Sobell Lodge - Care Home Physical Disabilities

We found the following examples of good practice.

¿ The registered manager had implemented procedures to minimise the risk of infection from visitors. All visits were by appointment only. Face to face visits by one visitor was allowed following a negative rapid test for COVID-19. Other visits took place in a designated visitor room which had separate access and a full screen in place. Enhanced cleaning was scheduled between visits.

¿ The service had enough personal protective equipment (PPE) to meet current and future demand. Staff were using PPE correctly and in accordance with government guidelines. Staff always wore masks; aprons, gloves and visors were used when giving personal care. Some staff wore special fit tested masks whilst undertaking certain procedures.

¿ The layout of the home had been adapted appropriately to support social distancing with taped markers to act as a visual aid in communal areas. There were posters throughout the service which gave reminders about PPE, infection control and hand washing for staff and people using the service.

¿ The service had up to date infection control policies including those specific to Covid-19 and infection outbreaks. The home looked clean and there were cleaning schedules in place which were monitored by the infection control lead. Regular infection control audits were done by the infection control champion and outcomes and actions were monitored by the manager and provider to ensure completion.

People’s experience of using this service:

People were happy and relatives told us their family member was safe. The management were proactive and responsive to anything we found during the inspection to maintain people’s safety. Medicines were managed safely and some risks had been identified with ways to mitigate them. People were protected from potential harm from pressure ulcers because regular checks were completed of specialist equipment and staff understood how to protect people from pressure ulcers. However, guidance for staff did not always reflect staff knowledge and actions being taken. People were protected from the spread of infection and there were regular, thorough health and safety checks including fire safety.

The provider and management had completed a range of audits to identify concerns and issues at the service. When these had identified concerns, action had been taken to resolve them. Additionally, when issues had been by external specialists, action had been taken to rectify them promptly.

People and staff felt there were enough staff and call bells were responded to promptly. Some staff felt weekends were not as well staffed. The management were already aware of this and had previously tried solutions to change this. Staff had received a range of training considered mandatory by the provider. In addition, staff had received a range of specialist training to meet people’s needs. There were occasions competency checks had not been completed as regularly as they should to make sure best practice was still being followed. Actions to resolve this were taken during the inspection.

Some people in the service lacked capacity to make specific decisions and there were systems in place to make them. When people were deprived of their liberty actions had been taken to ensure it was lawful. People were involved in making choices about their day to day care and these were respected by staff.

People had care plans which were personalised and provided a range of information for staff to use to support their needs and wishes. Currently, they were participating in a provider pilot to increase how personalised they were. There were good links with other health and social care professionals including access to onsite physiotherapists. This included developing links with occupational therapy colleges.

People were supported by kind and caring staff who knew them incredibly well. Staff respected people’s privacy and dignity throughout the inspection. People’s religious and cultural differences were respected at all times. Excellent links had been developed with the community. This had led to many regular volunteers and successful fundraising.

More information about the detailed findings can be found below.

Rating at last inspection:

At the last inspection, published on 29 November 2016, this service was rated good.

Why we inspected:

This was a planned inspection based on previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 had enough to eat and drink and were supported to make choices about their meals. Staff knew about and provided for people’s dietary preferences and restrictions. People were promptly referred to health care professionals when needed. Some people and their relatives told us that they would benefit from more frequent physiotherapy sessions. We have made a recommendation about this.

Staff knew how to recognise signs of abuse and how to report any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. The premises were well maintained, safe and comfortable for people to use. The home was kept clean and the risk of the spread of infection in the home had been assessed and managed.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references. Staff had completed training and relevant qualifications to enable them to carry out their roles. There was an ongoing programme of training and development for staff. Staff were supported and supervised by the registered manager.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions. When necessary, meetings were held to make decisions in people’s best interest, following the requirements of the Mental Capacity Act 2005. People were involved in making decisions about their care and treatment. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered.

Staff were responsive to people’s needs and requests. People’s needs were assessed and personalised plans written to meet them. Staff knew each person well and understood how to meet their needs. People received personalised care. The service had positive links with the local community and people were supported to participate in a range of social activities that met their needs and interests.

Staff communicated effectively with people and treated them with kindness and respect. People spoke highly about the attitude of staff and told us they were caring and kind. People’s right to privacy was maintained. They promoted people’s independence and encouraged people to do as much as possible for themselves.

There was a system for monitoring the quality and safety of the service to identify any improvements that needed to be made. Clear information about the service and how to complain was provided to people and visitors. The registered manager sought feedback from people and used the information to improve the service provided. The registered manager had a clear and effective improvement plan for the service.

During the inspection we were unable to find any evidence that action had been taken to improve the service following the review of annual quality assurance questionnaires.

People chose how to occupy themselves in the service. We observed that people were supported to follow their routines which included going shopping, attending day centres and bicycle riding. We observed staff spending the majority of their time with people using the service, listening to music, watching television and talking about their likes and interests.

People using the service told us "I am very happy here - I would not want to live anywhere else. I have lots of friends here and the staff are really nice". Another person told us "there is always someone to talk to and the staff always have a smile on their faces. It is a nice place to live".

We saw that people were encouraged to make decisions and choices about things in their lives. They were given the support they needed to be as independent as they could and there was sufficient suitable equipment available to help them with this. People were able to get around the home independently and were able to access the physiotherapy service to carry out their prescribed programme of exercise.

People told us that there was a choice of activities and entertainment and that they were offered the opportunity to go out for outings. One person said they liked to go to the shops with a particular member of staff. They told us 'when X comes in I say I want to go to the shop and he takes me'. We saw people taking part in a number of different activities throughout our visit.

Most people were satisfied that there were enough staff to meet their needs, although some people felt that it sometimes took too long to respond when they used their call bell. The manager was aware of this issue and was continuing to monitor response times.