected their wishes The support that we observed being given to people matched what their care plan said they needed. Care and support was delivered in a person focused manner and we saw that staff created opportunities for people to make daily choices and decisions. We found that the provider was in the process of updating the care plans of people who used the service and people told us that they were involved in the process.

We found that audits were completed regularly and we saw action plans to address any shortfalls that were identified. We saw evidence of regular audits in relation to documentation on accidents, infections, care planning and risk levels. We found that issues and discrepancies were addressed swiftly and effectively.

We saw minutes of regular staff meetings where changes or issues within peoples care were discussed. In addition, we saw evidence of meetings with people who used the service to ensure they were consulted and encouraged to contribute their ideas about the running of the home.