Archived: Lofthouse Grange and Lodge

At this inspection we found the provider was no longer in breach of regulations relating to infection control and cleanliness. We saw the provider had followed their action plan and we found new flooring and furnishings in place. All areas of the home we looked at were clean and free from malodours.

Lofthouse Grange and Lodge is a purpose built residential care home for older people. The home provides accommodation for up to 88 people. On the day of our inspection there were 84 people using the service. The building is divided into two units; one accommodates older people with general care needs and the other provides care and support for people with a diagnosis of dementia or other mental health illness. The home is set in its own grounds with enclosed gardens and car parking is available.

There was a registered manager in post on the day of our inspection. 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.

People who used the service told us they felt safe, and we found the provider had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in safeguarding of vulnerable adultsd. We found risks to individuals were well assessed and clear plans were in place to minimise these risks.

People, their relatives and staff told us they felt there were not always enough staff on duty. We saw the provider used a dependency tool to calculate how many staff were needed. The registered manager obtained a more robust dependency tool from the provider on the day of the inspection and said they would review staffing levels.

We saw evidence the provider had safer recruitment practices in place, and undertook background checks before new staff commenced work in the service.

The provider had systems in place to ensure the safe management of medicines.

We looked at records of training which evidenced staff undertook a range of training to support them in their roles, and we saw there was a plan in place to ensure mandatory training was refreshed at regular intervals. Staff told us they had a regular programme of supervision and appraisal which enabled them to discuss and receive feedback on their work.

People who used the service were well supported with their healthcare needs. We saw evidence of input from a range of health professionals and saw care plans contained detailed guidance to help staff support people to maintain good general health.

Care plans contained assessments of people’s capacity to make decisions in line with the Mental Capacity Act 2005. Where people lacked capacity to make a decision we saw best interests decisions had been made and recorded. We saw staff offering people choices and people who used the service told us how they made choices in relation to their care and support.

Some people had approved Deprivation of Liberty Safeguards (DoLS) in place, and we saw any conditions had been documented in people’s care plans..

Care plans contained detailed information relating to people’s hydration and nutrition needs, which we saw were well met. People told us they liked the meals at the service, and we saw good support given to people who needed assistance to eat.

People told us staff were caring and respectful, and we saw evidence of this throughout the inspection.. Care plans contained detailed information about people’s individuals’ likes, dislikes and preferences which would enable staff to form caring relationships with people.

People told us the activity programme in the service had improved, and we spoke with activities co-ordinators who told us about how they planned and funded activities. We saw evidence people were supported to maintain links with local communities.

We looked at records of complaints and saw these were well managed in line with the provider’s policy. We also saw the service received regular compliments from people who used the service and their relatives.

The registered manager and provider worked well together to monitor the quality of the service and make improvements where needed. People who used the service, their relatives and staff were consulted in the running of the home through regular meetings.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people's needs?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from looking at records.

Is the service safe?

Prior to our inspection we received concerns that staff were beginning work at Lofthouse Grange and Lodge without completing an induction.

We observed on the second floor and found people were left unattended for long periods of time whilst staff were either assisting people who used the service or were taking linen to the laundry.

Whilst reviewing people's care plans we saw an entry in the daily communication which stated a person had bruises all around both wrists and the tops of both hands. The entry also stated the 'seniors' and the 'managers' had been informed; however, we were unable to find an incident form or a referral to the local authority safeguarding unit.

Is the service effective?

We arrived at Lofthouse Grange and Lodge at 6.10 a.m. and we found of the 20 people living on the second floor there were eight people up. Five people were dressed and sitting in the lounge area when we arrived and one person was then assisted into the lounge still in their nightclothes. We were told due to continence issues two people had been 'showered and dressed and they were laid on their bed'. There were other people still asleep in their bedrooms and some were in the process of being assisted to get up by two care staff.

We looked at the care plans for some of the people who were up on our arrival and could not find information in their care plans about what their preferable time to rise was. In one person's care plan we saw in the 'daily communication' that the person was sleeping all day. We reviewed this person's medication and saw they were on medication which could make the person sleepy. We discussed this with the manager who told us this person had been referred back to their G.P. We could not see this information documented in the person's care plan.

We looked at the staff files of four people who worked at Lofthouse Grange and Lodge and found most people had completed a comprehensive induction prior to delivering care. Induction training was a week's course. Once the course was completed staff shadowed a member of staff for three days. However, on one occasion we found the person's induction was not completed prior to them delivering care. We were told by the manager this was very unusual and at the time of our inspection could not clarify why this had occurred. We saw the person did have previous experience of working in a care home environment.

Is the service caring?

We observed the interactions between staff and people who used the service and found them to be appropriate and caring. It was clear staff knew people well, we saw people chatting with staff and with each other.

Is the service responsive?

We did not look at this domain during our inspection.

Is the service well led?

We did not look at this domain during our inspection.

Care and support was planned and delivered in a way that ensured people's safety and welfare. Care files identified risks and how these were managed.

During our observations we noted positive interaction between the staff and people who used the service. We observed when people needed support; staff provided this in a sensitive and friendly way.

Care staff were able to tell us about how they met the different needs of people. They told us about the training they received to make sure they were able to care for people's care needs.

A staff member told us "This is a friendly home. Some staff come in even when they are not on duty to take part in activities.'

We looked at a number of records and audits which confirmed regular checks were being carried out to ensure the service was safe and effective.

We spoke with six members of staff who were knowledgeable about the care and support needs of the people in the home they explained how care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff said they had received training in relation to safeguarding and this was confirmed by the training matrix. All people and relatives spoken with were complimentary about the staff. One person commented 'The staff can't do enough for you.' Another person said 'The staff are good but they have a lot to do.'

The service had a complaints policy in place to provide staff and people who used the service with information on how to make a complaint and how this would be handled. Most people told us they knew who to speak to if they had a complaint or a concern and believed they would be listened to and their concerns acted on. The provider may find it useful to note that though there was an effective complaints system available they need to ensure the information is accessible for inspection on request.